Increase CSRA in Superior Court, followed by Application and Fair Hearing. After admission to a nursing home, but prior to application for Medicaid, the Superior Court in Glascock County issued an order setting aside all of Petitioner’s marital resources for the Community Spouse’s benefit for the purpose of generating sufficient income to reach the MMMNA. […]
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Use of Burial Funds for Care Results in them Being Treated as Income. In a one page decision, the ALJ affirmed an increase in Petitioner’s cost-share for December 2008 where Petitioner used funds set aside for burial for personal care. The ALJ noted this decision did not impact eligibility for any month other than December […]
No QIT, No Medicaid if Income Exceeds Cap, Part 2. Petitioner entered a nursing home in June 2008 and filed an application for Medicaid. DFCS did not receive or act on the application until July 22, 2008. As a result of inaction, Petitioner did not know that a QIT was needed because income exceeded the […]
No QIT means No Medicaid If Income Exceeds Cap. Petitioner entered the nursing home in July 2007 and applied for Medicaid in August 2007. No one told Petitioner a qualified income trust was needed. A denial was sent in October and Petitioner reapplied in November 2007, establishing the QIT by December 17, 2007. Eligibility was denied for […]
Calculation of Cost-Share. As of November 1, 2008, Petitioner’s gross monthly income was $2,385.54. DGCS calculated the cost-share as $2,189 after allowing deductions of $9.25 for federal taxes, $136.72 for health insurance premiums and $50 for Petitioner’s personal needs allowance. The decision does not indicate what additional deduction Petitioner sought, but the DFCS calculation was […]
Cost-share deduction for health insurance premiums. The ALJ stated the issue as whether a nursing home resident is entitled to a deduction from her patient liability for Medicaid for Health insurance premiums paid by her spouse who resides in the community. DFCS disallowed IME coverage for health insurance premiums paid y the Community Spouse, taking […]
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 […]
Ignorance of QIT Requirement Does Not Excuse Failure to Comply. Nursing home resident’s son assisted with her October 25, 2007 Medicaid application. At the intake interview on November 7, 2007, he disclosed that he opened a QIT with $50. He did not fund it further by transferring her excess income into the trust until that […]
Hire a Lawyer. An unrepresented nursing home resident applied for Medicaid on December 21, 2007. A 981 was issued after an intake interview on December 27, 2007. However, the 981 erroneously omitted a request for documentation regarding retirement income and social security benefits. The caseworker realized her error on February 5, 2008 (3 days after […]
In Timm v. Mont. Dep’t of Pub. HHS, 2008 MT 126 (2008), Linda Timm entered the nursing home in July 2002. The Timm family applied for Medicaid on November 1, 2002 reporting, among other resources, the Community Spouse’s one-third interest in J & R Transportation, Inc., worth roughly $20,150. The Department completed its first resource […]
