Medicaid

Seeking Adjustments to the CSRA or MMMNA

MCCA includes a mechanism for increasing both the CSRA and the MMMNA in certain cases. The methods by which this can be effected are described in 1396r-5(e), (d)(5) and (f)(3). Blumberg v. Tennessee Department of Human Resources, 2000 WL 1586454 (Tenn.Ct.App.) was a case where a Community Spouse sought a court adjustment of the default CSRA and MMMNA:

Frederic Blumberg (‘Blumberg’) filed a petition against his wife in the Sumner County Circuit Court, seeking all his wife’s marital assets and an increase in his minimum monthly maintenance needs allowance. On September 16, 1998, the Sumner County Circuit Court issued an Order requiring Mrs. Blumberg to pay as support for the benefit of Mr. Blumberg, all of her monthly income. Subsequently, Blumberg applied for Medicaid benefits on behalf of Mrs. Blumberg, administered by the Tennessee Department of Human Services (“DHS”), for which he was approved. On October 26, 1998, Blumberg received notice from DHS that his request for an income allocation was denied. Thereafter, Blumberg requested an administrative hearing appealing the denial of spousal allocations. On December 8, 1998, an administrative hearing with DHS was held, and Blumberg’s appeal was denied. The Chancery Court affirmed the decision of the DHS, finding that the support order was not validly adjudicated because of lack of notice to DHS.

On August 27, 1998, Mr. Blumberg had filed a petition in Circuit Court against his wife seeking a transfer of her marital property and an increase in the MMMNA. The court ordered Mrs. Blumberg to pay all of her monthly income to her husband as a community spouse allowance (increased MMMNA). Thereafter, Blumberg filed an application for Medicaid benefits and was denied. Blumberg appealed from that denial. On appeal, the Court of Appeals found that where a spouse seeks to increase the MMMNA, MCCA “sets out two different and independent avenues of procedure that can be followed in setting the increase.” Id., *2. First, 1396r-5(e)(2) gives the Community Spouse an opportunity to demonstrate needs beyond the MMMNA in an administrative Medicaid fair hearing. Alternatively, 1396r-5(d)(5) gives the Community Spouse a judicial option, by permitting her (or in this case, him) to seek court ordered support. “If a court has entered an order against an Institutionalized Spouse for monthly income for the support of the Community Spouse, the Community Spouse monthly income allowance for the spouse shall not be less than the amount of the monthly income so ordered.” Id., at *3.

Although the Tennessee legislature attempted to prevent Blumberg-type actions with its revision of T.C.A.§ 71-5-121, the advantage of pursuing the judicial option, in part, is the court’s familiarity with real life budgeting needs. Since MCCA does not prescribe the standard applied by the court when entering an order of support, the court has two options: first, apply the same standard used in fair hearing; second, apply the standard ordinarily applied in domestic relations cases.

OSAH-Unknown-Teate-2008 (February 5, 2008). 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. The Order was issued October 18, 2007, nunc pro tunc to July 2007 (three months prior to the Medicaid application). The resources set aside were approximately 4290,000 at a time when the default CSRA was $103,640. DFSC nonetheless denied eligibility alleging Petitioner was over resourced. The ALJ found that 42 U.S.C. § 1396r-5(d)(5) requires adjustment of the default resource allowance where an order for support has been entered. “In the current case, Petitioner made no application for benefits until after obtaining a Court order establishing a community spouse resource allowance that results in a PRA higher than that otherwise allowed for Petitioner in a manner consistent with the provisions of 42 U.S.C. § 1396r-5(f)(2)(A)(iv) and (f)(2) and (3). Whether the Superior Court order correctly determined the community spouse allocation is beyond the scope of this hearing.” OSAH-Carroll-Schroer-2017 (March 13, 2017). Valid Court Order Increases MMMNA. Petitioner’s Community Spouse resided at home and was earning $3,031 per month. Petitioner’s wife filed a Petitioner for Support in Superior Court after Petitioner suffered a massive stroke and was admitted to a nursing home. That Petition alleged that DFCS does not take debt into account when calculating the CSRA. Petitioner’s office building had a monthly mortgage payment of $1,074 and Petitioner had unsecured credit card debt of $68,777. Due to the Community Spouse’s earnings, none of Petitioner’s income would be set aside for her under the default MMMNA calculation. A medicaid application was filed on July 29, 2016, prior to the Superior Court’s ruling on August 12, 2016 that the Community Spouse was entitled to support equal to Petitioner’s Social Security income. DFCS refused to revise its calculation of the cost-share and Petitioner appealed. Citing 42 U.S.C. § 1396r-5(d)(5), the ALJ held that federal law requires that “as a valid order of support against Petitioner exists, the Respondent must first deduct the amount of that order when determining the amount Petitioner must pay each month toward the costs of care in the institution.”

Chapter 4 Table of Contents

Main Table of Contents