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In re Department of Institutions and Agencies Proposed Rule at 3 NJR 134

Decided: March 6, 1973.

IN RE DEPARTMENT OF INSTITUTIONS AND AGENCIES DECISION ON OBJECTIONS TO PROPOSED DEPARTMENT RULE WHICH WAS PUBLISHED AT 3 NJR 134 UNDER THE MEDICAL ASSISTANCE AND HEALTH SERVICES ACT. NJSA 30:4D-7(N)


Labrecque, Kolovsky and Matthews. The opinion of the court was delivered by Labrecque, P.J.A.D.

Labrecque

The Commissioner of the Department of Institutions and Agencies (Commissioner) gave notice of his intention to promulgate a rule governing payments to county welfare boards for eligibility investigations pursuant to the Medical Assistance and Health Services Act (Medicaid Act), N.J.S.A. 30:4D-1 et seq. Objections to the proposed rule were received and a hearing was held before the Acting Commissioner of the Department, in which those objecting to the proposed rule participated. On January 21, 1972 the Acting Commissioner filed his decision in which he concluded that the proposed rule complied with the letter and intent of the applicable statutes and should be adopted. It was formally adopted on February 2, 1972 as N.J.A.C. 10:49-1.1. The present appeal by the Essex County Welfare Board (Board) followed.

Appellate raises two points as follows: (1) "The reimbursement for investigating and determining eligibility provisions of N.J.A.C. 10:49-1.1 violate the intent of the medical assistance program (N.J.S.A. 30:4D-1 et seq.) and therefore were beyond the power of the Department of Institutions and Agencies to promulgate"; (2) "The regulation in question conflicts with 42 U.S.C.A. Section 1396(a)(2) [1396a(a)(2)] and therefore is void." We find them to be without merit.

Pursuant to Title XIX of the Social Security Act, which enabled the states to take advantage of partial federal funding of a state administered medical assistance program, 42 U.S.C.A. § 1396 et seq. , the New Jersey Legislature enacted the act setting up Medicaid, L. 1968 c. 413, N.J.S.A. 30:4D-1 et seq. The intent of the act was stated to be:

It is the intent of the Legislature to make statutory provision which will enable the State of New Jersey to provide medical assistance, insofar as practicable, on behalf of persons whose resources are determined to be inadequate to enable them to secure quality medical care at their own expense, and to enable the State, within the limits of funds available for any fiscal year for such purposes, to obtain all benefits for medical assistance provided by the Federal Social Security

Act as it now reads or as it may hereafter be amended, or by any other Federal act now in effect or which may hereafter be enacted. [ N.J.S.A. 30:4D-2]

The Department of Institutions and Agencies was designated as the single state agency to administer the act. N.J.S.A. 30:4D-3 and 5.

Title XIX makes appropriations available to those states which submit and have approved by the Secretary of Health, Education and Welfare plans for medical assistance which meet federal standards. 42 U.S.C.A. § 1396. One requirement is that the state plan include as persons eligible for medical assistance those who are recipients of aid under the federally established "categorical assistance" programs, i.e. , (1) old age assistance, 42 U.S.C.A. § 301 et seq.; (2) assistance for the permanently and totally disabled, 42 U.S.C.A. § 1351 et seq.; (3) assistance for the blind, 42 U.S.C.A. § 1201 et seq. , and (4) assistance for dependent children, 42 U.S.C.A. § 601 et seq. In compliance therewith, the New Jersey Medicaid Act includes in the definition of a "qualified applicant" for Medicaid a resident of the State who it is determined needs medical care and services as provided under the act, and who is a recipient of old age assistance, N.J.S.A. 44:7-1 et seq. , assistance for the permanently and totally disabled, N.J.S.A. 44:7-38 et seq. , assistance for the blind, N.J.S.A. 44:7-43 et seq. , or assistance for dependent children, N.J.S.A. 44:10-1 et seq., N.J.S.A. 30:4D-3(f).

The federal act also requires that the state medical assistance plan:

[P]rovide for financial participation by the State equal to not less than 40 per centum of the non-Federal share of the expenditures under the plan with respect to which payments under section 1396b of this title are authorized by this subchapter; and, effective July 1, 1969, provide for financial participation by the State equal to all of such non-Federal share or provide for distribution of funds from Federal or State sources, for carrying out the State plan, on an equalization or other basis which will assure that the lack of adequate funds from local sources will not result in lowering the amount, duration,

scope, or quality of care and services available under the plan. [42 ...


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