“With the memory of the pandemic’s toll in nursing homes still raw, the COVID-19 relief law is offering states a generous funding boost for home- and community-based care as an alternative to institutionalizing disabled people.” However, funding for the current bill is temporary, “raising concerns it will have just fleeting impact…” For the full story, […]
Medicaid, just one of the sets of rules applicable to most older adults, is one of the most complex laws ever enacted. Even Judges have difficulty understanding it. What follows are a few quotes from court decisions: “The Social Security Act is among the most intricate ever drafted by Congress. Its Byzantine construction, as Judge […]
The husband died six months after the decedent. The decedent had required nursing home care, and she received Medicaid assistance to pay for the care. The estate’s personal representative allowed $ 63,880 as a claim against the estate but disallowed $ 44,533. The county contended that it was entitled to full recovery because the value […]
Plaintiffs were a group of couples with one spouse in the nursing home and other spouse still in the community. In each case, the Community Spouse was the beneficiary of a Community Spouse Annuity Trust (“CSAT”). Some institutionalized spouses had been denied Medicaid, while others had applications pending. The Plaintiffs challenged the State’s treatment of […]
Guardians of two nursing home residents brought suit contending that the State erred by beginning a transfer penalty on the first day of the month after a transfer, rather than on the month of the transfer. The Court found the claims barred by the Eleventh Amendment. It dismissed the remainder of the Complaint for failure […]
Hazel Wilson and her husband executed and funded a revocable living trust in 1991. The trust became irrevocable at her husband’s death in 1998, forming an A/B trust. Hazel had access to the principal and income from trust A, but only the income from trust B. In 1999, Hazel transferred $636,638 in property to her […]
Carl Bergman had an annuity account which he transferred to his wife after he was admitted to a nursing home. After Lucille, his wife, was diagnosed with cancer, she gifted those assets to their children. Following Lucille’s death, the State filed an estate recovery claim in Lucille’s estate relating to payments made for Carl’s care. […]
Prior to his death, Harold Ullmer was on Medicaid. At his death, Harold and his wife, Agnes, owned their home in joint tenancy. Agnes continued to reside in the home. The State recorded a notice of lis pendens against the property, and filed a petition seeking to impose a lien in the amount of $144,475.76 […]
Beverly Tutinas’s husband, Julian, was on Medicaid, but she was not. When Beverly died owning a home valued at $69,641.89 and a car worth $2,000, the state of Illinois filed a claim against Beverly’s estate, seeking to recover what Medicaid had invested in Julian’s care. The court found that, although the state clearly had a […]
Seeking to increase the Community Spouse Resource Allowance (CSRA), the Staffords conveyed their home to a trust. After Mr. Stafford was institutionalized, the trust conveyed the home to Mrs. Stafford. The purpose of the transaction was to make the home countable during the resource assessment, thereby increasing the value of the marital assets; in Idaho […]
Robert and Josephine James were married when Robert went to the nursing home. A resource assessment was done and Medicaid determined they had $278,343 in available resources. To reduce their assets, Josephine purchased a $250,000 single premium immediate irrevocable annuity from General Electric Assurance Company. She then purchased a new vehicle for $8,550 and filed […]
Greene appealed denial of his application for Medicaid. The denial was affirmed by an administrative law judge. After review, the Commissioner adopted the findings of fact of the ALJ. The Commissioner addressed Greene’s specific arguments by explicitly noting the underlying evidence in the record supporting the ALJ’s decision and citing two cases: Atkinson v. Ledbetter […]
In Cruver v. Mitchell, Medicaid had paid many of Mitchell’s expenses until shortly before the hearing. Appellants, however, had decided to stop her benefits and “just pay for [the expenses] out of pocket,” using money from Mitchell’s bank accounts. Appellants explained that they removed their mother from the Medicaid program so that the State would […]
The undisputed record shows that in April 2004, Gladowski qualified for Medicaid assistance to pay for nursing home care, but the Department of Community Health delayed her benefits until September 2006 on the ground that Gladowski improperly transferred assets to qualify for Medicaid coverage. Gladowski appealed the decision to an administrative law judge (ALJ), who […]
White, a British citizen and a legal permanent resident of the United States entered the United States in 1991.She was issued a green card and resided in the U.S. continuously. When she applied for Medicaid, she was denied eligibility because she had not resided in the U.S. cotinuously for five years as provided for in […]
The Georgia Supreme Court granted certiorari to consider whether the Court of Appeals properly interpreted 42 USC § 1396p with respect to whether a Medicaid applicant’s purchase of an annuity was subject to an asset transfer penalty. In this case, the Georgia Department of Human Services, Family and Children Services (“DFCS”) granted appellee Jerry L. […]
In November 2002, Mrs. Medder’s husband died. Her husband left her real estate and personal property in his Will. In May, 2003, Mrs. Medders filed a renunciation and disclaimer “renouncing” the gift in her husband’s Will. Less than three years after the renunciation, Mrs. Medders applied for Medicaid. When Mrs. Medders applied for Medicaid, the […]
Margie Mary Anderson started receiving Medicaid benefits on January 1, 1994. She died on February 21, 2004. Prior to Ms. Anderson’s death, benefits in the amount of $99,345.81 were paid to her medical providers on her behalf by the Tennessee Bureau of TennCare. In June, October and November of 2003, TennCare sent letters to Henkel’s […]
Mary Virginia Jones Henkel started receiving Medicaid benefits on July 1, 1991. She died on February 19, 2003. In March of 2003, her Conservator sent the Tennessee Bureau of TennCare a copy of the final accounting for Henkel’s conservatorship. TennCare responded by sending a printout of medical services paid by the State to the conservator, […]
Lakeridge is an Ohio nursing home that participates in Medicare and Medicaid. When it was surveyed, it was found out of compliance with several provider requirements. It was fined a civil monetary penalty of $80,300. The fine was upheld and affirmed on appeal. Among the violations cited were “one violation of 42 C.F.R. § 483.25(h)(2), […]
A Tennessee case decided November 1, 2006, addresses estate recovery for married individuals. In In re Estate of Smith, Mr. and Mrs. Smith had been married for more than 60 years. Mrs. Smith suffered a series of strokes in 2001. She was then admitted to a nursing home in Madison, Tennessee. She predeceased her husband. […]
This is a motor vehicle case where Plaintiff cited Ahlborn, seeking to avoid reimbursing Medicaid. Decedent was injured in a collision on June 30, 2005 and died intestate on July 4, 2005 at age 85. A proposed settlement of $50,000 constituted the defendant’s insurance limits. All medical expenses associated with the collision were paid by […]
In this Medicaid case, the State appealed from a trial court decision. The trial court’s finding that the applicant was eligible for Medicaid was affirmed Reed entered Blanchette Place Care Center in July of 2003. In September, she and her daughter entered into a “personal care contract.” The contract required Reed’s daughter to perform duties […]
A community spouse purchased an actuarially sound single-premium irrevocable annuity for $250,000 for the purpose of spending down excess assets so her husband, a nursing home resident, would qualify for Medicaid. Pennsylvania denied eligibility, contending that the annuity was an available asset and that Medicaid eligibility could not be established until that asset was spent […]
A physician brought a qui tam action against two other physicians and several health care providers after a nurse showed him a progress note in a nursing home chart allegedly documenting a physician’s (Lachman’s) review of the chart. The problem was that the resident had died several weeks earlier. After seeing that record, the relator […]
In Arkansas Dept. Health and Human Services v. Ahlborn, 547 U.S. 268 (2006), Heidi Ahlborn suffered severe and permanent injuries at age 19 as a result of an automobile accident. She was left partially brain damaged and unable to complete her education. Medicaid determined she was eligible for benefits and paid providers $215,645.30 on her behalf. Later, […]
The wife was a personal representative of the husband’s estate. The husband was killed in a vehicle collision. Medicaid paid $168,691.58 in medical expenses and had an automatic lien. Medicaid filed its lien with the Court alleging a right to full payment. After the wrongful death action was brought, the case settled for $900,000, plus […]
Beverly Tutinas’s husband, Julian, was on Medicaid, but she was not. When Beverly died owning a home valued at $69,641.89 and a car worth $2,000, the State of Illinois filed a claim against Beverly’s estate, seeking to recover what Medicaid had invested in Julian’s care. The court found that, although the State clearly had a […]
When contrasted with Hines and Smith, a different result was reached where the legislature had re-written the property code. In 1993, Jack Willingham transferred certain real property to his son, reserving a life estate. In 1997, he applied for medical assistance from the state, which he received until his death in 2002. There, a 1995 […]
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