This matter is before the court on order to show cause for instructions as to whether the executors should pay the claim of the Department of Human Services.
During July 1974 decedent, who was then over the age of 65, applied for medical assistance benefits from the Department of Human Services, Division of Medical Assistance and Health Services. Commencing July 23, 1974 the Division reimbursed Medicenter for various medicaid expenses of decedent to the extent of $12,236.34. Decedent died April 11, 1976 leaving no surviving spouse or children eligible
for Medicaid benefits at the time of her death. Her estate, which consists primarily of a leasehold interest in Ocean Grove, after the payment of administration expenses and claims other than the claim of the Division, amounts to $8,585.50. If the Division's claim is paid, there will be no assets left for distribution under decedent's will.
The federal Medicaid statute (Grants to States for Medical Assistance and Health Services) is 42 U.S.C.A. § 1396-§ 1396k; Title XIX (§ 1901-§ 1912) of the Social Security Act. The statute was enacted to enable states to take advantage of partial federal funding of state-administered medical assistance programs. In order to be eligible for federal participation, the states were required to meet certain federal standards set forth in the federal Medicaid statute and regulations. See 42 U.S.C.A. § 1396a.
Failure to comply substantially with the terms of the federal standards or modification of the state plan so as to render it nonconforming with the requirements of 42 U.S.C.A. § 1396a may authorize the discontinuance of all or selected portions of the federal monies. 42 U.S.C.A. § 1396c.
The applicable federal statutory provision relating to recoupment of correctly paid Medicaid benefits from estates of certain deceased recipients, 42 U.S.C.A. § 1396a(a)(18), provides that a state plan for medical assistance must:
Similarly, the applicable federal regulatory provision relating to recoupment of correctly paid medical benefits from the estates of certain deceased recipients, 42 C.F.R. § 449.79(b), provides:
A State plan under title XIX of the Social Security Act must provide that: * * * (b) There will be no adjustment or recovery of medical assistance correctly-paid, except from the estate of an individual who was 65 years of age or older when he received such assistance, and then only after the death of his surviving spouse, if any, and only at a time when he has no surviving child who is under age 21 or is blind or permanently and totally disabled.
The New Jersey state plan was prepared and submitted to the Department of Health, Education and Welfare on December 18, 1969. It was approved by the federal agency on December 31, 1969, immediately prior to the January 1, 1970 effective date of the state Medicaid statute. (Medical Assistance and Health Services Act, N.J.S.A. 30:4D-1 et seq.)
According to the representations of both parties, the New Jersey plan included a provision authorizing recoupment of correctly paid benefits which was substantially identical to the federal statutory and regulatory provisions detailed above. Part IV, § g of the plan states:
There will be no adjustment or recovery of medical assistance correctly paid, except from the estate of an individual who was 65 years of age or older when he received such assistance, and then only after the death of his surviving spouse, if any, and only at a time when he has no surviving ...