Injunction not Available to Somebody with a Looming Medicaid Penalty Period

By Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, a Freehold, NJ Medicaid Attorney

A recent appellate division case considered whether a Medicaid applicant can prevent the Department of Medical Assistance and Human Services (DMAHS) of New Jersey from including a deceased spouse’s estate as an available resource(s) to spend down before being eligible for Medicaid. Here the applicant wanted the court to order NJ to pay Medicaid benefits to the institutionalized applicant.

The plaintiff filed a Medicaid application when her husband was still alive. Since her husband was alive at the time the application was made, Medicaid regulations make his resources, as the community spouse, available for purposes of determining eligibility.

The court found that the plaintiff’s inability to pay her nursing home bill is irreparable injury warranting a preliminary injunction due to the looming penalty period she was about to face, and because of the threat of being forced to leave the nursing home due to non-payment. This injury outweighed the amount of money the State would have to pay to keep her at the facility so the balance of hardships tipped in the favor of the plaintiff.

However, (and this is the fatal finding to the applicant), the court found that an injunction would not benefit the public interest.  The court held that the State would be forced to pay for benefits for someone even before determining if he or she was eligible for those benefits.  In this case the plaintiff did not claim an “elective share” against the decedent estate, nor had she filed a fair hearing appeal to determine if her husband’s estate was even available to her.  Because the court felt it would be encouraging federal lawsuits without an applicant pursuing a fair hearing appeal or a final determination, the court concluded the public interest was not served.

The injunction was therefore denied to the plaintiff, as the harm to the public interest outweighed any harm she would face if evicted by the nursing home.

To discuss your NJ Medicaid matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at  Please ask us about our video conferencing consultations if you are unable to come to our office.