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4 N.J.A.R. 237

F., K. v. Atlantic County Division of Welfare
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Citation: 4 N.J.A.R. 237
Decision Date: 1982
Synopsis: Petitioner sought relief from the decision of a local county welfare agency to discontinue reimbursement of round trip transportation expenses for travel from her home to an out-of-state site for rec- reational and socialization therapy. The administrative law judge found that petitioner, who was af- flicted with cerebral palsey, mental retardation and a chronic throat condition, traveled several times during the week from her home in southern New Jersey to a site in Philadelphia for recreational therapy. She had participated in such activities in 1978 when living in Penn- sylvania and continued such participation since moving to New Jersey in 1981; her physician had determined that such activity was medically necessary. While not disputing the benefits to petitioner, the agency sought to terminate reimbursement because the provider of the services was not a qualified New Jersey Medicaid provider. The administrative law judge noted that petitioner was indeed re- ceiving medical care at the Philadelphia site since she received medical and psychological therapy in addition to social and recreational ther- apy. In addition, the agency failed to show that an alternative facility was available within the state or that the Philadelphia provider was not a qualified Medicaid provider. The judge noted that even if the petitioner had failed to meet the start requirements of the agency's regulations, that this was an ap- prophate instance for a waiver of those regulations. Accordingly, the administrative law judge concluded that the denial of reimbursement of travel costs to petitioner had been improper and ordered retroactive and continued reimbursement. K.F.v. Atlantic County