Reed v. Missouri Department of Social Services, Family Support Div.,193 S.W.3d 839; 2006 Mo. App. LEXIS 879 (Mo. Ct. App., E.D., 2006)

In this Medicaid case, the State appealed from a trial court decision. The trial court’s finding that the applicant was eligible for Medicaid was affirmed

Reed entered Blanchette Place Care Center in July of 2003. In September, she and her daughter entered into a “personal care contract.” The contract required Reed’s daughter to perform duties such as “preparation of nutritious, appropriate meals, house cleaning and laundry; assistance with grooming, bathing, dressing, and personal shopping, including purchase of clothing, toiletries and other personal items; assistance with purchasing hobby, entertainment or other goods for Reed’s use and enjoyment, taking into account Reed’s ability to pay for such items; monitoring of Reed’s physical and mental condition and nutritional needs in cooperation with health care providers; arranging for transportation to health care providers and to the physician of Reed’s choice, as well as arranging for assessment, services and treatment by appropriate health care providers for Reed; assisting Reed in carrying out the instructions and directives of Reed’s health care providers; arranging for social services by social service personnel as needed; visiting at least weekly and encouraging social interaction; arranging for outings and walks, if reasonable and feasible for Reed; and interacting with and/or assisting any agent of Reed in interacting with health professionals, long-term care facility administrators, social service personnel, insurance companies, and government workers in order to safeguard Reed’s rights, benefits, or other resources as needed.”

Reed’s daughter was also her Conservator. On October 6, the contract was presented to the probate court for approval, where payment in the amount of $11,000 was approved for services to be provided under the contract. A check was then written to Reed’s daughter for $11,000.

Later that same month, the Medicaid case worker asked for a policy interpretation. The application for Medicaid and the contract were sent to Jefferson City for review to determine whether payment under the contract was a transfer of resources. One of the State’s arguments was that the services Reed’s daughter agreed to perform were duplicative of what the nursing home would be doing anyway. The State found that it was and denied Reed’s application for Medicaid benefits. A fair hearing took place where the Administrative Law Judge found for the State. The decision was appealed to Circuit Court where the ALJ’s ruling was reversed.

On appeal, the Court found there was substantial evidence showing that services to be provided under the contract had value and were not duplicative of those services provided by the nursing home. Among those unique services, “the Contract provided that Teson [Reed’s daughter] would provide a communication link between Reed and her doctors and nurses regarding the status of her health, as well as interact with facility personnel to safeguard Reed’s rights and benefits. Reed, as a result of her medical problems which include a stroke, has difficulty with verbal communication and is withdrawn and avoids communication with staff.” Further, “Reed has trouble eating because of her stroke and Parkinson’s disease. Specifically, she has trouble bringing utensils to her mouth. The staff is not able to spend lengthy amounts of time with Reed, helping her learn to hold a spoon and feed herself. Teson, on the other hand, does.” The court noted that Reed’s daughter provided other services such as purchasing special equipment for Reed, managing her finances and taking special note of parties and recreational events so Reed could attend. The court also noted that Teson drove sixty miles round trip three to four times per week to perform these services and without payment, shoe could not afford the gas to make those trips.

Citing these facts, the court found that Teson’s services supported Reed’s independence, autonomy, well-being and care in ways the facility’s services did not. They enhanced Reed’s quality of life. They were above and beyond those services provided by the facility. As such, the court found that payment under the contract was for valuable services and was not a transfer of resources.

Decided: June 20, 2006.