Daily v. STATE EX REL. DHS

2009 OK CIV APP 107, 228 P.3d 1199
CourtCourt of Civil Appeals of Oklahoma
DecidedSeptember 4, 2009
Docket106,968. Released for Publication by Order of the Court of Civil Appeals of Oklahoma, Division No. 3
StatusPublished

This text of 2009 OK CIV APP 107 (Daily v. STATE EX REL. DHS) is published on Counsel Stack Legal Research, covering Court of Civil Appeals of Oklahoma primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Daily v. STATE EX REL. DHS, 2009 OK CIV APP 107, 228 P.3d 1199 (Okla. Ct. App. 2009).

Opinion

228 P.3d 1199 (2009)
2009 OK CIV APP 107

John and Vernice DAILY, Plaintiff/Appellees,
v.
STATE of Oklahoma ex rel., OKLAHOMA DEPARTMENT OF HUMAN SERVICES; Howard Hendrick, Director of Oklahoma Department of Human Services; Oklahoma Health Care Authority; Mike Fogarty, Director of Oklahoma Health Care Authority; and Howard Hendrick, Individually, Defendant/Appellants.

No. 106,968. Released for Publication by Order of the Court of Civil Appeals of Oklahoma, Division No. 3.

Court of Civil Appeals of Oklahoma, Division No. 3.

September 4, 2009.
Certiorari Denied December 14, 2009.

*1200 Craig Riffel, Dalen D. McVay, Mitchel, Gaston, Riffel & Riffel, Enid, OK, for Plaintiff/Appellees.

Lynn S. Rambo Jones, Oklahoma City, OK, for Defendant/Appellants, Oklahoma Health Care Authority.

Travis Smith, Oklahoma City, OK, for Defendants/Appellants, Oklahoma Department of Human Services.

CAROL M. HANSEN, Presiding Judge.

¶ 1 Defendant/Appellants, State of Oklahoma ex rel. Oklahoma Department of Human Services (DHS), Howard Hendrick, director of DHS, Oklahoma Health Care Authority (OHCA), and Mike Fogarty, director of OHCA (collectively State), seek review of the district court's order granting summary judgment in favor of Plaintiff/Appellees, John Daily (Husband) and Vernice Daily (Wife) (collectively Applicants), in their action for judicial review of DHS's decision denying Husband's application for Medicaid benefits based upon Husband's transfer of his assets to a trust payable to Wife. We hold the corpus of the trust, to the extent it is payable to Wife, is a resource available to Husband. To the extent any portion of the corpus is not payable to Wife, it is a disposed asset that subjects Husband to a transfer penalty. We reverse the district court's order, leaving DHS's decision in effect.

¶ 2 Husband entered a nursing home in Kansas on November 28, 2006 and transferred *1201 to an Oklahoma nursing home on January 30, 2007. Wife continued to live at home. At the time Husband first entered a nursing home, Applicants owned countable resources totaling $121,740.00, of which half, or $60,870.00, was allocated to each spouse. In February 2008, Wife created an irrevocable trust. Husband funded the trust with $51,000.00 and spent down his remaining resources to $2,000.00 by paying for living expenses and his nursing home care.

¶ 3 The trust agreement stated the purpose of the trust was "to enable [Husband] to qualify for Medicaid assistance." It stated Wife was "the sole beneficiary of this trust" and provided the trustee would pay to Wife "all of the net income and principal of the trust in 48 monthly installments," beginning March 5, 2007. The trust agreement provided that if Wife died before the term of the trust expired, the remaining trust property would be paid as provided in her will or to her living descendants per stirpes.

¶ 4 Husband then applied to DHS for Medicaid benefits. DHS denied the application based upon Husband's possession of resources in excess of the $2,000.00 Medicaid resource limit. Husband sought an administrative hearing. After a hearing, the DHS hearing officer found Husband was ineligible for Medicaid based upon 42 U.S.C. § 1396p(c)(1),[1] because he had transferred assets for the purpose of qualifying for Medicaid and did not receive fair market value for the assets.

¶ 5 Applicants appealed the hearing officer's decision to Hendrick, the director of DHS. Hendrick concluded:

Mrs. Daily was entitled to receive half of the $121,739.23 the couple had when Mr. Daily entered the nursing home on November 28, 2006. Mrs. Daily kept her half, $60,896.50. Mr. Daily put $51,000 in the Trust, which solely benefitted Mrs. Daily-leaving Mrs. Daily with $111,896.50. Since she was only entitled to have $60,896.50, the extra $51,000 must be attributed to Mr. Daily. Since Mr. Daily has not shown that $49,000 has been spent for his benefit to bring his resources down to the $2,000 Medicaid cap, OKDHS acted correctly in denying his application.

¶ 6 Pursuant to 75 O.S.2001 § 322, Applicants sought judicial review of the agency's final decision in the district court of Dewey County. They moved for summary judgment, first arguing DHS is barred by issue preclusion from denying Husband benefits. They asserted DHS's final administrative decision in In re: Arvel Hayes, Case No. M731902, Hearing No. H49751 (2006), holding the wife's trust was not an available resource in determining the husband's Medicaid *1202 eligibility, precluded DHS from determining Wife's trust in the present case is an available resource. They also argued the trust corpus was not an available resource under 42 U.S.C. § 1396p(d)(3)(B)(I)[2] and OAC 317:35-5-41.6(5)(C)(ii)[3] because Wife's trust was irrevocable, she was the sole beneficiary, and Husband was never entitled to receive any property from the trust. They argued, therefore, there were no circumstances under which payments could be made to the trust to Husband or for his benefit.

¶ 7 In response, State argued 42 U.S.C. § 1396r-5(c)(2)[4] required it to attribute the $51,000.00 in the trust to Husband. Any resources belonging to the couple in excess of Wife's allocation of $60,870.00 must be attributed to Husband and counts against the $2,000.00 resource limit. State argued in the alternative that funding the trust was a disqualifying transfer which would subject Applicants to a penalty period before they could be eligible for Medicaid. In addition, State argued issue preclusion was inapplicable because this case did not involve the same parties as the Hayes case.

¶ 8 After oral argument, the district court granted summary judgment in favor of Applicants, finding the trust was unavailable for Medicaid purposes. State appeals without appellate briefs in conformance with the procedures for the appellate accelerated docket, Okla.Sup.Ct.R. 1.36, 12 O.S.Supp.2003, Ch. 15, App. 1. However, State moved for an order to treat this matter as an ordinary appeal from a final order of the district court rather than a Rule 1.36 accelerated procedure. The Oklahoma Supreme Court denied the motion without prejudice to the reviewing court permitting briefs to be filed. We decline to permit further briefing.

¶ 9 Medicaid is a cooperative program of the state and federal governments to provide medical assistance for the poor. A state is not obliged to participate in a Medicaid *1203 program, but if it does participate, it must operate its program in compliance with federal statutes and regulations. Pharmcare Oklahoma, Inc. v. State Health Care Authority, 2007 OK CIV APP 5, 152 P.3d 267, 269-270. OHCA is the designated state agency for the administration of the Oklahoma Medicaid Program. It contracts with DHS for the determination of Medicaid eligibility and other administrative or operational functions related to the Oklahoma Medicaid Program. 63 O.S.Supp.2004 § 5009(B)(1).

¶ 10 DHS's determination as to Medicaid eligibility is subject to judicial review pursuant to the Oklahoma Administrative Procedures Act, 75 O.S.2001 § 318 et seq.

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Related

Johnson v. Guhl
357 F.3d 403 (Third Circuit, 2004)
Pharmcare Oklahoma, Inc. v. State Health Care Authority
2007 OK CIV APP 5 (Court of Civil Appeals of Oklahoma, 2006)
Daily v. State ex rel. Oklahoma Department of Human Services
2009 OK CIV APP 107 (Court of Civil Appeals of Oklahoma, 2009)

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Bluebook (online)
2009 OK CIV APP 107, 228 P.3d 1199, Counsel Stack Legal Research, https://law.counselstack.com/opinion/daily-v-state-ex-rel-dhs-oklacivapp-2009.