Medicaid and court reject certain payments to caregivers without proof of level of care NJ

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Medicaid and court reject certain payments to caregivers without proof of level of care D.Z. v. Ocean County Bd. of Soc. Serv. Petitioner appealed the decision imposing a penalty for assets she transferred during the look-back period. | Petitioner appealed the decision finding her eligible for Medicaid benefits but imposing a penalty for assets she transferred during the look-back period. Petitioner requested a fair hearing as to the penalty. At the hearing, son and power of attorney testified petitioner hired three health care aides to assist her at home in the years before she was transferred to a nursing facility. The aides assisted petitioner with dressing, ambulating, bathing, cooking and cleaning in rotating shifts. One aide lived with petitioner full time for several months. Son testified his attempt to secure testimony from the aides was futile. ALJ found petitioner paid three aides for home health care, those payments were not subject to the look-back penalty and modified the amount of the penalty. Agency director adopted ALJ's decision in part and reversed it in part. Director found petitioner did not establish the type of services provided to her, the amount she paid for the services and the prevailing rates in the community for similar services. Court found agency's decision was supported by substantial credible evidence. There was no evidence the rate petitioner paid was warranted by the aides' skill level and training, the evidence was imprecise as to the amount paid and agency could not determine the fair market value of the services petitioner received source . https://www.law.com/njlawjournal/almID/1592939409NJA596217T