Full Opinion

NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION This opinion shall not "constitute precedent or be binding upon any court ."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-3005-24 T.R., Petitioner-Appellant, v. MONMOUTH COUNTY DIVISION OF SOCIAL SERVICES, Respondent-Respondent. _________________________ Submitted October 27, 2026 – Decided November 9, 2026 Before Judges Firko and Bergman. On appeal from the New Jersey Department of Human Services, Division of Medical Assistance and Health Services. Simon P. Wercberger LLC, attorneys for appellant (Simon P. Wercberger, on the briefs). Jennifer Davenport, Attorney General, attorney for respondent Department of Human Services, Division of Medical Assistance and Health Services (Sookie Bae- Park, Assistant Attorney General, of counsel; Jacqueline R. D'Alessandro, Deputy Attorney General, on the brief). PER CURIAM Petitioner T.R. appeals from a May 20, 2025 initial decision of an Administrative Law Judge (ALJ), later adopted by the New Jersey Division of Medical Assistance and Health Services (Division) as its final agency decision affirming the denial of his application for New Jersey Family Care Aged, Blind, and Disabled Medicaid benefits. We affirm. I. On November 30, 2023, a designated authorized representative (DAR) at T.R.'s nursing facility filed an application on his behalf for Medicaid benefits. The DAR was employed by Future Care Consultants (FCC). In that application, the DAR attested T.R. receives Social Security income of $944.90 per month, has no cash on hand, maintains an active checking account at Bank of America (BOA) with no current value, owns a house, and a 2017 Nissan Rogue Sport, and T.R. is married. After submitting the application, respondent Monmouth County Division of Social Services (MCDSS) determined it needed additional information to determine T.R.'s eligibility for benefits. On May 7, 2024, MCDSS sent the DAR a request for information (RFI), seeking BOA bank statements for accounts A-3005-24 2 ending in 4439 and 9640 for various months from 2019, through 2024; an explanation for any transaction listed on those statements over $1,000 or for any recurring transaction; and any evidence to support the explanations provided. The RFI was mailed to 14C 53rd Street, Suite 220, Brooklyn, New York 11232, the mailing address listed on the application and as listed on the DAR's mailing address on the DAR form. The RFI was not returned to MCDSS as undeliverable. The requested information was to be submitted to MCDSS by May 21, 2024. No verifications were provided. On May 29, 2024, the MCDSS denied T.R.'s application. The notice stated T.R.'s benefits were denied for failure to provide requested information required to determine eligibility in a timely manner pursuant to 42 C.F.R. §435.952. The denial letter was mailed to the above-stated Brooklyn address. It is undisputed the denial letter was received. In response, the DAR requested a fair hearing, and the matter was transferred to the Office of Administrative Law as a contested case. On April 29, 2025, the ALJ conducted the fair hearing. Sariya Brown, an MCDSS caseworker, Changyou Yu, Brown's supervisor, and Robert Kurtz, the mailroom supervisor, testified on MCDSS's behalf. A-3005-24 3 Brown testified she received T.R.'s application in May of 2024 and issued an RFI. Brown explained the RFI is generated on an online portal and was the same system the DAR used to submit the Medicaid application. Brown verified the RFI was mailed to 14C 53rd Street, Suite 220, Brooklyn, New York 11232 and was not returned as undeliverable. Brown stated the due date for the verifications to be submitted to MCDSS was May 21, 2024, and no verifications were provided. Yu testified the RFI is partially created by the portal and how a caseworker manually adds information and documents. Yu stated an applicant can view an application's status by accessing the portal and how sending a letter and other actions affects an application's status. Kurtz testified about MCDSS's mail pickup procedures. He testified mail is picked up twice a day, and any undeliverable mail is returned to the mailroom before being transferred to the proper unit. T.R. presented Shmuel 1 Moore and Sosie Steif as witnesses. Moore testified he was the DAR's supervisor and that the DAR terminated his employment with FCC in February of 2025. Moore stated the DAR submitted 1 This witness's first name is spelt differently in the record. We use "Shmuel," which is contained in the ALJ's initial decision. This discrepancy is not germane to our opinion. A-3005-24 4 T.R.'s application via the portal, which lets you know an RFI has been issued. Moore confirmed the status changes to "Your response is needed." Moore did not know whether the DAR saw the status change on the portal after the RFI was issued and did not check the portal himself. Moore agreed the denial letter contained the correct address, and the office received it. On May 20, 2025, the ALJ issued an initial decision, which was adopted as the final agency decision. The ALJ affirmed the denial of T.R.'s application because his DAR failed to respond to the RFI. The ALJ determined T.R.'s assertion that the RFI was not received "was not proven." The ALJ noted the agency failed to inform T.R. of its delay in processing the application under N.J.A.C. 10:71-2.3(d). However, the ALJ concluded the failure "was not sufficient under these facts to return the application to the agency for processing." This appeal followed. Before us, T.R. argues the MCDSS failed to comply with multiple Federal and State regulations. T.R. contends MCDSS: (1) violated N.J.A.C. 10:71- 1.6(a)(4), which requires "strict adherence to law and complete conformity with administrative policies"; (2) violated 42 C.F.R. §435.918A(a), which provides: "[T]he agency must provide individuals with a choice to receive notices and information . . . in electronic format or by regular mail"; (3) violated 42 C .F.R. A-3005-24 5 §435.952(d), which states: "The agency may not deny or terminate eligibility . . . unless the agency has sought additional information from the individual . . ."; and (4) violated 42 C.F.R. §435.912(c)(3) and N.J.A.C. 10:71-2.3(a) and (d), by failing to process the application within forty-five days. II. On judicial review of an agency decision, "[o]ur function is to determine whether the administrative action was arbitrary, capricious or unreasonable." Burris v. Police Dep't, Twp. of W. Orange, 338 N.J. Super. 493, 496 (App. Div. 2001) (citing Henry v. Rahway State Prison, 81 N.J. 571, 580 (1980)). The agency decision must be supported by "'substantial evidence'" in the record as a whole. Circus Liquors, Inc. v. Middletown Twp., 199 N.J. 1, 10 (2009) (quoting Mazza v. Bd. of Trs., 143 N.J. 22, 25 (1995)). A presumption of validity attaches to an agency's decision. See Brady v. Bd. of Rev., 152 N.J. 197, 210 (1997). This is so because "[i]n administrative law, the overarching informative principle guiding appellate review requires that courts defer to the specialized or technical expertise of the agency charged with administration of a regulatory system." In re Virtua-West Jersey Hosp. Voorhees for a Certificate of Need, 194 N.J. 413, 422 (2008) (citation omitted). But we are "in no way bound by the agency's interpretation of a statute or its A-3005-24 6 determination of a strictly legal issue." In re Carter, 191 N.J. 474, 483 (2007) (quoting Mayflower Sec. Co. v. Bureau of Sec., 64 N.J. 85, 93 (1973)). Finally, the party challenging the validity of an agency's decision has the burden of showing that it was arbitrary, capricious, or unreasonable. J.B. v. N.J. State Parole Bd., 444 N.J. Super. 115, 149 (App. Div. 2016) (citing In re Arenas, 385 N.J. Super. 440, 443-44 (App. Div. 2006)). "Medicaid is a federally-created, state-implemented program that provides 'medical assistance to the poor at the expense of the public.'" Matter of Estate of Brown, 448 N.J. Super. 252, 256 (App. Div. 2017) (quoting Est. of DeMartino v. Div. of Med. Assistance & Health Servs., 373 N.J. Super. 210, 217 (App. Div. 2004)); see also 42 U.S.C. § 1396-1. To receive funding, a state must comply with all federal statutes and regulations, including eligibility requirements set by the federal government. Harris v. McRae, 448 U.S. 297, 301 (1980); Zahner v. Sec'y Pa. Dep't of Human Servs., 802 F.3d 497, 512 (3d Cir. 2015). Pursuant to the New Jersey Medical Assistance and Health Services Act, N.J.S.A. 30:4D-1 to -19.5, the Division is responsible for administering the Medicaid program in New Jersey and is charged with doing so in a fiscally responsible manner to ensure funds are available for all eligible participants. A-3005-24 7 See Dougherty v. Dep't of Hum. Servs., Div. of Med. Assistance & Health Servs., 91 N.J. 1, 4-5 (1982); Est. of DeMartino, 373 N.J. Super. at 217-19. "[T]o be financially eligible, the applicant must meet both income and resource standards." Matter of Est. of Brown, 448 N.J. Super. 252, 257 (App. Div. 2017); see also N.J.A.C. 10:71-3.15; N.J.A.C. 10:71-1.2(a). Through its regulations, the Division establishes "policy and procedures for the application process." N.J.A.C. 10:71-2.2(b). In turn, County Welfare Agencies (CWA), like MCDSS, evaluate eligibility. N.J.S.A. 30:4D-7(a); N.J.A.C. 10:71-1.5, -2.2(c). A CWA exercises direct responsibility in the application process to: (1) Inform the applicants about the purpose and eligibility requirements for Medicaid Only, inform them of their rights and responsibilities under its provisions and inform applicants of their right to a fair hearing; (2) Receive applications; (3) Assist the applicants in exploring their eligibility for assistance; (4) Make known to the applicants the appropriate resources and services both within the agency and the community, and, if necessary, assist in their use; and (5) Assure the prompt and accurate submission of eligibility data to the Medicaid status files for eligible A-3005-24 8 persons and prompt notification to ineligible persons of the reason(s) for their ineligibility. [N.J.A.C. 10:71-2.2(c)(1) to (5).] While the applicant is "the primary source of information," the CWA is responsible for making "the determination of eligibility and to use secondary sources when necessary, with the applicant's knowledge and consent." N.J.A.C. 10:71-1.6(a)(2). Accordingly, the CWA must "verify the equity value of resources through appropriate and credible sources," and "shall evaluate the applicant's past circumstances and present living standards . . . to ascertain the existence of resources that may not have been reported." N.J.A.C. 10:71- 4.1(d)(3). "If the applicant's resource statements are questionable, or there is reason to believe the identification of resources is incomplete, the [CWA] shall verify the applicant's resource statements through one or more third parties." Ibid. Further, a CWA is required to process applications within specified timeframes and the "maximum period of time normally essential to process an application for the aged is [forty-five] days," whereas an application for the disabled or blind is given ninety days. N.J.A.C. 10:71-2.3(a). After expiration of the applicable period, the CWA must find an exceptional reason for the delay in order to extend the application time limit. N.J.A.C. 10:71-2.3(c). Thus, if an A-3005-24 9 applicant fails to provide timely a verification, absent an extension, the CWA may determine that eligibility cannot be established and deny an application. We are unpersuaded by T.R.'s arguments and affirm substantially for the reasons stated in the Division's decision, adopting the ALJ's written decision. The ALJ's factual findings are fully supported by the record, and her legal conclusions fully consistent with applicable law. We provide the following comments to amplify our decision. Federal regulation 42 C.F.R. § 435.918(a) provides: "[T]he agency must provide individuals with a choice to receive notices and information . . . in electronic format or by regular mail." T.R. argues that MCDSS violated federal regulations because applicants cannot view a pending RFI via the portal or receive an RFI via email. T.R.'s argument lacks merit because Moore's testimony confirmed that the portal was used regularly for status updates on his Medicaid application. Likewise, Yu testified that applicants can view on the portal that an application's status has changed when agency action has occurred. Thus, we reject T.R.'s argument that MCDSS violated 42 C.F.R. § 435.918 because it did not provide notices and information in electronic format based on the undisputed record. A-3005-24 10 We are unpersuaded by T.R.'s contention that MCDSS did not mail an RFI. Federal regulation 42 C.F.R. § 435.952(d) provides: "The agency may not deny or terminate eligibility . . . unless the agency has sought additional information from the individual . . . ." N.J.A.C. 10:71-2.2(c)(1) to (5), requires a caseworker to: "[i]nform the applicants about the purpose and eligibility requirements for Medicaid Only, inform them of their rights and responsibilities under its provisions and inform applicants of their right to a fair hearing; [r]eceive applications; [a]ssist . . . applicants in exploring their eligibility for assistance; [m]ake known to . . . applicants the appropriate resources and services both within the agency and the community, and, if necessary, assist in their use; and [a]ssure the prompt and accurate submission of eligibility data to the Medicaid status files for eligible persons and prompt notification to ineligible persons of the reason(s) for their ineligibility." [N.J.A.C. 10:71-2.2(c)(1)-(5).] Our Court has long "recognized a presumption that mail properly addressed, stamped, and posted was received by the party to whom it was addressed." SSI Med. Servs. v. HHS, Div. of Med. Assistance & Health Servs., 146 N.J. 614, 621 (1996). In order to benefit from the "presumption that mail properly addressed, stamped, and posted was received by the party to whom it was addressed," the proponent must show "(1) that the mailing was correctly A-3005-24 11 addressed; (2) that proper postage was affixed; (3) that the return address was correct; and (4) that the mailing was deposited in a proper mail receptacle or at the post office." Ibid. "Evidence of office custom requires other corroboration that the custom was followed in a particular instance, in order to raise a presumption of mailing and receipt and meet the preponderance of the evidence standard." Id. at 622-23. "[P]roof of mailing can be established by evidence of habit or routine practice." Id. at 622. Here, MCDSS presented substantial evidence that it sought additional information before denying T.R.'s application. Brown testified that after reviewing the application, she created an RFI on May 7, 2024, addressed it to 14C 53rd Street, Suite 220, Brooklyn, New York 11232—the address listed on T.R.'s application—and placed it in the outgoing mail bin pursuant to standard procedure. Brown further testified that the RFI was due May 21, 2024, no response was received, and the RFI was not returned as undeliverable. Moreover, Brown's testimony was corroborated by Kurtz, who described the county's regular mail procedures, including collection from office bins, transport to the mailroom, processing, and delivery to the post office. Although Kurtz acknowledged that mail is occasionally lost, he testified that such an occurrence is not likely. Further, the record is unrefuted that the May 29, 2024 A-3005-24 12 denial letter was mailed to the same Brooklyn address and was received. Thus, we conclude T.R. did not overcome the presumption that the RFI was sent and cannot successfully claim MCDSS violated federal regulations by not seeking additional information before denying the application. Addressing the timeline issue, even accepting that MCDSS failed to comply with the ordinary forty-five-day processing period and failed to send written notice explaining the delay, we are convinced that procedural deficiency did not require reversal of the denial. The regulations do not provide that a late- processed application must be granted, or even automatically reopened, where the applicant still failed to supply the verifications needed to establish eligibility. To the contrary, "eligibility must be established 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(a). Thus, although timeliness requirements are mandatory, they do not displace the applicant's independent burden to provide corroborative evidence and assist the agency in determining eligibility. See N.J.A.C. 10:71-2.2(e); N.J.A.C. 10:71-3.1(b). Here, the ALJ determined the agency failed to inform T.R. of its delay in processing the application under N.J.A.C. 10:71-2.3(d), but further found that the agency's "[f]ailure was not sufficient under these facts to return the A-3005-24 13 application to the agency for processing." Once the application was reviewed, MCDSS issued an RFI seeking documents necessary to determine eligibility, including extensive bank records, explanations for transactions over $1,000, and facility-related documentation. The ALJ highlighted that T.R. "did not timely provide all the required documentation under N.J.A.C. 10:71-2.2(e) and -2.3(a), and that no exceptional circumstances exist." The record supports that determination. The regulations expressly provide a remedy when an application is "not acted upon with reasonable promptness": the applicant may request a fair hearing. N.J.A.C. 10:49-10.3(b). Thus, the regulatory framework recognizes that an agency's delay is remediable, but it does not transform delay into proof of Medicaid eligibility. Moreover, although T.R. ultimately requested a fair hearing after the denial, there is no evidence that he or his DAR invoked that remedy while the application remained pending during the period of delay. And, there is no evidence that they contacted MCDSS during that period to inquire about the status of the application or to seek intervention based on the agency 's lack of action. Accordingly, the ALJ properly treated the delay standing alone, as a regulatory violation, which did not warrant reversal. In summary, all of the A-3005-24 14 ALJ's factual findings were based on the testimony she deemed credible and were further supported by the documentary evidence. To the extent we have not specifically addressed T.R.'s remaining arguments, it is because we have determined they lack sufficient merit to warrant extended discussion in a written opinion. R. 2:11-3(e)(1)(E). The administrative decision is supported by sufficient credible evidence on the record as a whole. R. 2:11-3(e)(1)(D). Affirmed. A-3005-24 15