HLD, v. 33, n. 9 (September 2005)
Second Circuit Holds
Nursing Home Resident Improperly Denied Eligibility For
Circuit ruled July 14 that a nursing home resident in Connecticut was improperly denied
eligibility for Medicaid on the basis of his wife's assets where he had validly
assigned his spousal support rights to the state.
Robert Morenz, a nursing home resident, and his wife,
Clara Morenz, sued Patricia Wilson-Coker, the
Commissioner of the Connecticut Department of Social Services (DSS), after DSS
denied Robert's Medicaid application. According to DSS, Robert, as the
"institutionalized spouse," was ineligible for Medicaid because his assets
combined with his wife's, the "community spouse," exceeded the applicable statutory
threshold. The Morenzes argued, however, that Robert
should not be deemed ineligible on the basis of his wife's assets because he
had executed a valid assignment of spousal support rights to the state of Connecticut. The
district court granted summary judgment in the Morenzes'
favor. The court also ordered Robert's eligibility become effective three
months before the court's decision. Wilson-Coker appealed.
the Second Circuit first agreed with the district court's conclusion that the
Medicare Catastrophic Coverage Act of 1988 (MCCA) prohibits a state from
counting the assets of a community spouse when determining the initial Medicaid
eligibility of the institutionalized spouse where the institutionalized spouse
has assigned to the state all rights to support from the community spouse. The
appeals court agreed with the district court's conclusion that the MCCA's provisions "could not be less ambiguous" on this
point. The appeals court also found support for this interpretation in the
Centers for Medicare and Medicaid Services State Medicaid Manual. The district
court rightly gave deference to the agency's interpretation, particularly given
the complex nature of the Medicaid statute, the appeals court said.
appeals court held that the assignment of support rights to the state in the
instant action was valid under the applicable state law. The appeals court
rejected Wilson-Coker's argument that a valid assignment of support rights is
limited to situations in which the community spouse is unwilling or unable to
provide the information necessary to determine the institutionalized spouse's
eligibility. But the appeals court concluded that "neither the statute nor DSS's own published regulations" supported such an
interpretation of the statute.
appeals court found no Eleventh Amendment problems with the district court's
retroactive award of benefits. "Here, the order that payments begin
retroactively is not compensation for accrued liability, but is rather an
incident of the present eligibility determination required by the Medicaid
statute itself," said the appeals court.
Morenz v. Wilson-Coker, No. 04-4107-cv (2d
Cir. July 14, 2005). To read the case, go to http://www.ca2.uscourts.gov:81/isysnative/RDpcT3BpbnNcT1BOXDA0LTQxMDctY3Zfb3BuLnBkZg==/04-4107-cv_opn.pdf#xml=http://10.213.23.111:81/isysquery/irlf582/1/hilite