United States District Court, D. New Jersey, Camden Vicinage
PATRICE DEAL, EXECUTRIX OF THE ESTATE OF GRACE DEAL, DECEASED, Plaintiff,
JENNIFER VELEZ, et al., Defendants.
H. RODRIGUEZ U.S.D. JUDGE.
matter is before the Court on a motion for summary judgment
pursuant to Fed.R.Civ.P. 56 filed by the sole remaining
Defendant, Charles SanFilippo, Director of Burlington County
Board of Social Services. The Court has reviewed the submissions
and decides the matter based on the briefs pursuant to
Fed.R.Civ.P. 78(b). For the reasons stated here, Defendant
SanFilippo's motion will be granted.
case arises out of a series of applications for assisted
living benefits made by or on behalf of decedent Grace Deal,
which were originally denied by the State of New Jersey in
conjunction with the Burlington County Board of Social
Services (“BCBOSS”). Although the State
eventually granted Deal's application, Plaintiff Patrice
Deal, Executrix of the Estate of Grace Deal, asserts that
Defendants wrongly determined that Grace Deal was not
eligible for the Medicaid Waiver Program to cover assisted
living services of $63, 411.28 for the period from July 1,
2014 to February 28, 2015. Detailed facts regarding the
application process and determinations of benefits are
familiar to the parties and were outlined by the Court in its
March 20, 2017 Opinion dismissing all claims except those
asserted against Defendant SanFilippo.
to the instant motion is that on January 6, 2014, Grace Deal
applied for Medicaid benefits through the Global Options
Assisted Living Medicaid Waiver (“GO”) Program,
the only Medicaid funded program in New Jersey that covered
benefits received for assisted living facilities. On March 4,
2014, BCBOSS, the county welfare agency, denied Deal
eligibility for the GO Program because on December 13, 2013
she had entered into a Consent Order reducing the amount of
monthly spousal support to which she was entitled pursuant to
a March 17, 2010 settlement agreement which accompanied her
Limited Divorce from Bed and Board from $2055 to $1, 500.
BCBOSS presumed that Deal's request for the Order
decreasing her monthly support was improperly motivated to
obtain Medicaid, which had a $2, 163 monthly income limit,
contrary to N.J. Admin. Code 10:71-4.10(b)3, which prohibits
disposal of assets at less than fair market value for five
years prior to application for benefits.
timely filed an administrative appeal on March 12, 2014. On
June 20, 2014, following a state administrative hearing, the
administrative law judge issued an initial decision affirming
the denial of Deal's eligibility. On August 1, 2014, the
DMAHS issued a final agency decision affirming the
administrative law judge's decision denying Deal GO
Program eligibility. Plaintiff did not appeal that decision
to the Superior Court of New Jersey, Appellate Division.
Rather, on October 17, 2014, Plaintiff filed the Complaint in
this case. Deal filed a second Medicaid application January
20, 2015 and set up a Qualified Income Trust the next day.
She alleges that in processing this second application,
Defendants required her to obtain judicial modification of
her monthly spousal support payment back to $2055, which she
did effective by court Order dated June 5, 2015. Deal passed
away June 28, 2015.
about July 22, 2015, Deal was determined eligible for the
Medicaid waiver program as of June 1, 2015, and based on
undue hardship while seeking legal action to reverse the
“transfer of assets, ” granted her eligibility
effective March 1, 2015.
asserts violations of Deal's statutory rights as granted
by the Federal Medicaid Act, enforceable under 42 U.S.C.
§ 1983. The Amended Complaint asserts claims for: (1)
failure to establish an appropriate date of eligibility (July
1, 2014) in operation of a Medicaid Assisted Living Waiver in
violation of 42 U.S.C. § 1396a(a)(34); (2) denial of due
process in operation of the Medicaid AL Waiver in violation
of 42 U.S.C. § 1396a(a)(3) by failing to notify Deal
that she was denied coverage for the time between the
effective date of eligibility (July 1, 2014) and the date in
which she was enrolled; (3) failure to provide medical
assistance with reasonable promptness in operation of the
Medicaid AL Waiver in violation of 42 U.S.C. §
1396a(a)(8); (4) denial of due process in operation of the
Medicaid AL Waiver by failing to give full faith and credit
to the December 13, 2013 Superior Court Order reducing
Plaintiff's spousal support; and (5) declaratory relief
directing Defendants to properly process Deal's Medicaid
application and determine her to be eligible for Medicaid
effective July 1, 2014.
judgment is proper if there is no genuine issue of material
fact and if, viewing the facts in the light most favorable to
the non-moving party, the moving party is entitled to
judgment as a matter of law.” Pearson v.
Component Tech. Corp., 247 F.3d 471, 482 n.1 (3d Cir.
2001) (citing Celotex Corp. v. Catrett, 477 U.S.
317, 322 (1986)); accord Fed.R.Civ.P. 56 (a). Thus,
the Court will enter summary judgment in favor of a movant
who shows that it is entitled to judgment as a matter of law,
and supports the showing that there is no genuine dispute as
to any material fact by “citing to particular parts of
materials in the record, including depositions, documents,
electronically stored information, affidavits or
declarations, stipulations . . . admissions, interrogatory
answers, or other materials.” Fed.R.Civ.P. 56
issue is “genuine” if supported by evidence such
that a reasonable jury could return a verdict in the
nonmoving party's favor. Anderson v. Liberty Lobby,
Inc., 477 U.S. 242, 248 (1986). A fact is
“material” if, under the governing substantive
law, a dispute about the fact might affect the outcome of the
suit. Id. In determining whether a genuine issue of
material fact exists, the court must view the facts and all
reasonable inferences drawn from those facts in the light
most favorable to the nonmoving party. Matsushita Elec.
Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587
the moving party has the burden of demonstrating the absence
of a genuine issue of material fact. Celotex Corp. v.
Catrett, 477 U.S. 317, 323 (1986). Once the moving party
has met this burden, the nonmoving party must identify, by
affidavits or otherwise, specific facts showing that there is
a genuine issue for trial. Id.; Maidenbaum v.
Bally's Park Place, Inc., 870 F.Supp. 1254,
1258 (D.N.J. 1994). Thus, to withstand a properly supported
motion for summary judgment, the nonmoving party must
identify specific facts and affirmative evidence that
contradict those offered by the moving party.
Andersen, 477 U.S. at 256-57. “A nonmoving
party may not ‘rest upon mere allegations, general
denials or . . . vague statements . . . .'”
Trap Rock Indus., Inc. v. Local 825, Int'l Union
of Operating Eng'rs, 982 F.2d 884, 890 (3d
Cir. 1992) (quoting Quiroga v. Hasbro, Inc., 934
F.2d 497, 500 (3d Cir. 1991)). Indeed,
the plain language of Rule 56(c) mandates the entry of
summary judgment, after adequate time for discovery and upon
motion, against a party who fails to make a showing
sufficient to establish the existence of an element essential
to that party's case, and on which that party will bear
the burden of proof at trial.
Celotex, 477 U.S. at 322. That is, the movant can
support the assertion that a fact cannot be genuinely
disputed by showing that “an adverse party cannot
produce admissible evidence to support the [alleged dispute
of] fact.” ...