June 28, 2011
DEPARTMENT OF HUMAN SERVICES, DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES, RESPONDENT.
On appeal from the Department of Human Services, Division of Medical Assistance and Health Services.
RECORD IMPOUNDED NOT FOR PUBLICATION WITHOUT
THE APPROVAL OF THE APPELLATE DIVISION
Submitted May 18, 2011 - Decided
Before Judges Simonelli and Fasciale.
Appellant, C.B., appeals from an August 2, 2010 order of the New Jersey FamilyCare Grievance Review Board (the Board) affirming a decision of the Statewide Eligibility Determination Agency (FamilyCare) that C.B. and his wife were ineligible for health care coverage. We affirm.
On February 15, 2010, FamilyCare notified C.B. he was required to renew his family's enrollment by April 15, 2010. On April 13, 2010 FamilyCare received C.B.'s renewal application and financial information, including his 2009 federal income tax return. Based on this information, FamilyCare advised C.B. that he and his wife were to be terminated from the program. C.B. then mailed FamilyCare a different un-filed 2009 federal tax return, and later, a profit and loss statement for January to April 2010. FamilyCare notified C.B. that he, his wife, and their three children were ineligible for benefits. In response, C.B. filed a grievance review with the Board.
The Board determined that C.B. and his wife were ineligible for FamilyCare because the family's gross monthly income exceeded the limit for parental coverage. The Board explained that parents of dependant children who receive FamilyCare must continually meet eligibility requirements in order to remain eligible. N.J.A.C. 10:78-1. The monthly income limit for parents covered under the program is 200% of the federal poverty limit. Ibid. The Board found that 200% of the federal poverty limit for a family of five was $4299, and that the financial information reported by C.B. indicated that his "family's gross monthly income exceeded the limit for parent coverage." The Board determined that C.B.'s three children remained eligible for FamilyCare, however, because the monthly income limit for children is higher.
On appeal, C.B. argues that the Board miscalculated his income because it failed to follow the FamilyCare guidelines.
C.B. contends that the Board failed to supply clear and specific details, and that it increased his income by erroneously adding earnings reflected in his tax returns for 2009 and 2010. We disagree.
Our role in reviewing a decision of an administrative agency is to determine whether the agency's decision was arbitrary, capricious or unreasonable. E.S. v. Div. of Med. Assistance & Health Servs., 412 N.J. Super. 340, 348 (App. Div. 2009); see also Henry v. Rahway State Prison, 82 N.J. 571, 580 (1980). "The agency decision must be supported by substantial credible evidence in the record as a whole." E.S., supra, 412 N.J. Super. at 348 (citing Circus Liquors, Inc. v. Middletown Twp., 199 N.J. 1, 10 (2009)). "It must not offend either the state or federal constitution and must be in accord with the agency's legislative mandate." E.S., supra, 412 N.J. Super. at 348. The party challenging the agency's decision has the burden of demonstrating that the decision was arbitrary, capricious or unreasonable. Ibid.
We find that the Board's decision was reasonable and see no basis for disturbing it. We affirm substantially for the reasons expressed by the Board in its thoughtful and detailed written opinion dated August 2, 2010. We add the following brief comments.
C.B.'s gross monthly income exceeded 200% of the federal poverty limit whether his monthly income is calculated using his 2009 federal income tax return, 2009 un-filed federal tax return, or his profit and loss statement for January to April 2010. Thus, the Board did not act arbitrarily or capriciously, but rather found by substantial, credible evidence that C.B. was ineligible for health coverage provided by FamilyCare.
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