Palomba-Bourke v. Dep’t of Soc. Services, CV116010448S, 2012 WL 2044788 (Conn. Super. Ct. May 10, 2012)
In a case before the Superior Court of Connecticut, a wife appealed the final decision of the Department of Social Services determining that her husband did not qualify for Title XIX (Medicaid) benefits to cover his long term care because the wife’s testamentary trust was considered an available asset. The Superior Court determined that the wife’s testamentary trust was appropriately classified and dismissed the appeal.
In 1976, the wife’s first husband died and made her the beneficiary of a testamentary trust. The provisions of the testamentary trust provide that the trustees will pay the wife during her lifetime “so much of the annual net income from the Residuary Trust and so much of the principal thereof as the Trustees in their sole discretion shall deem advisable for [her] more comfortable care, maintenance and support.” The wife later remarried.
In 2009, her second husband entered a long term care facility and applied for Medicaid. In June 2010, the Department of Social Services determined that the Community Spouse Protected Amount (CPSA) was $109,540. The CPSA included the principal value of the testamentary trust in its calculations because the trust was deemed by the Department of Social Service’s legal counsel to be a resource that was available to the wife. Because the husband’s assets exceeded the allowable limit, the Department of Social Services denied his request for Medicaid.
Conclusions Made by the Department of Social Services
At the November 2010 administrative hearing on the denial of the husband’s Medicaid application, the Department of Social Services hearing officer made several conclusions of law.
First, he found that the wife and her husband were considered to be spouses as defined by the Medicare Catastrophic Coverage Act (MCCA) of 1998. Second, this act provides that all the resources held by either spouse, or by both spouses, are considered available to the institutionalized spouse. Third, effective June 2010, the wife’s assets were $514,977, which was the value of her testamentary trust. Fourth, the Department of Social Services correctly determined the CPSA to be $109,560. Fifth, the uniform policy manual (UPM) of the Department of Social Services provides that the assets of the spouse still living in the community in excess of the CPSA to be available to the institutional spouse.
Therefore, after allowing the wife her CPSA of $109,560, the Department of Social Services determined that $405,417 of her assets were available to her husband. Sixth, the asset limit for Medicaid was $1,600. Therefore, because the husband’s available assets of $407,417 were in excess of the $1,600 limit, the Department of Social Services was correct in denying the husband’s request for Medicaid.
On appeal to the Superior Court, the wife contended that the Department of Social Services illegally determined that the corpus of her testamentary trust was available to her husband because the trust was created before the effective date of the MCCA. However, the court determined that the precedent cited by the wife in support of this argument was narrowly applicable a special type of self-created inter vivos trust that was affected by U.S. Congressional legislation purporting to close loopholes. This precedent did not propose a general role that would restrict the applicability of the MCCA to the husband’s Medicaid eligibility determination.
The Superior Court re-iterated the general rule that a Medicaid applicant is subject to the federal and state statutes regarding assets that are in effect at the time of the institutionalization or application. The MCCA rules for treatment of resources, 42 U.S.C. § 1396r-5(c)(2)(A), and the Connecticut implementation of federal law, UPM § 4025.67(A), both support this interpretation. Both statutes require assets held either by the spouse living in the community or by the institutionalized spouse to be considered available to the institutionalized spouse for the purposes of Medicaid eligibility.
Furthermore, the legislative history of the MCCA regarding the attribution of resources requires “Any countable resources belonging to either or both spouses would be included in this determination, including resources from inheritance or previous marriages.” H.R. Rep. 100-05(II), at 70 (1998), reprinted in 1998 U.S.S.C.A.N. 893.
Therefore, the Superior Court determined that the Department of Social Services appropriately deemed the wife’s testamentary trust to be an asset available to her institutionalized husband when determining his eligibility for Medicaid, and that the denial of the husband’s request for Medicaid was correct. The wife’s appeal of the Department of Social Services determination was denied.