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Radogna v. Connelly

United States District Court, D. New Jersey

August 24, 2018

JOAN RADOGNA, as personal representative of the Estate of Dominic Radogna, and SHERRI KRUPKA, as the personal representative of the Estate of Solomon Krupka, Plaintiffs,
v.
ELIZABETH CONNELLY, Commissioner, New Jersey Department of Human Services, and MEGAN DAVEY, Director, New Jersey Department of Human Services, Division of Medical Assistance and Health Services, Defendants.

          ROXANE LOUISE CROWLEY JANE M. FEARN-ZIMMER ROTHKOFF LAW GROUP On behalf of Plaintiffs.

          GREGORY J. SULLIVAN NEW JERSEY ATTORNEY GENERAL'S OFFICE DIVISION OF LAW, TORT LITIGATION AND JUDICIARY R.J. HUGHES JUSTICE COMPLEX On behalf of Defendants.

          OPINION

          NOEL L. HILLMAN, U.S.D.J.

         This matter arises from the denial of Dominic Radogna's and Solomon Krupka's Medicaid applications. Before the Court is Defendants' Motion to Dismiss the Amended Complaint. For the reasons that follow, the Court will grant Defendants' Motion to Dismiss.

         I.

         The Court takes its facts from Plaintiffs' November 16, 2017 Amended Complaint.

         A. Dominic Radogna's Medicaid Application

         On October 1, 2015, a Medicaid application was filed on behalf of Dominic Radogna requesting a Medicaid eligibility date of August 1, 2015. The application was filed with the Division of Medical Assistance and Health Services through the Burlington County Board of Social Services. The Burlington County Board of Social Services thereafter requested additional documents to complete the Medicaid application. These documents were timely filed. Twenty-five days after the filing of the application, Radogna died.

         On November 19, 2015, the Burlington County Board of Social Services requested additional documents prior to November 30, 2015, the first Monday after the Thanksgiving holiday. This letter was not received by the Rothkoff Law Group (“RLG”) until November 24, 2016, and RLG was closed for business on Thanksgiving, November 26, 2015, and the following Friday, November 27, 2015.[1]

         In response to the letter request, RLG requested an extension via e-mail, to which no response was received. RLG then followed up in-person on the extension requests. On December 18, 2015, the Burlington County Board of Social Services denied the underlying Medicaid application, based on the failure to provide the documentation requested in the November 19, 2015 notice prior to November 30, 2015.

         On December 24, 2015, RLG delivered additional items that had been requested in the November 19, 2015 notice to the Burlington County Board of Social Services. RLG received the December 18, 2015 denial notice on January 6, 2016. The original denial notice had been sent to Radogna's former nursing home.

         Due to the need to obtain some of the requested documentation from third-party financial institutions, a task complicated by Radogna's passing, the remaining requested documents were not available until January 2016. On January 25, 2016, RLG supplied the remaining requested documents to the Burlington County Board of Social Services.

         The Burlington County Board of Social Services issued a February 8, 2016 letter advising that the Medicaid application for Radogna would remain denied. On February 18, 2016, RLG contacted the Burlington County Board of Social Services, requesting that the Medicaid denial be rescinded and Radogna's application be processed.

         By way of a March 16, 2016 letter, Defendants, through the Burlington County Board of Social Services, communicated that additional time was provided prior to the December 18, 2015 denial notice to provide the requested documentation. No. new determination has been made on the Medicaid application. The matter was scheduled for a Medicaid Fair Hearing before and Administrative Law Judge in late 2017.

         B. Solomon Krupka's Medicaid Application

         On November 9, 2015, a Medicaid application was filed on behalf of Solomon Krupka with the Division of Medical Assistance and Health Services, through the Passaic County Board of Social Services. On November 9, 2015, the Passaic County Board of Social Services issued a letter requesting additional documents be filed to complete the Medicaid application. The list was “vaguely worded and did not clearly state which verifications were needed to complete the Medicaid application.”

         Krupka's spouse obtained as many of the requested documents as she could by the December 24, 2015 deadline. Nearly all of the requested documents were filed by December 23, 2015. By phone, RLG requested additional time to provide the remaining documents. The RLG employee was unable to reach the Medicaid caseworker and left a message.

         Also on December 23, 2015, RLG mailed additional documents to the Passaic County Board of Social Services with a written request for an extension of time. No. response was received, and RLG followed up with a January 26, 2016 letter, sending additional documents and requesting clarification as to whether any further documents were required. No. response was received, and RLG followed up with a telephone call on February 22, 2016 to the Medicaid caseworker. The caseworker stated she had not reviewed the additional documentation and was unable to clarify whether any additional documents were required at that time. RLG then spoke with the Medicaid supervisor on March 10, 2016. The caseworker thereafter communicated that she would review the file and get back to RLG as to whether any additional documentation was required.

         On April 9, 2016, the Passaic County Board of Social Services denied the underlying Medicaid application based on the failure to provide timely the requested documentation. RLG did not receive a copy of the notice until April 15, 2016, as the notice was sent directly to Krupka's nursing home. At the time, Krupka was disabled and incapacitated. Additional documents were provided to the Passaic County Board of Social Services on June 8, 2016.

         This matter proceeded to a Fair Hearing in the Office of Administrative Law on November 28, 2016. An Initial Decision was issued on December 6, 2016 reversing the determination and ordering that the Medicaid application be reinstated as of November 9, 2015. However, this Initial Decision was reversed by the Agency Director and remanded for additional proceedings.

         Krupka died on July 2, 2017. A subsequent Fair Hearing was held on August 28, 2017. The September 11, 2017 Initial Decision concluded that the Medicaid application should be granted from November 9, 2015 until July 2016 if Krupka was deemed eligible.[2] Krupka was subsequently determined eligible for Medicaid on a subsequently filed Medicaid application from Essex County beginning on July 1, 2016 until his ...


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