United States District Court, D. New Jersey
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,
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.
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.
L. HILLMAN, U.S.D.J.
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.
Court takes its facts from Plaintiffs' November 16, 2017
Dominic Radogna's Medicaid Application
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.
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.
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.
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
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.
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.
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.
Solomon Krupka's Medicaid Application
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
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.
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.
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.
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
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. Krupka was subsequently determined
eligible for Medicaid on a subsequently filed Medicaid
application from Essex County beginning on July 1, 2016 until