by Jose D. Roman | Feb 20, 2025 | Legal Bulletin, Medicaid
Public health advocates applauded the Court’s decision in D.C. v. Division of Medical Assistance & Health Services, 464 N.J. Super. 343 (App. Div. 2020), because it resolved a longstanding logistical issue that caused severe hardship for people transitioning from one Medicaid program to another. Specifically, the New Jersey Appellate Division ruled that state Medicaid agencies must screen beneficiaries for eligibility in alternative programs before terminating their existing benefits, ensuring a seamless transition and continuous benefits. Despite the Court’s clear mandate, over four years later, New Jersey has repeatedly failed to implement an effective “screen before terminate” system, leaving many vulnerable individuals exposed to gaps in coverage and financial hardship. Let’s revisit the case.
Factual Background
A married couple receiving Social Security Disability benefits were enrolled in New Jersey’s Aged, Blind, and Disabled (ABD) Medicaid Program. The program provides Medicaid health coverage for people with limited income who are blind, have been determined disabled by the Social Security Administration, or are 65 and over. However, following a change in circumstances the couple’s income exceeded the limit ABD eligibility. As a result, the Essex County Board of Social Services sent them a letter indicating that their ABD coverage would terminate effective August 31, 2017. Although they no longer qualified for ABD Medicaid, the couple still qualified for the Specified Low-Income Medicare Beneficiaries (SLMB) Program, which covers Medicare Part B premiums for low-income Medicare beneficiaries. The couple applied for the SLMB Program on August 30, 2017. Although they clearly qualified, the Essex County explained that their application could not be processed until their ABD benefits were officially terminated, which caused a gap in benefits. They filed for a Fair Hearing before an Administrative Law Judge who concluded that since benefits could be applied retroactively for 90 days, the state could terminate benefits without first assessing eligibility for other programs. The ALJ’s decision was adopted by the Division of Medical Assistance & Health Services (DMAHS) and the matter was then appealed to the Superior Court, Appellate Division.
Appellate Division Decision
The couple argued that federal regulations, including provisions found at 42 CFR 435.916(f)(1), mandate that state agencies screen beneficiaries for eligibility in other Medicaid programs before terminating existing benefits. They contended that the Division of Medical Assistance and Health Services (DMAHS) failed to perform this pre-termination screening for the SLMB Program, thereby causing a gap in benefits. DMAHS argued that the SLMB Program was “a Medicare savings program that allows states to pay Medicare Part B premiums,” rather than a Medicaid program, and since beneficiaries cannot be eligible for Medicaid and SLMB in the same month, they had to wait until coverage was terminated before applying. They argued that the requirement to screen for other programs prior to termination did not apply because SLMB was not a Medicaid program.
Importantly, the ALJ and DMAHS relied heavily on the 90 day retroactivity of New Jersey Medicaid to justify forcing people to have a disruptive gap in benefits, rather than implement a more efficient system. Under these rules, SLMB benefits could be applied retroactively for up to three months. The agency’s rationale was that even if there was a gap in immediate coverage, the retroactive provisions would compensate for the period during which the petitioners were without benefits. However, the couple argued that this reasoning did not absolve the agency of its responsibility to ensure a seamless transition in coverage. They also noted that the gap created a hardship because they had current obligations such as rent, food, and utilities.
The court found that SLMB was clearly a Medicaid program and that DMAHS erred by not screening the couple for eligibility in the SLMB Program before terminating their ABD benefits. The court held that relying on retroactive benefits subverted the purpose of pre-termination screening and did not justify a policy that permitted gaps in essential healthcare coverage. The court held that this was a circumstance where DMAHS acted in a way that was clearly inconsistent with its statutory mission and legislative policy. The court concluded that DMAHS’s decision was arbitrary, unreasonable, and erroneous, and therefore subject to being overturned. The decision was clear: DMAHS was required to proactively assess eligibility for other programs to prevent the disruption of benefits.
Current Challenges – County-Level Variability
In New Jersey, a significant portion of Medicaid eligibility decisions are handled by county-level agencies. As a result, compliance with the pre-termination screening requirement varies considerably from one county to another. Limited resources, inexperienced staff, and clerical errors lead to inconsistent application of the screening mandate. Instead of proactively transferring eligible beneficiaries between various Medicaid programs—such as SSI Medicaid, NJ Family Care/MAGI Medicaid, ABD Medicaid, MLTSS Medicaid, Workability Medicaid, and SLMB—the county offices often merely provide a referral or a new application and leave beneficiaries to navigate the system on their own.
Despite the clear mandate from the court, DMAHS has yet to develop and implement a robust, statewide system for conducting the required pre-termination eligibility screening and facilitating seamless transitions between programs. In practice, many beneficiaries continue to experience gaps in coverage because DMAHS appears to lack an integrated, automated system that cross-references a beneficiary’s eligibility for other Medicaid programs prior to terminating existing benefits. This means that the court’s requirement is not uniformly applied, leaving beneficiaries vulnerable to disruptions in care.
These challenges underscore the need for DMAHS and county agencies to collaborate on developing a comprehensive, statewide protocol. Or perhaps eliminate the county system altogether. Such a system should not only automate the screening process but also establish clear guidelines and accountability measures to ensure that beneficiaries do not experience unnecessary interruptions in their Medicaid benefits.
Final Thoughts
The ruling in D.C. v. Division of Medical Assistance & Health Services emphasizes the critical need for proactive administrative practices in the management of Medicaid benefits. By failing to pre-screen for eligibility in alternative programs, DMAHS not only violated federal regulatory requirements but also jeopardized the well-being of vulnerable low income people. Moreover, the lack of a cohesive, state-wide system to implement this requirement further compounds the problem, resulting in inconsistent and often inadequate protections for those most in need. This case just one example highlighting the need to reexamine and overhaul Medicaid administrative processes.
by Jose D. Roman | Feb 12, 2025 | Estate Planning, Legal Bulletin, Power of Attorney
Recently it was reported that an Asbury Park resident was detained by ICE after dropping his child off at school. Situations like this raise the question of who will care for the child if the parent remains in custody or is deported. Will someone be appointed guardian? Navigating New Jersey’s guardianship laws can be daunting, especially when a parent is temporarily unable to care for their child. Fortunately, N.J.S.A. 3B:12-39 provides a practical, court-free solution: it allows parents and legal guardians to delegate parental authority through a properly executed Power of Attorney. This flexibility is a lifeline for families, particularly immigrant parents who face the ever-present risk of detention, removal, or deportation in today’s unpredictable socio-political climate.
A Modern Solution for Modern Challenges
Under N.J.S.A. 3B:12-39, parents, custodians, or guardians can delegate their authority over a minor child’s care, custody, or property to a trusted individual. The delegation can take effect immediately or upon the occurrence of a specific “activating event.” The statute explicitly identifies several such events, including:
- A determination by the parent’s, custodian’s, or guardian’s attending physician that they are incapacitated or debilitated.
- Immigration administrative action, such as detention, removal, or deportation, which may separate a parent from their child.
- Criminal proceedings.
- Military service.
This streamlined process empowers families to plan ahead, avoiding the delays, costs, and complexities of court-appointed guardianship.
Why This Law is a Game-Changer for Immigrant Families
For immigrant parents, the fear of sudden detention or deportation can cast a long shadow over their ability to care for their children. In a political landscape where immigration policies are constantly in flux, this law provides a critical safety net. By including “immigration administrative action” as an activating event, N.J.S.A. 3B:12-39 directly addresses the unique challenges immigrant families face, offering several key advantages:
- Proactive Planning: Parents can execute a Power of Attorney in advance, designating a trusted individual to step in if an immigration action occurs.
- Avoiding Traumatic Placements: With a delegation in place, children are less likely to end up in temporary group settings and can remain with someone the family knows and trusts.
- Preserving Parental Rights: Even after delegating authority, parents retain the right to revoke the Power of Attorney or resume decision-making when circumstances allow.
- Peace of Mind: Knowing that a legal framework exists to protect their children allows immigrant parents to face their challenges with greater confidence.
This legal tool ensures that children continue to receive the care and stability they deserve, even in the face of immigration-related disruptions.
Practical Steps for Parents and Guardians
If you’re considering delegating parental authority under N.J.S.A. 3B:12-39, here are some key steps to keep in mind:
- Free Forms v. Paying a Lawyer: While it is always best to consult an experienced lawyer, there are free forms available. In fact, the text of the law itself actually provides a form you can use. If you can’t afford an attorney you should stick with the language from N.J.S.A. 3B:12-39 or use forms published by trusted sources such as local law school legal clinics or government websites. Here is a form from Rutgers Law School, along with an FAQ to answer common questions. Here is a form published by the New Jersey Department of Children and Families.
- Tailor the Power of Attorney: The document should clearly outline the scope of delegated powers and specify which activating events will trigger the delegation (including immigration-related issues).
- Address Consent Requirements: Obtain the consent of both parents or explain why the other parent is unable to provide consent (deceased, incapacitated, whereabouts unknown, etc.). This is outlined in the law and should be addressed in the form.
- Execute Properly: New Jersey requires a Power of Attorney to be notarized. However, it is recommended that you execute the document before two witnesses and a notary.
- Understand Renewal and Revocation: Be aware that the delegation expires after one year (with possible extensions under exigent circumstances). It can also be revoked by you at any time.
By taking these steps, parents can create a safety net for their families, ensuring stability even in the most uncertain times.
Final Thoughts
The Minor/Parental Power of Attorney under N.J.S.A. 3B:12-39 is a testament to New Jersey’s commitment to protecting families in crisis. By allowing parents to delegate parental authority without court intervention, the law provides a practical, compassionate solution for families facing emergencies. For immigrant parents, who often bear the brunt of shifting immigration policies, this legal mechanism is more than just a tool—it’s a vital safeguard for their children’s well-being.
by Jose D. Roman | Feb 10, 2025 | Estate Planning, Guardianship, Power of Attorney
A Springing Power of Attorneyis a legal document that allows someone you appoint as your agent to manage your financial affairs, but only when a specific condition is met—typically, your incapacitation. Unlike a typical Power of Attorney, which takes effect upon signing, a Springing Power of Attorney “springs” to life when you (“the principal”) become unable to handle your own financial matters.
How to Create a Springing Power of Attorney in New Jersey
To create a valid Springing Power of Attorney in New Jersey, be mindful of the following:
- State Clearly that it is Springing: The Power of Attorney should clearly state that it is springing and specify the triggering event, usually incapacitation. The document should also outline how incapacity is determined. In New Jersey, this often requires written certification from two licensed physicians confirming that the principal is unable to manage their affairs.
- Appoint a Trusted Agent: Choose a responsible individual who will act in the your best interest and handle your financial matters effectively.
- Choose Alternates: It is highly recommended that you choose alternate agents in case your first choice is unwilling or unavailable to serve.
- Include Specific Powers: The document should explicitly list the powers granted to the agent, as powers not listed are often not recognized, especially by banks and other financial institutions.
- Meet Legal Requirements: New Jersey law requires the Power of Attorney to be signed before a notary public or an attorney. Because other states may require two witnesses as well, it is recommended that you also sign it before two witnesses. Any person you are designating as an agent should not serve as a witness.
- Distribute Copies: Provide copies to the appointed agent, financial institutions, and any relevant parties who may need to recognize the Power of Attorney when the time comes. Keep the original in a safe place that is accessible by your agent.
Why Choose a Springing Power of Attorney?
A Springing Power of Attorney offers additional protections over an immediate Power of Attorney. Reasons people may choose a Springing Power of Attorney often include:
- Discomfort with Relinquishing Control: Since the agent’s authority only activates upon incapacity, the principal retains sole control of their financial affairs while competent. With an immediate Power of Attorney, your agent may act right away, which may not be desirable if you are uncomfortable with the idea of an immediate Power of Attorney.
- No Close Relatives or Friends Available: Individuals often appoint their spouse, children or a close friend as agent. If you don’t anyone close to you who can serve as your agent, you may want to opt for a Springing Power of Attorney.
- Trust Issues: Perhaps you don’t completely trust your designated agent but still want to appoint the person in case something happens to you. A Springing Power of Attorney may be the appropriate solution in these circumstances.
Ultimately, aSpringing Power of Attorney provides a safeguard against financial mismanagement, as no one can act on the principal’s behalf unless they truly become incapacitated. However, there are potential downsides. Proving incapacity can be challenging, as physicians may be hesitant to certify incompetency, and financial institutions may require additional proof before recognizing the agent’s authority. After all one of the purposes of having a Power of Attorney is to make your life and your loved one’s lives easier often during a difficult time. A Springing Power of Attorney may add extra hurdles and stress.
When Does a Springing Power of Attorney Go Into Effect?
A Springing Power of Attorney becomes effective upon the happening of a condition specified in the document — most commonly when the principal is deemed incapacitated. Typically, this means:
- Two physicians certify in writing that the principal is mentally or physically unable to manage their own affairs.
- The agent presents these certifications along with the Power of Attorney document to banks and financial institutions.
- The entity accepting the Power of Attorney determines that the incapacity provisions have been satisfied.
Because banks and other financial institutions may have their own standards for verifying incapacity, the agent might face hurdles in getting the Power of Attorney recognized. To avoid complications, you should inquire about any such issues with your financial institutions ahead of time and consider opting for an immediate Power of Attorney.
Is a Springing Power of Attorney Different from a Durable Power of Attorney?
No is the short answer. A Durable Power of Attorney remains valid even after the principal becomes incapacitated. However, a Durable Power of Attorney can be either immediate (effective upon signing) or springing (effective upon incapacity). All springing Powers of Attorney must be durable; otherwise, they would become invalid when the principal loses capacity, defeating their purpose.
Conclusion
A Springing Power of Attorney in New Jersey can be a valuable tool for those who wish to retain sole control over their finances while they are capable but ensure that someone can manage their affairs if needed. When drafting a Springing Power of Attorney, it is crucial to carefully define the terms of incapacity and ensure that the document meets all legal requirements to avoid delays or challenges in enforcement. Consulting an estate planning attorney can help tailor a Power of Attorney to fit individual needs and ensure it aligns with New Jersey law.
by Jose D. Roman | Feb 8, 2025 | Medicaid, Medicaid Planning, Trusts
Supplemental Security Income (SSI) is a federal program that provides basic income support to individuals who are over the age of 65, are blind, or have been determined disabled by the Social Security Administration (SSA). In New Jersey, SSI recipients are automatically enrolled in Medicaid, which ensures access to essential medical services. This seamless integration creates a vital safety net for vulnerable populations who need extra financial and healthcare support.
In this post, we’ll break down what SSI Medicaid is in New Jersey and explain the eligibility rules—including income and asset requirements.
What is SSI Medicaid in New Jersey?
SSI Medicaid provides healthcare coverage to those who qualify for federal SSI benefits. Because New Jersey is designated as a “1634 state,” SSI recipients are automatically enrolled in Medicaid without needing to complete a separate application. This automatic enrollment guarantees that vulnerable residents have access to comprehensive healthcare services as soon as they become eligible for SSI.
Eligibility Criteria
To qualify for SSI Medicaid in New Jersey, applicants must meet the following federal SSI requirements:
1. Categorical Requirements
- Age: 65 or older,
- Vision: Blind,
- Disability: Have a qualifying disability as defined by the Social Security Administration.
2. Financial Requirements
- Income: Must fall within prescribed monthly thresholds.
- Assets: Must remain below specific limits.
3. Residency and Citizenship
- Residency: Must be a resident of New Jersey.
- Citizenship: Must be a U.S. citizen or have lawful non-citizen status.
Income and Asset Requirements
SSI Medicaid eligibility is closely tied to both income and asset levels, ensuring that benefits are directed toward those with truly limited financial resources.
In New Jersey, for 2025, income must not exceed $967 per month for an individual, and $1,450 per month for a married couple. Countable income includes not only traditional wages but also other sources of income such as pensions, Social Security benefits, or even certain types of assistance. It’s important to note that while many forms of income count toward these limits, there are also specific exclusions built into the system. For example, a modest portion of earned income is partially disregarded to encourage self-sufficiency. This means that not every dollar earned by a beneficiary will be counted on a one-to-one basis toward the income limit.
In tandem with income restrictions, asset limits are a critical factor in SSI Medicaid eligibility. For an individual, countable assets must remain below $2,000, and for couples, the threshold is set at $3,000. Here, “countable assets” refer to cash, bank accounts, stocks, and other financial resources that could be converted to cash. However, the program recognizes that certain assets are essential for an individual’s day-to-day life and therefore exempts them from consideration. For instance, the primary residence is excluded from the asset calculation up to an equity value of $1,033,000, ensuring that having a home does not disqualify someone from receiving assistance. Similarly, one vehicle is exempt—so owning a car, which is often necessary for transportation to medical appointments or work, does not negatively impact eligibility. Personal property, including household goods and certain burial funds (up to $1,500), are also not counted.
Strategies to Maintain Eligibility
Maintaining eligibility for SSI Medicaid requires ongoing attention to financial details and proactive planning. Beneficiaries can use a variety of strategies to protect their benefits while working toward greater financial independence. Below are some key strategies:
1. Timely Reporting of Changes
One of the most critical aspects of maintaining eligibility is promptly reporting any changes in your circumstances to both the Social Security Administration (SSA) and New Jersey Medicaid. This includes changes in income, marital status, residency, or asset levels. Keeping these agencies updated helps avoid overpayments, penalties, or even termination of benefits.
2. Avoiding Improper Asset Transfers
It can be tempting to make gifts or transfer assets to a family member, but doing so without proper planning can lead to penalties or periods of ineligibility. Transferring assets at below-market values or without appropriate legal guidance can count against you. Before making any such transfers, it’s wise to consult with a legal expert or benefits counselor.
3. Creating a Special Needs Trust (SNT)
A Special Needs Trust is a powerful tool for individuals who wish to preserve their eligibility for SSI Medicaid while setting aside funds for future needs. By placing assets into an SNT, beneficiaries can ensure that these resources are used for supplemental purposes (such as education, therapy, or unforeseen medical expenses) without counting toward the asset limits. This trust is carefully structured so that while the funds are available to enhance quality of life, they do not disqualify an individual from receiving benefits.
4. Monitoring Income and Savings
Regularly reviewing your income sources and savings is crucial. Even small changes in earnings—whether from part-time work, inheritances, or other windfalls—can push you over the eligibility thresholds. Establishing a budgeting strategy and working with a financial advisor familiar with SSI rules can help you plan effectively and avoid unintentional disqualifications.
5. Utilizing Work Incentives Wisely
For those able to work, taking advantage of the work incentives offered under SSI is a great way to boost income while safeguarding benefits. However, it is important to plan carefully. Make sure to keep track of how much you earn each month and consult with a benefits counselor to understand how your work might affect your eligibility. Programs like the trial work period can provide a buffer as you transition into employment, but adherence to reporting guidelines remains essential.
6. Professional Guidance
Given the complexity of the rules surrounding SSI Medicaid, partnering with professionals—a Medicaid planning attorney, benefits counselor, or financial advisor—can be invaluable. These experts can help you navigate the nuances of income limits, asset management, and work incentives while ensuring you remain in compliance with all reporting requirements.
By incorporating these strategies into your financial planning, you can help secure your SSI Medicaid benefits and maintain a safety net for essential healthcare coverage.
Key Considerations
- SSI vs. SSDI:
Remember that SSI is a needs-based program, while Social Security Disability Insurance (SSDI) is based on work history. Medicaid rules differ between the two programs.
- NJ FamilyCare:
SSI Medicaid is part of New Jersey’s broader Medicaid initiative, NJ FamilyCare, which aims to provide comprehensive healthcare coverage to all eligible residents.
Conclusion
SSI Medicaid in New Jersey offers a lifeline for those who need extra financial and healthcare support. By understanding the intricacies of income and asset rules and staying informed about work incentives and reporting requirements (a topic for another day), beneficiaries can maintain uninterrupted coverage while exploring opportunities to improve their financial independence. If you’re facing complex situations—whether it involves asset management or navigating the work rules—it’s wise to consult with a Medicaid planning attorney or a benefits counselor.
Navigating SSI Medicaid can be challenging, but with the right information and careful planning, you can secure the benefits you need to ensure your well-being and move toward greater self-sufficiency.
by Jose D. Roman | Feb 6, 2025 | Estate Planning, Power of Attorney
The Social Security Representative Payee Program serves as an essential safeguard for individuals who receive Social Security benefits but are unable to manage their own finances due to disability, cognitive impairments, or aging-related challenges. This program is particularly important for young people with special needs or intellectual disabilities, as well as seniors who require assistance with their finances. Let’s explore how the program works, how a representative payee is appointed, and their responsibilities.
The Role of a Representative Payee
A representative payee is a person or organization appointed by the Social Security Administration (SSA) to manage Social Security or Supplemental Security Income (SSI) payments on behalf of a beneficiary who cannot do so themselves. The payee ensures that the funds are used for the beneficiary’s essential needs, such as housing, food, medical care, and personal expenses.
Why Power of Attorney is Not Accepted by the SSA
Unlike other financial institutions, the SSA does not recognize Powers of Attorney (POA) for managing Social Security benefits. Even if a person has a legally executed Power of Attorney, they must still apply and be approved as a representative payee to manage Social Security benefits on behalf of someone else. This distinction is critical because the SSA maintains strict oversight of how benefits are used to protect beneficiaries from potential financial exploitation.
How a Representative Payee is Appointed
The process of appointing a representative payee begins when the SSA determines that a beneficiary is incapable of managing their benefits. This can occur through medical evidence, reports from caregivers, or statements from the beneficiary themselves. If the SSA decides a payee is needed, they prioritize individuals in the following order:
- A legal guardian or custodian
- A close family member (spouse, parent, or adult child)
- A friend or other interested party
- An organization, such as a social service agency or nonprofit
The individual or entity seeking to become a representative payee must complete Form SSA-11 (Request to Be Selected as Payee) and provide supporting documentation. The SSA may also require an in-person interview to assess the applicant’s suitability.
Responsibilities of a Representative Payee
Once appointed, a representative payee has several crucial responsibilities:
- Managing Benefits Properly: The payee must ensure that the Social Security or SSI benefits are used for the beneficiary’s current and foreseeable needs, such as rent, food, medical expenses, and personal care.
- Budgeting and Financial Planning: Any remaining funds after covering essential expenses should be saved for the beneficiary’s future needs, ideally in an interest-bearing account.
- Preventing Misuse: The payee must never use the funds for personal expenses or any purpose that does not directly benefit the beneficiary.
- Reporting to the SSA: The payee must inform the SSA of any changes in the beneficiary’s circumstances, such as changes in living arrangements, work status, or medical conditions that may affect eligibility.
- Submitting Annual Reports: In many cases, a representative payee is required to submit an annual accounting report detailing how the benefits were spent or saved. This ensures transparency and accountability.
Managing the Beneficiary’s Money
A representative payee must keep the beneficiary’s funds separate from their own, preferably in a dedicated checking or savings account. The account should be titled to reflect the fiduciary role, such as “[Beneficiary’s Name] by [Payee’s Name], Representative Payee.” This prevents commingling of funds and ensures proper tracking of expenditures.
Final Thoughts
The Social Security Representative Payee Program provides critical financial management support for individuals who need assistance handling their benefits. Because the SSA does not recognize Powers of Attorney, it is essential to follow the proper procedures to become a representative payee. By understanding the appointment process, responsibilities, and financial management rules, representative payees can help ensure that vulnerable individuals receive the financial stability they need to lead secure and dignified lives.