N.S. VS. DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES (DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES)

NOT FOR PUBLICATION WITHOUT THE
APPROVAL OF THE APPELLATE DIVISION
This opinion shall not "constitute precedent or be binding upon any court." Although it is posted on the
internet, this opinion is binding only on the parties in the case and its use in other cases is limited. R. 1:36-3.
SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
DOCKET NO. A-3562-17T2
N.S.,
Petitioner-Appellant,
v.
DIVISION OF MEDICAL
ASSISTANCE AND HEALTH
SERVICES and ATLANTIC
COUNTY BOARD OF
SOCIAL SERVICES,
Respondents-Respondents.
___________________________
Argued telephonically May 29, 2019 – Decided July 3, 2019
Before Judges Sabatino and Mitterhoff.
On appeal from the New Jersey Department of Human
Services, Division of Medical Assistance and Health
Services.
Cari-Ann R. Levine argued the cause for appellant
(Cowart Dizzia LLP, attorneys for appellant; Lycette
Nelson, on the brief).
Jacqueline R. D'Alessandro, Deputy Attorney General,
argued the cause for respondent Division of Medical
Assistance and Health Services (Gurbir S. Grewal,
Attorney General, attorney; Melissa H. Raksa,
Assistant Attorney General, of counsel; Jacqueline R.
D'Alessandro, on the brief).
PER CURIAM
Petitioner N.S.1 appeals the final agency decision of the New Jersey
Division of Medical Assistance and Health Services ("the Division") denying
his application for Medicaid benefits. The Division found that N.S. failed to
timely provide verifications and documents needed to make an eligibility
determination. The Division also determined that N.S. was not entitled to a
spousal waiver under 42 U.S.C. § 1396r-5(c)(3). For the reasons that follow,
we reverse and remand with direction that the agency process N.S.'s application
and determine his eligibility for benefits.
I.
A.
On May 24, 2016, N.S., through his authorized representative, L.P.,
submitted an application for Medicaid benefits to the Atlantic County Medicaid
Long Term Care Unit ("the CWA").2 At that time, N.S. was eighty-seven years
1
N.S.'s daughter and legal guardian, L.P., applied for benefits on behalf of N.S.
2
A county welfare agency determines Medicaid eligibility. N.J.S.A. 30:4D-7a;
N.J.A.C. 10:71-2.2(a).
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2
old residing in long-term nursing care at Hammonton Center for Rehabilitation
and Healthcare ("Hammonton Center"). Prior to his admission to Hammonton
Center in August 2015, N.S. resided with his wife, D.S. At the time of N.S.'s
application, D.S. was eighty-six years old.
On the same date the application was submitted, the CWA sent L.P. a
written notification that additional documentation was required in order to
process the application, including information concerning N.S.'s life insurance,
bank statements, and marriage certificate. The CWA also requested information
regarding D.S.'s income and resources, social security number, and date of birth.
On June 13, 2016, L.P., on behalf of N.S., appointed Jannell Thomas, the
Medicaid coordinator for Hammonton Center, as an authorized representative of
N.S. On June 14, 2016, L.P. provided the CWA with some of N.S.'s bank
statements, N.S.'s marriage license, and D.S.'s social security number and date
of birth. L.P. also informed the CWA that N.S. did not have a life insurance
policy and that N.S. paid $900 rent to lease an apartment, but the lease was not
in his name. L.P. noted in her correspondence that she "was unable to obtain
any additional information from [D.S.]."
On June 21, 2016, a CWA caseworker requested additional
documentation, including N.S.'s bank statements from February to June of 2016,
A-3562-17T2
3
and a close out statement and transaction history for N.S.'s certificate of deposit
("CD"), and N.S.'s rental lease. The caseworker also requested quarterly bank
statements for all of N.S.'s accounts for the past five years and information
regarding N.S.'s income.
On July 21, 2016. L.P. emailed the caseworker cancelled checks and bills
for transactions L.P. had made with money from N.S.'s accounts. L.P. noted she
was still trying to obtain a transaction image for a December 2014 deposit in
question, as well as the lease. The caseworker responded the next day, again
requesting information regarding D.S.'s income and resources.
On July 27, 2016, L.P. emailed the caseworker and notified her that the
bank would not provide a transaction image for the December 2014 deposit
because the account was in N.S.'s name. L.P. informed the caseworker that D.S.
could not locate a copy of the lease, but provided the landlord's contact
information. L.P. also disclosed that N.S. was self-employed for many years,
but "stopped working due to poor health a few years ago." L.P. noted that N.S.
purchased a van for his business in 2012. L.P. had paid the insurance on the van
after her father had stopped working so that it could remain parked on the street.
On July 28, 2018, the CWA caseworker responded to L.P, requesting
information regarding N.S.'s 2016 income and resources and any business
A-3562-17T2
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accounts for N.S.'s business. On August 2, 2016, the CWA sent a letter to L.P.
requesting: (1) the date on which N.S.'s business closed, and if it closed within
the previous five years, documents regarding the business; (2) D.S.'s income and
resource documents; and (3) a transaction image for the December 2014 deposit.
The letter informed that these documents must be provided within ten days or
N.S.'s application would be dismissed.
On August 4, 2016, L.P. emailed the caseworker and informed her that
N.S. did not have a business account. On August 5, 2016, L.P. provided a copy
of N.S.'s lease. On August 8, 2016, the caseworker emailed L.P. again asking if
N.S. had any business accounts and requesting D.S.'s income and resource
information.
L.P. replied via email the same day and indicated that N.S. had been self-
employed as a paper wall-scraper, but had not worked during the previous five
years due to his age and other health issues. L.P. reiterated: "[N.S.] does not
have any bank accounts, nor does he have a business bank account. I have
presented you all of his banking information. I can provide you with a signed
statement from me if needed." L.P. also indicated that the bank had agreed to
release the transaction image for the December 2014 deposit and attached
A-3562-17T2
5
"verification."3 Finally, L.P. requested an extension to obtain any outstanding
documentation.
On August 10, 2016, Hammonton Center's attorney sent a letter to the
CWA requesting that N.S.'s application be processed without regard to D.S.'s
income and resource information. The letter stated that "42 U.S.C. § 1396r-5,
known as the 'spousal refusal provision,' prohibits the denial of Medicaid
coverage to individuals whose spouses refuse to cooperate with the state." The
letter provided that L.P. had been unable to obtain D.S.'s information through
no fault of her own, and that Jannell Thomas had sent three letters requesting
financial information to D.S. in June and July 2016, but that the letters were
returned as unclaimed. The letter also argued that "[a]ny denial of [N.S.]'s
application because of his spouse's refusal to provide information would . . .
cause an undue hardship on [N.S.]" under 42 U.S.C. § 1396r-5(c)(3).
After receiving the correspondence from Hammonton Center, the CWA
caseworker replied via email to L.P. According to the caseworker, it "d[id] not
matter how many attempt[s] [Jannell Thomas] made to get information from
3
The attachment is not contained in the appellate record. It is unclear whether
the transaction image was attached to the email. On August 29 and 31, 2016,
the caseworker emailed L.P. again requesting a transaction image for the
December 2014 deposit, as well as N.S.'s bank statements from June 22, 2016
to present.
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[D.S.], it does not count. I have to send her notice." The caseworker also stated
that the application could not be processed without D.S.'s income and resource
information. In addition, the caseworker requested documentation confirming
that N.S.'s business was not active.
After L.P. provided D.S.'s address, the CWA sent three notices directly to
D.S. requesting the needed information on August 15, 22, and 29, 2016. D.S.
did not respond to any of these requests. On August 31, 2016, the CWA sent
L.P. a letter advising that the application could not be processed without D.S.'s
information because N.S. and D.S. were legally married and had been living
together before N.S. was admitted to Hammonton Center. The letter provided
that the application would be closed if D.S.'s information was not provided by
September 9, 2016. The letter did not address N.S.'s previous request for a
spousal waiver based on D.S.'s failure to cooperate.
On September 9, 2016, Hammonton Center's attorney sent the CWA
another letter requesting a spousal waiver under 42 U.S.C. § 1396r-5 and that
the application be processed without regard to D.S.'s resources. On the same
date, the CWA sent written notice to L.P. that N.S.'s application had been denied
for failure to provide necessary documentation.
D.S. died on October 2, 2016. N.S. died on November 30, 2016.
A-3562-17T2
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B.
L.P. timely requested a fair hearing on N.S.'s behalf. A fair hearing was
held on December 5, 2017 before an administrative law judge ("ALJ") in the
Office of Administrative Law.
Barbara Paugh, the assistant administrator and supervisor of the Medicaid
unit, testified first for the CWA. Paugh testified that at the time of the denial of
N.S.'s application, information regarding the following items was outstanding:
(1) N.S.'s business accounts or business tax returns; (2) N.S.'s work van; (3) the
distribution of funds from N.S.'s CD; and (4) D.S.'s income and resources. Paugh
stated that the CWA required images of all checks for all bank accounts, and
that N.S. did not provide images for all transactions in question.
Paugh also testified that it was not necessary to forward L.P.'s request for
a spousal waiver to the Division because the spouses were living together prior
to N.S.'s admission to Hammonton Center and there was no history of spousal
abuse. Paugh noted that the CWA generally requires three failed attempts to
contact an uncooperative spouse before it transmits a spousal waiver request to
the Division.
Jannell Thomas testified for N.S. Thomas testified that she was aware
L.P. was having difficulty retrieving D.S.'s information and recommended that
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L.P. submit a request a spousal waiver to the CWA. Thomas, who had
previously worked for the CWA, sent three letters via certified mail to N.S.
because she believed such documentation was necessary to receive a spousal
waiver.
L.P. testified primarily via an affidavit because she has a voice disability,
but supplemented her affidavit with some live testimony and cross-examination.
L.P. testified that she is not close with D.S. because D.S. is L.P.'s step-mother.
After submitting the application. L.P. visited D.S. two times at D.S.'s home to
request her information and documentation. D.S. provided some information
initially, but became upset when pressed for more documents. D.S. told L.P. to
stop asking for the information because it was causing her stress. L.P. explained
that D.S. "wasn't well [out of microphone range] in a wheelchair. And she had
a husband who was in a nursing home and it was causing her stress." L.P.'s
husband also visited D.S. to request information, but D.S. asked them stop
pressuring her because it was making her sick.
L.P. also testified that she was appointed as N.S.'s guardian in January
2016. The ALJ requested that L.P. supplement the record with her complaint
for guardianship.
A-3562-17T2
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On January 19, 2018, the ALJ issued an initial decision affirming the
CWA's denial of benefits. The ALJ found that the CWA properly denied N.S.'s
application for benefits because, as testified to by Paugh, L.P. failed to provide
all the information requested by the CWA. The ALJ noted that L.P. provided
an affidavit of N.S.'s assets in support of the guardianship complaint, which
identified N.S.'s bank account, CD, and vehicle. The ALJ reasoned that as N.S.'s
guardian, L.P. could obtain the outstanding documentation requested by the
CWA. For these reasons, the ALJ found that "[e]ven if D.S.'s income and
resources were excluded, petitioner failed to produce his own information."
The ALJ also rejected N.S.'s argument that the CWA acted arbitrarily and
capaciously in failing to process the requests for a spousal waiver. The ALJ
found that there was no evidence in the record that there was a break in marital
ties or that D.S. was suffering from any illness which prevented her from
providing the requested information. Overall, the ALJ found that there were no
"exceptional circumstances" excusing the failure to submit the necessary
verifications or warranting an extension of time to provide the outstanding
documents.
On March 1, 2018, the Division adopted the ALJ's initial decision. The
Division noted that is does waive the spousal resource assessment for an undue
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10
hardship pursuant to 42 U.S.C. § 1396r-5(c)(3) "in certain circumstances where
there has been a break in the marital ties and the community spouse refuses to
cooperate with the eligibility determination." The Division found, however, that
N.S.'s request for a spousal waiver was properly denied because "[t]here is no
evidence in the record to support a finding that there was a break in marital ties
between [N.S.] and his wife. Nor is there evidence to support that either [N.S.]
or his family was not in contact with his wife."
II.
On appeal, N.S. contends that DMAHS misapplied 42 U.S.C. § 1396r-
5(c)(3)(A) by failing to accept N.S.'s assignment of support to the State in his
Medicaid application as a basis for a spousal waiver. N.S. also contends that
DMAHS misapplied 42 U.S.C. § 1396r-5(c)(3)(C). He argues that the agency’s
estrangement requirement for a spousal waiver based on an undue hardship is
overly restrictive, and that a spousal waiver should be granted when the
community spouse is uncooperative because of his or her own health and age.
Finally, N.S. argues that the Division's decision was arbitrary and capricious in
upholding the CWA's refusal to forward the requests for a spousal waiver to the
Division.
A-3562-17T2
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The Division responds that 42 U.S.C. § 1396r-5(c)(3)(A) is inapplicable
because N.S. was never deemed eligible for Medicaid benefits and therefore had
not yet made a valid assignment of his rights. In addition, the Division argues
that an undue hardship waiver was inappropriate under 42 U.S.C. § 1396r-
5(c)(3)(C) because no illness prevented D.S.'s cooperation, the spouses were not
estranged, and they lived together prior to N.S.'s admission to Hammonton
Center. The Division posits that accepting N.S.'s arguments "would allow any
spouse to refuse to cooperate and have their income and resource information
excluded from the institutionalized spouse's eligibility determination."
A.
We review a final agency decision to determine whether the decision was
arbitrary, capricious or unreasonable. E.S. v. Div. of Med. Assistance & Health
Servs., 412 N.J. Super. 340, 348 (App. Div. 2010). "The burden of
demonstrating the agency's action was arbitrary, capricious or unreasonable
rests upon the [party] challenging the administrative action." Id. at 349 (quoting
In re Arenas, 385 N.J. Super. 440, 443-44 (App. Div. 2006)). We consider:
(1) whether the agency action violates the enabling act's
express or implied legislative policies; (2) whether
there is substantial evidence in the record to support the
findings upon which the agency based application of
legislative policies; and (3) whether, in applying the
legislative policies to the facts, the agency clearly erred
A-3562-17T2
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by reaching a conclusion that could not reasonably have
been made upon a showing of the relevant factors.
[H.K. v. Div. of Med. Assistance & Health Servs., 379
N.J. Super. 321, 327 (App. Div. 2005) (quoting Public
Serv. Elec. v. N.J. Dep't of Envtl. Prot., 101 N.J. 95,
103 (1985)).]
See also Clowes v. Terminix Int'l, Inc., 109 N.J. 575, 589 (1988) (noting that
the "sense of 'wrongness' [necessary to overturn an administrative decision] can
arise in numerous way—from manifest lack of inherently credible evidence to
support the finding, obvious overlooking or underevaluation of crucial evidence,
a clearly unjust result, and many others." (quoting State v. Johnson, 42 N.J. 146,
162 (1964)).
In conducting this review, we "defer to the specialized or technical
expertise of the agency charged with administration of a regulatory system."
K.K. v. Div. of Med. Assistance & Health Servs., 453 N.J. Super. 157, 160 (App.
Div. 2018) (quoting In re Virtua-W. Jersey Hosp.Voorhees for Certificate of
Need, 194 N.J. 413, 422 (2008)). In general, "[w]e give deference 'to the
interpretation of statutory language by the agency charged with the expertise
and responsibility to administer the scheme[.]'" Zimmerman v. Sussex Cty.
Educ. Servs. Comm'n, 237 N.J. 465, 475-76 (2019) (quoting Acoli v. State
Parole Bd., 224 N.J. 213, 229 (2016)). Nonetheless, we are "in no way bound
A-3562-17T2
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by the agency's interpretation of a statute or its determination of a strictly legal
issue." Univ. Cottage Club of Princeton New Jersey Corp. v. New Jersey Dep't
of Envtl. Prot., 191 N.J. 38, 48 (2007) (quoting In re Taylor, 158 N.J. 644, 658
(1999)).
B.
"Medicaid is a federally-created, state-implemented program that
provides 'medical assistance to the poor at the expense of the public.'" In re
Estate of Brown, 448 N.J. Super. 252, 256 (App. Div. 2017) (quoting Estate of
DeMartino v. Div. of Med. Assistance & Health Servs., 373 N.J. Super. 210,
217 (App. Div. 2004)); see 42 U.S.C. § 1396-1. "Although a state is not required
to participate, once it has been accepted into the Medicaid program it must
comply with the federal Medicaid statutes and regulations." Ibid. (citing Harris
v. McRae, 448 U.S. 297, 301 (1980)).
In New Jersey, the Medicaid program is administered by the Division
pursuant to the New Jersey Medical Assistance and Health Services Act,
N.J.S.A. 30:4D-1 to -19.5. Through its regulations, the Division establishes
"policy and procedures for the application process." N.J.A.C. 10:71-2.2(b).
Local county welfare agencies evaluate Medicaid eligibility. N.J.S.A.
30:4D-7a; N.J.A.C. 10:71-1.5, 2.2(c). An applicant must establish "eligibility .
A-3562-17T2
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. . in relation to each legal requirement to provide a valid basis for granting or
denying medical assistance." N.J.A.C. 10:71-3.1. "The CWA exercises direct
responsibility in the application process to . . . [a]ssist the applicants in exploring
their eligibility for assistance." N.J.A.C. 10:71-2.2(c)(3). Similarly, an
applicant shall "[a]ssist the CWA in securing evidence that corroborates his or
her statements." N.J.A.C. 10:71-2.2(e)(2). The CWA "review[s] . . . the
application for completeness, consistency, and reasonableness." N.J.A.C.
10:71-2.9.
"[T]o be financially eligible [for benefits], the applicant must meet both
income and resource standards." Brown, 448 N.J. Super. at 257 (citing N.J.S.A.
10:71-3.15). Specifically, "[t]he regulations governing an individual's
eligibility for Medicaid reimbursement of nursing home costs provide that in
order for an individual to participate in the Medicaid Only Program, the value
of that individual's resources may not exceed $2,000." H.K. v. State, 184 N.J.
367, 380 (2005) (footnote omitted) (citing N.J.A.C. 10:71-4.5(c)). To determine
eligibility, the agency evaluates the available assets both of the "institutionalized
spouse" and the "community spouse" during a five-year "look back" period.
N.J.A.C. 10:71-4.8; N.J.A.C. 10:71-4.10(b)(9); see also 42 U.S.C. § 1396r-
5(c)(1)(A).
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C.
With this background in mind, we turn to questions presented in this
appeal. Having carefully reviewed the administrative record and the relevant
statutory provisions, we reverse the final agency decision because the Division's
denial of a spousal waiver for an undue hardship was arbitrary and capricious.4
Initially, we agree with N.S. that the Division employed an overly narrow
construction of an "undue hardship" in relying solely on the fact that N.S. and
D.S. were living together and were not estranged prior to N.S.'s admission to
Hammonton Center. 42 U.S.C. § 1396r-5(c)(3)(C) provides: "The
institutionalized spouse shall not be ineligible by reason of resources determined
. . . to be available for the cost of care where . . . the State determines that denial
of eligibility would work an undue hardship." The statute does define "undue
hardship."
Although we accord deference to the Division's interpretation of the
Medicaid Act, we find it significant that the Division cites no authority, or even
informal guidance, expressing the requirement that spouses be estranged in
order to receive a spousal waiver for an undue hardship under 42 U.S.C. § 1396r-
4
Having determined that N.S. should be entitled to a spousal waiver for an
undue hardship, we need not address N.S.'s remaining arguments for reversal.
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5(c)(3)(C). While "[d]eference to an agency decision is particularly appropriate
where interpretation of the [a]gency's own regulation is in issue[,]" I.L. v. N.J.
Dep't of Human Servs., Div. of Med. Assistance & Health Servs., 389 N.J.
Super. 354, 364 (App. Div. 2006), the Division has not promulgated regulations
interpreting the spousal waiver requirements in 42 U.S.C. § 1396r-5(c)(3)(C).5
Ultimately, we are not bound by the Division's interpretation and "we will not
uphold an unreasonable interpretation[.]" Zimmerman, 237 N.J. at 476.
Under the distinctive facts of this case, we conclude that the Division's
interpretation is arbitrary, capricious, and unreasonable. In concluding that N.S.
was not entitled to a spousal waiver based on undue hardship, the Division and
the ALJ disregarded unrebutted evidence in the record that: (1) D.S. was eighty-
six years old and had asked L.P. to stop requesting information because it was
causing her stress; (2) D.S. did not respond to six letters requesting information,
both from the CWA and from Jannell Thomas; (3) the CWA's usual policy was
5
The Division also does not cite any informal written guidance it has issued
regarding the spousal waiver requirements. See E.B. v. Div. of Med. Assistance
& Health Servs., 431 N.J. Super. 183, 206 (App. Div. 2013). An agency,
however, may not offer an interpretation through informal means and must
engage in formal rulemaking when its interpretation constitutes an
"administrative rule." See Metromedia, Inc. v. Dir., Div. of Taxation, 97 N.J.
313, 331-32 (1984) (providing factors to consider in assessing whether an
agency action is an administrative rule).
A-3562-17T2
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to forward a spousal waiver request to the Division after three unsuccessful
attempts to obtain information from the spouse; (4) L.P. was appointed as N.S.'s
guardian because N.S. could not manage his own affairs; and (5) L.P. did not
have a close relationship with her stepmother. The Division ignored all this
evidence that would support a finding of undue hardship, instead placing
inordinate weight on the fact that the spouses were not estranged prior to N.S.'s
admission to Hammonton Center. See Trantino v. New Jersey State Parole Bd.,
166 N.J. 113, 189 (2001) (reversing the Parole Board's decision based upon "the
Board's selective and arbitrary reliance on only those portions of the record that
could possibly support the Board's conclusion."). A determination of undue
hardship should be a fact-sensitive inquiry taking into account the totality of the
circumstances.
We also find no indication in the record that N.S. was intentionally
refusing to cooperate with the CWA so that her resources would be excluded
from the eligibility determination. To the contrary, L.P.'s testimony reflected
that N.S.'s refusal to cooperate stemmed from her stress that her husband was in
a nursing home and that L.P. was pressuring her to provide documents. N.S.'s
contention that D.S.'s age and health prevented her from complying with the
requests for documents is further supported by the fact that N.S. passed away
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only months after N.S. submitted his application for benefits. In these ways, we
find the Division's policy argument to be misplaced on the facts of this case.
For these reasons, we conclude that the Division's denial of N.S.'s request
for a spousal waiver was arbitrary and capricious. In applying 42 U.S.C. §
1396r-5(c)(3)(C) to the facts of this case, "the agency clearly erred by reaching
a conclusion that could not reasonably have been made upon a showing of the
relevant factors." H.K., 379 N.J. Super. at 327 (quoting Public Serv. Elec., 101
N.J. 95 at 103). Accordingly, we hold that N.S. is entitled to a spousal waiver
for an undue hardship pursuant to 42 U.S.C. § 1396r-5(c)(3)(C) and remand to
the agency to determine N.S.'s eligibility for Medicaid benefits without regard
to D.S's resources.
We also conclude that the ALJ's findings, adopted by the Division, that
there were outstanding items regarding N.S.'s business and assets, are not
supported by substantial evidence in the record. As detailed above, L.P.
corresponded extensively with the CWA caseworker in attempting to
accommodate the various requests for information and documents. Although
the ALJ implicitly credited Paugh's testimony regarding the information that
was outstanding, her testimony was belied by documentary evidence in the
record.
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Paugh testified that information regarding N.S.'s work van was needed,
but L.P. had provided information regarding the van in an email to the
caseworker on July 27, 2016. None of the CWA's subsequent correspondence
with L.P., including the notices of outstanding documents sent on August 10 and
31, 2016, requested further information about the work van. Similarly, Paugh
testified that L.P. did not provide information regarding business accounts or
business tax returns, but L.P. notified the caseworker on August 8 that N.S. did
not have a business account and had not worked during the five-year look back
period. The CWA's August 31, 2016 notice did not request further information
about N.S.'s business. Based on the documentary evidence in the record of L.P.'s
communications with the caseworker, we conclude that the ALJ's finding that
L.P. failed to provide information requested by the CWA about the N.S.'s work
van and business is clearly mistaken and not supported by substantial evidence
in the record. See Campbell v. New Jersey Racing Comm'n, 169 N.J. 579, 587-
88 (2001) (providing that an appellate court may overturn an agency's fact
finding where it "is clearly a mistaken one and so plainly unwarranted that the
interests of justice demand intervention and correction." (quoting Clowes, 109
N.J. at 588)).
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We similarly conclude that the record lacks support for the ALJ's finding
that L.P. failed to provide information regarding the distribution of N.S.'s C.D.
and images of checks for bank accounts. The CWA's August 2, 2016 letter
requested a transaction image for a December 2014 deposit, but did not request
any other images for checks or transactions or any other information regarding
the distribution of funds from the CD. On August 8, 2016, L.P. notified the
caseworker that the bank had agreed to release this transaction image and
attached "verification." As noted above, the record is ultimately unclear as to
whether L.P. provided the transaction image for the 2014 deposit, but the CWA
did not request this transaction image in the final notice it provided to L.P. on
August 31, 2016 before denying N.S.'s application for benefits. Likewise, the
CWA's August 31, 2016 letter did not request any other transactions images or
information about the distribution of funds from CD. Ultimately, the record
reveals that the CWA's multiple requests for information were not consistent
and failed to conclusively specify what documentation was needed.
For these reasons, we hold that the ALJ's finding that "[e]ven if D.S.'s
income and resources were excluded, petitioner failed to produce his own
information" is not supported by substantial evidence in the record. Therefore,
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we direct the agency to process N.S.'s application for benefits based upon the
information and documents already submitted.
In summary, we reverse the Division's final agency decision and remand
with direction that the agency timely process N.S.'s application and determine
his eligibility for benefits without regard to D.S.'s income and resources.
Reversed and remanded. We do not retain jurisdiction.
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