Medicaid: Court Adjusted CSRA

Increase CSRA in Superior Court, followed by Application and Fair Hearing. After admission to a nursing home, but prior to application for Medicaid, the Superior Court in Glascock County issued an order setting aside all of Petitioner’s marital resources for the Community Spouse’s benefit for the purpose of generating sufficient income to reach the MMMNA. The Order was issued  October 18, 2007, nunc pro tunc to July 2007 (three months prior to the Medicaid application). The resources set aside were approximately 4290,000 at a time when the default CSRA was $103,640. DFSC nonetheless denied eligibility alleging Petitioner was over resourced. The ALJ found that 42 U.S.C. § 1396r-5(d)(5) requires adjustment of the default resource allowance where an order for support has been entered. “In the current case, Petitioner made no application for benefits until after obtaining a Court order establishing a community spouse resource allowance that results in a PRA higher than that otherwise allowed for Petitioner in a manner consistent with the provisions of 42 U.S.C. § 1396r-5(f)(2)(A)(iv) and (f)(2) and (3). Whether the Superior Court order correctly determined the community spouse allocation is beyond the scope of this hearing.”

OSAH-Unknown-Teate-2008 (February 5, 2008).