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Alford v. Somerset County Welfare Board

Decided: March 21, 1978.

ELDORA ALFORD, APPELLANT,
v.
SOMERSET COUNTY WELFARE BOARD, DEPARTMENT OF INSTITUTIONS AND AGENCIES, RESPONDENTS



On appeal from the determination of the Director, Division of Public Welfare, Department of Institutions and Agencies.

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

Matthews

This is an appeal from a decision of the Division of Public Welfare of the Department of Human Services (formerly the Department of Institutions and Agencies) upholding a determination of the Somerset County Welfare Board to terminate payment of Medicaid benefits to the five children of Eldora Alford (recipient), based on the availability of income in excess of program standards.

As a result of the physical incapacity of her husband, recipient and her five children, as of December 1, 1975, became eligible for monthly benefits in the amount of $506 provided under the Aid to Families with Dependent Children (AFDC) program. See 42 U.S.C.A. § 606(a)(1); N.J.S.A. 44:10-1(c)(1). As such, the Alford family was entitled to services provided under New Jersey's Medicaid program. N.J.S.A. 30:4D-3(f)(1). In June 1976 Mr. Alford was notified by the Social Security Administration that he had been determined eligible for Social Security disability benefits retroactive to June 16, 1975. As of July 1976 the Alford family began to receive monthly benefits from the Social Security Administration totalling $616.10: $47.20 for each of the Alford's five children, the oldest of whom was then 14, and Mrs. Alford, and $332.90 for Mr. Alford. Upon reevaluation of the income available to the family, the welfare board in March 1977 concluded that AFDC benefits must be terminated since the family income exceeded the allowable AFDC income level of $361. On March 18, 1977 recipient was notified by the board as to

the termination proposed to be effective April 1, 1977. The board also notified recipient that her minor children could no longer be deemed eligible for benefits provided under the Medicaid special program. (R. 1976, d. 97 (Exempt, Emergency Rule), 8 N.J.R. § 231 (March 29, 1976)). The basis for the board's action was its determination that the Alford children, being financially and emotionally dependent upon their parents for support and guidance, could only be deemed eligible if the family's income, as calculated by AFDC procedures, would render the family financially eligible for AFDC. Public Assistance Manual (PAM) § 8541.3, 8 N.J.R. § 231. Since the family's total income of $616.10 exceeded the AFDC schedule allowance of $361, eligibility under PAM § 8541.3 was not established.

On April 4, 1977 recipient filed a request with the Division of Public Welfare for a fair hearing to challenge the action taken by the county welfare board. The children's Medicaid benefits were continued pending completion of the fair hearing process.

At the fair hearing conducted on April 26, 1977 recipient presented testimony as to the income available to the children and to the family unit from the Social Security Administration, and an itemization of the family's monthly expenses. The sole evidence proffered in support of the appellant's contention as to the children's independency was the receipt by each of $47.10 a month in Social Security benefits.

The hearing officer found that recipient had failed to meet her burden of establishing the independence of her minor children. The officer concluded that the agency therefor correctly computed Medicaid Special eligibility based upon the family unit's total income, and recommended to the Director of the Division of Public Welfare that the agency's termination of benefits be upheld. In an opinion dated June 8, 1977 the Director adopted the hearing officer's findings and affirmed the board's termination of benefits. [158 NJSuper Page 307] Title XIX of the Social Security Act, 42 U.S.C.A. § 1396 et seq. , authorizes the appropriation of federal monies to states which have chosen to implement a medical assistance program in accordance with the terms set forth in 42 U.S.C.A. § 1396a(a)(1)-(36). The purpose of the federal contribution is to enable each participating state: " as far as practicable under the conditions in such state , to furnish (1) medical assistance on behalf of families with dependent children and of aged, blind or disabled individuals, whose income and resources are insufficient to meet the costs of necessary medical services * * *." 42 U.S.C.A. § 1396 (emphasis supplied). The Congress, in enacting this legislation, did not mandate that participating states assume the burden of aiding all needy individuals who were incapable of obtaining necessary medical services. Dimery v. Iowa Dep't of Social Services , 344 F. Supp. 1181 (D. Iowa 1972). Rather, it was the legislative intent that the condition for the receipt of federal contributions be only such that the individual states provide supplemental assistance to persons receiving benefits under the Supplemental Security Income (SSI), 42 U.S.C.A. § 1382 et seq. , its predecessor programs, or the Aid to Families with Dependent Children (AFDC) program, 42 U.S.C.A. § 602 et seq. (see 42 U.S.C.A. § 1396a(a)(10)(A)), as well as three additional "categorically needy" segments: (1) persons financially eligible for SSI or AFDC benefits who are disqualified under the state's program by an age, residency or citizenship requirement prohibited by the Medicaid Act, 42 U.S.C.A. § 1396a(b)(1), (3) and (4), 45 C.F.R. § 248.1(b)(3)(i); (2) individuals under 21, who are disqualified for AFDC benefits by age or school attendance requirements, 42 U.S.C.A. § 1396a(b)(2), 45 C.F.R. § 248.1(b)(1)(ii), and (3) essential spouses of SSI (or its superceded programs) recipients who live with such recipients and whose needs are considered in determining the amount of such assistance, 42 U.S.C.A. § 1396d(a)(vi), 45 C.F.R. § 248.1(b)(2)(v). Beyond this core

group no additional classes of individuals need be provided for under a state Medicaid plan.

Participating states may, however, choose to extend benefits to additional categories of individuals: (1) one or more of the six designated groups set forth in 45 C.F.R. § 248.1(c)(1)-(6) (the "optional categorically needy"), or (2) individuals who fall without the financial eligibility levels of the state AFDC or SSI programs, 42 U.S.C.A. § 1396a(a)(10)(C) (the "medically needy"). Of these suggested classes of eligible recipients, New Jersey has undertaken to extend benefits only to three of the "optional categorically needy" groups: (1) individuals who are categorically eligible for AFDC or SSI or state supplementary SSI benefits but who have not applied for such assistance, 45 C.F.R. § 248.1(c)(1), N.J.S.A. 30:4D-3(f)(6), N.J.S.A. 44:7-90; (2) families who would be eligible for benefits provided under AFDC-U (42 U.S.C.A. § 607, 45 C.F.R. § 248.1(c)(3), N.J.S.A. 30:4D-3(f)(7), Public Assistance Manual (PAM) § 8541.2 (groups of individuals under 21 who qualify on the basis of financial eligibility for AFDC benefits but do not satisfy the criteria for dependent children under the State's AFDC plan, 45 C.F.R. § 248.1(c)(4). As to the latter category New Jersey has designated three eligible groupings:

(1) Children under 21 in foster homes or private institutions for whom the Division of Youth and Family Services or a private adoption agency is assuming ...


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