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Second Circuit Holds Nursing Home Resident Improperly Denied Eligibility For Medicaid

 
 

HLD, v. 33, n. 9 (September 2005)

Second Circuit Holds Nursing Home Resident Improperly Denied Eligibility For Medicaid

            The Second 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.

            Plaintiffs 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.

            Affirming, 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.

            Next, the 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.  

            Finally, the 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

 

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