Case Law Library

Weatherbee v. Richman validated that a Medicaid Compliant Annuity would not be deemed available to an institutionalized spouse when applying for Medicaid.

On November 13, 2006, the appellant was admitted to a medical institution. On this date, both the appellant and his spouse, Susan Vieth, had a total of $300,828.46 in resources. Then, on January 29, 2007, the spouse purchased two annuities in the amounts of $127,110.92 and $13,814.51. The department agreed that the annuities are within the provision of Ohio Adm. Code 5101:1-39-22.8.

In 2006, Congress amended certain regulations in the Medicaid Act in order to "tighten loopholes" that allowed people to transfer their assets for less than fair market value to qualify for benefits. A corresponding Kentucky rule mistakenly included the incorrect language. The Branch Manager for Eligibility Policy for the Kentucky Department of Medicaid Services, Marchetta Carmicle, realized that the Kentucky regulations had to align with the federal regulations so she enforced the correct federal regulation rather than the Kentucky regulation. The Singletons then sued Carmicle and the state agency "claiming a right to relief under the state regulation."

Morris v. Oklahoma Department of Human Services validated the traditional community spouse MCA planning strategy. That is to say, the ability to purchase an MCA in the name of the community spouse as a way to spend-down excess countable assets of the couple is allowable.

Miller v. Ibara is a landmark case that created the "Miller Trust," otherwise known as a Qualified Income Trust. Four elderly "mentally incompetent women" brought suit against Irene Ibarra who was the Executive Director of the Colorado Department of Social Services. These women's income was "too low to enable them to pay their own nursing home costs, but too high to qualify for Medicaid benefits." And thus, these women did not receive any benefits.

Hughes v. McCarthy validated the ability for the community spouse to purchase an annuity for their sole benefit before the institutionalized spouse is Medicaid eligible but after they have been institutionalized.

Mr. Martin Fagan and Mrs. Pamela Fagan filed suit in January 2016 against Roderick Bremby who was Commissioner of the Connecticut Department of Social Services ("DSS"). The Fagans received a transfer penalty from Bremby which made Mr. Fagan ineligible for Medicaid benefits for six years.

Bryant v. Perales, 161 A.D.2d 1186 (N.Y. App. Div. 1990), is certainly not the longest decision ever written by the New York Supreme Court Appellate Division (coming in at just under six hundred words), but it is an interesting case worth discussing.  In Perales, the petitioner had requested a fair hearing after the state discontinued her medical assistance, public assistance, and food stamp benefits. The Commissioner did not review the petitioner's request relating to her Medicaid and public assistance benefits because her request for a fair hearing was not made within sixty days of the discontinuation notice.

In Ortiz v. Eichler, 794 F.2d 889 (3d Cir. 1986), the Third Circuit addressed two key elements: (1) the state's pre-hearing notice requirements under the 14th amendment; and (2) the extent to which applicants are afforded the right to confront witnesses at a hearing.

In our January 29, 2020 article, we discussed how the Massachusetts Superior Court's decision in Dermody v. Executive Office of Health and Human Services, (Mass. Super. Ct., No. 1781CV02342, Jan. 16, 2020) impacted how elder law attorneys use Medicaid Compliant Annuities in crisis planning. The primary issues in Dermody related to what is known as the "sole benefit rule" and the beneficiary designation requirements under the federal and state Medicaid law. Recently, the Suffolk County Superior Court addressed the same issues but came to a different conclusion than the court did in Dermody. Today we will discuss American National Insurance Company v. Jennifer Breslouf and the Commonwealth of Massachusetts (Mass. Super. Ct., No. 2084CV02374).