C.M. VS. SUSSEX COUNTY BOARD OF SOCIAL SERVICES (NEW JERSEY DEPARTMENT OF HUMAN SERVICES)
A-1337-19
| N.J. Super. Ct. App. Div. | Nov 17, 2021Background
- C.M. lived with her husband and four tax-dependent children; family qualified for NJ FamilyCare Medicaid in 2018 based on 2017 taxes.
- In Dec. 2018 the county welfare agency (CWA) learned C.M. earned $3,917.26/month, husband had monthly business losses of $1,217.50, and son J.M. earned about $1,348.91/month from ShopRite; CWA projected 2019 household income of $4,048.67/month, exceeding the MAGI threshold, and notified the family of termination.
- An ALJ (Feb. 2019) initially reversed termination, finding it premature to assume J.M. would continue working in 2019; DMAHS rejected that decision in May 2019 and reinstated the termination.
- Appellate Division granted emergent relief in June 2019 and remanded for a plenary hearing focused on J.M.’s projected 2019 income.
- At the Aug. 30, 2019 remand hearing, J.M. testified he stopped working in March 2019; the ALJ found his 2019 gross income was $3,710.63 and he was not required to file a 2019 federal tax return, and reinstated benefits on Sept. 3.
- DMAHS rejected the ALJ’s remand decision on Oct. 28, 2019 (reasoning the updated info was not available to the CWA in Dec. 2018); the Appellate Division reversed, holding DMAHS erred in ignoring remand hearing findings and remanded for current eligibility determination.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Inclusion of a tax-dependent's income under MAGI | C.M.: agency violated ACA/MAGI rules by counting exempt dependent income | DMAHS/CWA: using dependent’s projected 2019 earnings (known Dec. 2018) to calculate household MAGI was proper | Court: CWA’s initial projection was reasonable, but after remand evidence showed dependent not required to file, agency could not ignore that; reversal and remand |
| Use of projected future income to terminate benefits | C.M.: agency wrongly relied on projected future income of her son to terminate household benefits | DMAHS/CWA: projection based on most recent available monthly income was reasonable and supported termination | Court: prospective estimates are permitted, but here remand produced changed facts the agency was obliged to consider; agency erred by rejecting ALJ’s remand findings |
| Failure to follow appellate remand and ALJ findings | C.M.: DMAHS ignored the court-ordered remand and attendant factual findings | DMAHS: updated facts were not available to CWA at time of original decision in Dec. 2018 | Held: appellate remand created a duty to consider the remand hearing results; DMAHS improperly reversed ALJ’s reinstatement and must reassess eligibility |
Key Cases Cited
- In re Stallworth, 208 N.J. 182 (2011) (appellate review standards for agency factual findings)
- Lowenstein v. Newark Bd. of Educ., 35 N.J. 94 (1961) (appellate mandate binds agencies on remand)
- L.M. v. State, Div. of Med. Assistance & Health Servs., 140 N.J. 480 (1995) (state obligations when administering Medicaid)
- Univ. Cottage Club of Princeton N.J. Corp. v. N.J. Dep't of Env't Prot., 191 N.J. 38 (2007) (courts are not bound by agency legal interpretations)
- Pritchett v. State, 248 N.J. 85 (2021) (relief from a court remand must be sought in the appellate court)