Albert v. Ohio Department of Human Services

740 N.E.2d 310, 138 Ohio App. 3d 31
CourtOhio Court of Appeals
DecidedMay 22, 2000
DocketNo. 76207.
StatusPublished
Cited by5 cases

This text of 740 N.E.2d 310 (Albert v. Ohio Department of Human Services) is published on Counsel Stack Legal Research, covering Ohio Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Albert v. Ohio Department of Human Services, 740 N.E.2d 310, 138 Ohio App. 3d 31 (Ohio Ct. App. 2000).

Opinion

Ann Dyke, Administrative Judge.

Appellant, Zsofia Albert, is appealing the trial court’s order affirming the decision of the Ohio Department of Human Services (“ODHS”) denying Medicaid benefits to appellant. For the following reasons, we affirm.

Appellant’s date of birth is May 3, 1900. She has resided in a nursing home since January 27, 1997. On January 28, 1997, her relatives cashed her certificates of deposits, and placed the net proceeds, after penalties, in appellant’s bank account.

On April 28, 1997, when appellant was approaching her ninety-seventh birthday, appellant transferred $75,000 in cash to her grandchildren. The grandchildren executed a promissory note, whereby they would pay seven percent interest each month on the principal, and pay back the principal in three years. Prepayments were prohibited.- The promissory note was unsecured and non-negotiable. Upon appellant’s death, the grandchildren become the holders of the note.

On June 27, 1997, appellant applied for Medicaid payments to the nursing home. The nursing home vendor payment was denied on September 26, 1997. Appellant filed a request for a state hearing on October 17, 1997. A hearing was set for November 20, 1997. The hearing was rescheduled for December 2, 1997, at the request of both appellant’s attorney and the prosecutor. The hearing was reset to December 10,1997, at the request of appellant’s attorney.

At the hearing, appellee’s expert testified that the note had no fair market value because the note was not transferable, unsecured, the investment was risky because appellant may not survive three more years, and the interest rate was low for the amount of risk involved. Federal government bonds, a low risk investment, would yield 6.9 percent.

Appellant’s expert testified that the promissory note had a fair market value of $75,000. The note generated a higher return than what appellant was receiving through certificates of deposit. The expert admitted that the note had no resale value, because it was non-negotiable.

The state hearing officer found that the note had no market value. Appellant did not show the transfer was for purposes other than qualifying for Medicaid. Coverage was restricted for twenty-three months ($75,000 divided by the monthly *34 rate for a long-term care facility, $3,162). This decision was issued on April 29, 1998.

Appellant appealed this decision, raising the additional claims that the ODHS delayed in issuing its opinion and the state hearing officer was not an attorney. The administrative appeal decision found (1) that the transfer was not a gift, but was for less than fair market value; (2) appellant cannot receive Medicaid if she is ineligible, solely because of an untimely decision; and (3) R.C. 5101.35 does not require state hearing officers to be admitted to the bar. The administrative hearing examiner was an attorney.

The Common Pleas Court of Cuyahoga County affirmed the decision of the ODHS, finding it was supported by reliable, probative, and substantial evidence.

I

Appellant’s first assignment of error states:

“The trial court erred in affirming appellee’s denial of benefits because Zsofia Albert received fair value, not no value, for her $75,000.”

This court’s review is limited to whether the court of common pleas abused its discretion as to whether the administrative decision was supported by reliable, probative, and substantial evidence and was in accordance with law. Payne v. Ohio Dept. of Human Serv. (1997), 123 Ohio App.3d 341, 704 N.E.2d 270.

A resource transfer is improper if an individual transfers his interest in a countable resource for less than fair market value, for the purpose of qualifying for Medicaid benefits. Ohio Adm.Code 5101:1-39-072; 5101:1-39-07. The ODHS had the burden to demonstrate that the transfer of the $75,000 to the grandchildren was for less than fair market value. “Fair market value” is defined as the going price for which the asset can be sold on the market. Ohio Adm.Code 5101:l-39-05(A)(5). The note was not transferrable, and could not be sold on a market. Appellant points out that the issue is whether appellant received fair market value, not whether the promissory note could be subsequently resold on the market. Ohio Adm.Code 5101:1-39-07(B).

Appellant did not receive fair market value in exchange for the transfer of the $75,000. All but $40 of each interest payment had to be spent on nursing home expenses, whereas she could have used the $75,000 for nursing home expenses. Ohio Adm.Code 5101:1-39-222. Appellant was not likely to receive the principal, because her life expectancy was less than three years. When the transfer was made, appellant was four days away from her ninety-seventh birthday. According to the ODHS tables, a ninety-seven-year-old female has a life expectancy of *35 2.97 years, and a ninety-six-year-old female has a life expectancy of 3.16 years. See Ohio Adm.Code 5101:l-39-228(G). Appellant’s life expectancy on the date of transfer was approximately 2.972 years. There was sufficient evidence from which the trial court could find that ODHS maintained its burden to show that the transfer was for less than fair market value.

The individual then has the burden to show that the property transfer was made for a purpose other than to qualify for Medicaid. Ohio Adm.Code 5101:1-39-073. The individual may show another purpose for the transfer; that attempts were made to dispose the asset at fair market value; and/or there were reasons why less than fair market value was accepted. Id. The relationship of the transferee to the transferor may be relevant. Id. The presumption of an improper transfer is overcome when the accounting and the evidence discloses that the transfer was made for reasons unrelated to the receipt of assistance. Id.

There was no evidence that the transfer was made for a purpose other than qualifying for Medicaid benefits. There was no evidence that appellant was unable to dispose of the asset for fair market value. Appellant contends that she had to demonstrate only that she intended to dispose of the assets for fair market value or other valuable consideration. See Section 1396p(c)(2)(C), Title 42, U.S.Code. A reasonable trier of fact could find that appellant did not intend to dispose of the $75,000 cash for fair market value, because it was probable she would not receive the principal.

The ineligibility period is the uncompensated value of all assets transferred by an individual, divided by the average monthly cost of a nursing facility. Ohio Adm.Code 5101:l-39-077(B). Appellant contends that she was compensated in part for the $75,000. For annuities, the payout of the annuity for the period after the person’s life expectancy is the amount subject to penalty. Ohio Adm.Code 5101:l-39-228(E). Here, appellant would be paid $437.50 per month interest for 2.972 years, for a total of $15,603. Appellant is urging that we deduct $15,603 from $75,000 to determine the ineligibility period.

This would be incorrect, as annuities typically involve period payments of both principal and interest.

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Bluebook (online)
740 N.E.2d 310, 138 Ohio App. 3d 31, Counsel Stack Legal Research, https://law.counselstack.com/opinion/albert-v-ohio-department-of-human-services-ohioctapp-2000.