SUPERIOR COURT OF NEW JERSEY

APPELLATE DIVISION

DOCKET NO. A-0461-18T4

J.T.,

Petitioner-Appellant,

v.

DIVISION OF MEDICAL

ASSISTANCE AND HEALTH

SERVICES and GLOUCESTER

COUNTY BOARD OF 

SOCIAL SERVICES,

Respondents-Respondents.

_______________________________

Argued telephonically March 19, 2020 –

Decided April 29, 2020

Before Judges Suter and DeAlmeida.

On appeal from the New Jersey Department of Human 

Services, Division of Medical Assistance and Health 

Services.

Carri-ann R. Levine, argued the cause for appellant 

(Cowart Dizzia, LLP, attorneys; Cari-ann R. Levine, on 

the brief).

NOT FOR PUBLICATION WITHOUT THE

APPROVAL OF THE APPELLATE DIVISION

This opinion shall not "constitute precedent or be binding upon any court." Although it is posted on the 

internet, this opinion is binding only on the parties in the case and its use in other cases is limited. R. 1:36-3.
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A-0461-18T4

Jacqueline R. D'Alessandro, Deputy Attorney General, 

argued the cause for respondent Division of Medical 

Assistance and Health Services (Gurbir S. Grewal, 

Attorney General, attorney; Melissa H. Raksa, 

Assistant Attorney General, of counsel; Jacqueline R. 

D'Alessandro, on the brief).

John Anthony Alice argued the cause for respondent 

Gloucester County Board for Social Services.

PER CURIAM

Petitioner J.T.1appeals from an August 13, 2018 final decision of the 

Director, Division of Medical Assistance and Health Services (DMAHS), 

adopting the initial decision of an Administrative Law Judge (ALJ) finding him 

ineligible for Medicaid benefits because he failed to submit documents 

necessary to verify his eligibility. We affirm.

I.

The following facts are derived from the record. On June 21, 2017, J.T.'s 

daughter, F.T., brought him to Deptford Center for Rehabilitation and 

Healthcare (Deptford Center) for short-term rehabilitation. J.T. previously 

executed a power of attorney in favor of F.T. After J.T. was admitted to 

Deptford Center, F.T. failed to appear for scheduled care meetings and did not 

 

1

 We identify petitioner by his initials to protect the confidentiality of his 

medical records.
3

A-0461-18T4

respond to communications regarding her father's medical care. Deptford 

Center did not initially file an application on behalf of J.T. for Medicaid benefits 

because his stay was expected to be short term.

On August 10, 2017, it became apparent to Deptford Center J.T. would 

need long-term treatment at its facility. J.T. could not speak and suffered from 

dementia. In light of F.T.'s absence, on August 15, 2017, J.T.'s son, Ja.T.,

purported to act on behalf of his father by executing a form designating Cheryl 

Zuchowski,

2

a Deptford Center employee, as the designated authorized 

representative (DAR) for J.T.

Zuchowski submitted an application for Medicaid benefits on J.T.'s behalf 

to respondent Gloucester County Board of Social Services, the county welfare 

agency (CWA) for Gloucester County. On October 17, 2017, the CWA denied 

J.T.'s application for failure to provide the asset verification necessary to 

establish eligibility for the program.

On October 23, 2017, Zuchowski filed a second application for Medicaid 

benefits on behalf of J.T. The application listed an account at Sun National 

Bank with a value of $755 as J.T.'s only asset.

 

2

 Zuchowski is also identified in the record as Cheryl Soistmann. Her name 

change is immaterial to the issues before the court.
4

A-0461-18T4

On October 31, 2017, Zuchowski sent an email to the CWA seeking 

advice. She informed the agency of J.T.'s inability to speak or write and that 

F.T. had "disappeared" and was not returning telephone calls. Zuchowski

reported that her efforts to obtain J.T.'s bank records in support of the application 

had failed because the bank demanded verbal consent of J.T. or approval of F.T. 

According to Zuchowski, the bank would not accept Ja.T.'s authorization to 

release the bank records.

On November 8, 2017, a CWA representative responded to Zuchowski's 

email and suggested she initiate proceedings for the appointment of a guardian 

for J.T. The CWA also ran an asset verification system report for J.T. in an 

effort to obtain his bank record. The Sun National Bank account records, 

however, did not appear on the report.

On November 22, 2017, the CWA informed Zuchowski in writing that the 

production of statements for J.T.'s Sun National Bank account for the period 

from August 1, 2016 to October 1, 2017 was necessary to evaluate his eligibility 

for benefits. The letter stated that "[i]f this information is not received by 

[December 11, 2017], the case will be denied."

On December 1, 2017, a physician conducted an examination of J.T. He 

diagnosed J.T. with dementia and probable Alzheimer's disease. Zuchowski did 
5

A-0461-18T4

not inform the CWA of the physician's report or initiate guardianship 

proceedings for J.T. at that time.

On December 26, 2017, the CWA denied J.T.'s second application. The 

agency stated it was unable to determine J.T.'s eligibility without the bank 

records requested in the November 22, 2017 letter.

J.T. died on January 23, 2018. The following day, Deptford Center 

attempted to initiate guardianship proceedings for J.T. Because J.T. had died, 

the guardianship petition was not processed.

J.T. challenged the denial of his application through a request for a fair 

hearing.

3

 The matter was transferred to the Office of Administrative Law, where 

a fair hearing was held before ALJ Susan L. Olgiati.

On July 5, 2018, ALJ Olgiati issued an initial decision recommending the 

denial of benefits be affirmed. The ALJ determined the maximum forty-fiveday period for deciding an application, N.J.A.C. 10:71-2.3(a), applied here and 

began with the filing of J.T.'s second application for benefits. In light of the 

denial of J.T.'s first application, the ALJ found his representatives were aware 

of the need to secure his bank records when they filed the second application.

 

3

 The record does not contain evidence the Administrator of J.T.'s estate 

authorized Deptford Center to appeal the CWA's decision on his behalf.
6

A-0461-18T4

The ALJ determined the CWA satisfied its obligation to assist J.T. in 

securing the information necessary to determine his eligibility. As ALJ Olgiati 

noted, the CWA suggested initiation of guardianship proceedings before setting 

the December 11, 2017 deadline. Zuchowski obtained a medical evaluation of 

J.T. but did not share the results with the CWA, advise the CWA of continued 

difficulty obtaining J.T.'s bank records, request an extension of the December 

11, 2017 deadline, or initiate the guardianship process. In addition, the ALJ 

found that after the deadline passed, the CWA waited an additional fifteen days, 

until December 26, 2017, sixty-four days after the application was filed, to issue 

a denial. ALJ Olgiati found the circumstances surrounding J.T.'s application 

were exceptional, requiring additional time beyond the maximum forty-five-day 

period, which the CWA provided.

On August 13, 2018, the Director issued a final decision adopting the 

ALJ's recommendation. The Director agreed with the ALJ's determination J.T. 

"failed to provide the needed information prior to the December 26, 2017 denial 

of benefits. Without this information, the [CWA] was unable to complete its 

eligibility determination and the denial was appropriate."

This appeal followed. J.T. raises the following arguments for our 

consideration:
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A-0461-18T4

POINT I

THE FINAL DECISION WAS ARBITRARY AND 

CAPRICIOUS BECAUSE IT HELD J.T. AND HIS 

ATTORNEY-IN-FACT TO AN IMPOSSIBLE 

STANDARD CONTRARY TO CONTROLLING 

LAW.

A. THE MEDICAL CONDITIONS OF J.T. AND 

HIS SISTER4 CREATED EXCEPTIONAL 

CIRCUMSTANCES, MAKING THE DENIAL IN 

[EIGHTY-ONE]5 DAYS CONTRARY TO STATE 

AND FEDERAL LAW.

B. [THE CWA] OWED A DUTY OF 

ASSISTANCE, PARTICULARLY TO J.T. WHO WAS 

PERMANENTLY UNABLE TO COMMUNICATE.

POINT II

THE FINAL AGENCY DECISION WAS 

CAPRICIOUS BECAUSE IT UNFAIRLY 

DISCRIMINATES ON THE BASIS OF DISABILITY.

POINT III

RAPID DENIALS OF MEDICAID TO 

INCAPACITATED RESIDENTS IN NEED OF A 

 

4

 J.T.'s brief refers to F.T. both as J.T.'s daughter and J.T.'s sister. ALJ Olgiati's 

findings of fact identify F.T. as J.T.'s daughter. The exact familial relationship 

between J.T. and F.T. is immaterial to our legal analysis. In addition, despite 

the reference in J.T.'s point heading, the record contains no evidence with 

respect to F.T. having a medical condition.

5

 It is not clear why J.T.'s point heading refers to an eighty-one-day period. As 

found by ALJ Olgiati and as recognized elsewhere in J.T.'s brief, the CWA 

denied J.T.'s application sixty-four days after it was filed.
8

A-0461-18T4

GUARDIAN CREATE SERIOUS PUBLIC POLICY

IMPLICATIONS.

II.

"Judicial review of agency determinations is limited." Allstars Auto Grp., 

Inc. v. N.J. Motor Vehicle Comm'n, 234 N.J. 150, 157 (2018). "An 

administrative agency's final quasi-judicial decision will be sustained unless 

there is a clear showing that it is arbitrary, capricious, or unreasonable, or that 

it lacks fair support in the record." Ibid. (quoting Russo v. Bd. of Trs., Police 

& Firemen's Ret. Sys., 206 N.J. 14, 27 (2011)). In reviewing the agency's 

decision, we consider:

(1) whether the agency's action violates express or 

implied legislative policies, that is, did the agency 

follow the law;

(2) whether the record contains substantial evidence to 

support the findings on which the agency based its 

action; and

(3) whether in applying the legislative policies to the 

facts, the agency clearly erred in reaching a conclusion 

that could not reasonably have been made on a showing 

of the relevant factors.

[Ibid. (quoting In re Stallworth, 208 N.J. 182, 194 

(2011)).]

"A reviewing court 'must be mindful of, and deferential to, the agency's 

expertise and superior knowledge of a particular field.'" Id. at 158 (quoting 
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A-0461-18T4

Circus Liquors, Inc. v. Governing Body of Middletown Twp., 199 N.J. 1, 10 

(2009) (internal quotation omitted)). "A reviewing court 'may not substitute its 

own judgment for the agency's, even though the court might have reached a 

different result.'" Stallworth, 208 N.J. at 194 (quoting In re Carter, 191 N.J. 

474, 483 (2007)). "Deference to an agency decision is particularly appropriate 

where interpretation of the [a]gency's own regulation is in issue." R.S. v. Div. 

of Med. Assistance & Health Servs., 434 N.J. Super. 250, 261 (App. Div. 2014) 

(quoting I.L. v. N.J. Dep't of Human Servs., Div. of Med. Assistance & Health 

Servs., 389 N.J. Super. 354, 364 (App. Div. 2006)). "However, a reviewing 

court is 'in no way bound by [an] agency's interpretation of a statute or its 

determination of a strictly legal issue.'" Allstars Auto Grp., 234 N.J. at 158 

(alteration in original) (quoting Dep't of Children & Families, Div. of Youth & 

Family Servs. v. T.B., 207 N.J. 294, 302 (2011)).

"Medicaid is a federally-created, state-implemented program that 

provides 'medical assistance to the poor at the expense of the public.'" In re 

Estate of Brown, 448 N.J. Super. 252, 256 (App. Div. 2017) (quoting Estate of 

DeMartino v. Div. of Med. Assistance & Health Servs., 373 N.J. Super. 210, 

217 (App. Div. 2004)); see also 42 U.S.C. § 1396-1. To receive federal funding 
10 A-0461-18T4

the State must comply with all federal statutes and regulations. Harris v. McRae, 

448 U.S. 297, 301 (1980).

Pursuant to the New Jersey Medical Assistance and Health Services Act, 

N.J.S.A. 30:4D-1 to -19.5, DMAHS is responsible for administering Medicaid 

in our State. N.J.S.A. 30:4D-4. Through its regulations, DMAHS establishes 

"policy and procedures for the application process . . . ." N.J.A.C. 10:71-2.2(b). 

"[T]o be financially eligible, the applicant must meet both income and resource 

standards." Estate of Brown, 448 N.J. Super. at 257; see also N.J.A.C. 10:71-

3.15; N.J.A.C. 10:71-1.2(a).

We begin with J.T.'s argument the CWA provided insufficient assistance 

in completing his second application. In New Jersey, the Medicaid applicant is 

"the primary source of information. However, it is the responsibility of the 

agency to make the determination of eligibility and to use secondary sources 

when necessary, with the applicant's knowledge and consent." N.J.A.C. 10:71-

1.6(a)(2). The CWA must "[a]ssist the applicant[] in exploring their eligibility 

for assistance[,]" and "[m]ake known to the applicant[] the appropriate resources 

and services both within the agency and the community, and, if necessary, assist 

in their use . . . ." N.J.A.C. 10:71-2.2(c)(3) to (4). However, the applicant must: 

"1. [c]omplete, with assistance from the CWA if needed, any forms required by 
11 A-0461-18T4

the CWA as a part of the application process; 2. [a]ssist the CWA in securing 

evidence that corroborates his or her statements; and 3. [r]eport promptly any 

change affecting his or her circumstances." N.J.A.C. 10:71-2.2 (e).

The CWA shall verify the equity value of resources 

through appropriate and credible sources. 

Additionally, the CWA shall evaluate the applicant's 

past circumstances and present living standards in order 

to ascertain the existence of resources that may not have 

been reported. If the applicant's resource statements are 

questionable, or there is reason to believe the 

identification of resources is incomplete, the CWA 

shall verify the applicant's resource statements through 

one or more third parties.

[N.J.A.C. 10:71-4.1(d)(3).]

The applicant bears a duty to cooperate fully with the CWA in its verification 

efforts, providing authorization to the CWA to obtain information when 

appropriate. N.J.A.C. 10:71-4.1(d)(3)(i).

If verification is required in accordance with the 

provisions of N.J.A.C. 10:71-4.1(d)[(3)], the CWA 

shall . . . . verify the existence or nonexistence of any 

cash, savings or checking accounts, time or demand 

deposits, stocks, bonds, notes receivable or any other 

financial instrument or interest. Verification shall be 

accomplished through contact with financial 

institutions, such as banks, credit unions, brokerage 

firms and savings and loan associations. Minimally, 

the CWA shall contact those financial institutions in 

close proximity to the residence of the applicant or the 

applicant's relatives and those institutions which 
12 A-0461-18T4

currently provide or previously provided services to the 

applicant.

[N.J.A.C. 10:71-4.2(b)(3).]

The CWA may perform a "[c]ollateral investigation" wherein the agency 

contacts "individuals other than members of applicant's immediate household, 

made with the knowledge and consent of the applicant . . . ." N.J.A.C. 10:71-

2.10(a). "The primary purpose of collateral contacts is to verify, supplement or 

clarify essential information." N.J.A.C. 10:71-2.10(b). Neither N.J.A.C. 10:71-

4.1(d)(3) nor N.J.A.C. 10:71-2.10 require a CWA to undertake an independent 

investigation of an applicant. The agency instead is charged with verifying 

information provided by an applicant. For example, while N.J.A.C. 10:71-

4.2(b)(3) requires the CWA to contact an applicant's financial institutions to 

verify an account's existence, it does not require the agency to obtain records 

directly from a financial institution.

After carefully reviewing the record, we conclude there is sufficient 

support for the Director's determination the CWA fulfilled its obligation to assist 

J.T. in obtaining the information necessary to determine his eligibility for 

benefits. J.T.'s representative contacted the CWA eight days after submitting 

his second application to inform the agency of F.T.'s unavailability, J.T.'s 

medical condition, and the bank's insistence on securing approval of either F.T.
13 A-0461-18T4

or J.T. before releasing his bank records. The CWA advised Zuchowski to seek 

appointment of a guardian for J.T.

In addition, the agency ran an electronic search for J.T.'s bank records, 

which proved unsuccessful. After waiting more than three weeks from the 

submission of the application, the CWA set a December 11, 2017 deadline for 

production of the bank records. As of that date, J.T.'s representative had not 

initiated guardianship proceedings, informed the CWA of J.T.'s medical 

evaluation, or reported on the progress, if any, of its efforts to obtain the bank 

records. J.T.'s representative did not request an extension of the December 11, 

2017 deadline or acknowledge it passing. After the deadline passed, the CWA 

waited an additional fifteen days, during which it received no communication 

from J.T.'s representative, before denying his application. In the days following

the denial of the application, J.T.'s representative did not communicate with the 

CWA. It was not until January 24, 2018, the day after J.T. died, that Zuchowski 

attempted to initiate guardianship proceedings. The CWA satisfied its 

obligation to provide assistance and advice to J.T.'s representative. J.T.'s 

representative failed to act with sufficient diligence to complete his application.

Nor do we agree with J.T.'s argument the CWA acted inappropriately 

when it denied his application after sixty-four days. "The maximum period of 
14 A-0461-18T4

time normally essential to process an application for the aged is [forty-five] 

days; for the disabled or blind, [ninety] days." N.J.A.C. 10:71-2.3(a). The 

regulation recognizes, however,

that there will be exceptional cases where the proper 

processing of an application cannot be completed 

within the [forty-five/ninety-] day period. Where 

substantially reliable evidence of eligibility is still 

lacking at the end of the designated period, the 

application may be continued in pending status. In each 

such case, the CWA shall be prepared to demonstrate 

that the delay resulted from one of the following:

1. Circumstances wholly within the applicant's 

control;

2. A determination to afford the applicant, whose 

proof of eligibility has been inconclusive, a further 

opportunity to develop additional evidence of 

eligibility before final action on his or her application;

3. An administrative or other emergency that could 

not reasonably have been avoided; or

4. Circumstances wholly outside the control of both 

the applicant and CWA.

[N.J.A.C. 10:71-2.3(c).]

The regulation establishes a maximum period for the CWA to process an 

application. It does not give applicants the right to hold their applications open 

for forty-five or ninety days to obtain the information necessary to establish 

eligibility for benefits. While the regulation authorizes a CWA to keep an 
15 A-0461-18T4

application in pending status for longer than the prescribed periods, it does not 

require that it do so in every instance in which an application is incomplete, 

particularly in the absence of a request for an extension by the applicant. Here, 

J.T.'s representative did not seek an extension of the December 11, 2017 

deadline, either before its expiration or in the fifteen days thereafter before 

issuance of the December 26, 2017 denial. We see no abuse of discretion in the 

CWA deciding J.T.'s application sixty-four days after it was filed.6

To the extent we have not addressed other arguments raised by J.T., we 

conclude they are without sufficient merit to warrant discussion in a written 

opinion. R. 2:11-3(e)(1)(E).

Affirmed.

 

6

 In light of our holding, we need not decide whether the Director's decision 

applying the forty-five-day period was correct, given J.T.'s apparent disability.