Medicaid: Court Reaches Wrong Conclusion Regarding Community Spouse

Incorrect Decision Reached Regarding Status of Community Spouse. A nursing home resident’s spouse was denied a Community Spouse Monthly Income Allowance when she moved to the Philippines after her husband was admitted to a nursing home. She was attempting to secure a visa to return to the U.S. at the time of the hearing and does not appear to have been represented by counsel. Apparently because no diversion was allowed, Petitioner was over-resourced and denied eligibility from July 2007 through February 2008. DFCS and the ALJ found that the marital relationship ceased when the spouse left the country under Section 2501 of the Georgia Medicaid Manual and, as a result, was not entitled to the CSMIA. That decision was incorrect and should have been appealed. Section 2501 states when deeming ends, but it does not result in termination of the marriage. Under 42 U.S.C. § 1396r-5, while the marriage continued, the Community Spouse was entitled to the CSMIA regardless of her place of residence.

OSAH-Gwinnett-Barnes-4-2008.pdf (April 11, 2008).