Dale Singleton v. Commw. of Ky.

843 F.3d 238, 2016 U.S. App. LEXIS 21694, 2016 WL 7093989
CourtCourt of Appeals for the Sixth Circuit
DecidedDecember 6, 2016
Docket16-5596
StatusPublished
Cited by9 cases

This text of 843 F.3d 238 (Dale Singleton v. Commw. of Ky.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Dale Singleton v. Commw. of Ky., 843 F.3d 238, 2016 U.S. App. LEXIS 21694, 2016 WL 7093989 (6th Cir. 2016).

Opinion

OPINION

SUTTON, Circuit Judge.

This dispute concerns a conflict between a provision of the Medicaid statute and a corresponding Kentucky state regulation. In 2006, in an effort to tighten loopholes in the Medicaid Act that .had allowed individuals, to transfer assets below fair market value in order to qualify for Medicaid coverage, Congress amended the language of 42 U.S.C. § 1396p(c)(l)(F)(i). A corresponding Kentucky regulation, promulgated just four months later, mistakenly included the pre-amendment language of the provision.

Marchetta Carmicle, the Branch Manager for Eligibility Policy for the' Kentucky Department of Medicaid Services, realized that Kentucky law could not contradict the federal Medicaid statute and thus enforced *240 the corrected federal statute, not the uncorrected state regulation. Arguing that Kentucky was authorized by Congress to adopt a less restrictive alternative, the Singletons sued Carmicle and the state agency, 'Claiming a right to relief under the state regulation. Because the federal Medicaid law preempts the contrary state regulation, we reverse the district court’s denial of Carmicle’s motion to dismiss the claims against her under Civil Rule 12(b)(6)..

Medicare does not cover “custodial care,” such as the services provided in nursing homes. 42 U.S.C. § 1395y(a)(9). Medicaid does. Id. § 1396d(a)(4)(A). By statutory design, an individual who needs custodial care must spend down any assets that exceed the Medicaid eligibility threshold before the government will pick up the tab. The spouse of an institutionalized individual is also required to chip in, but only up to a point. Congress does not consider the healthy spouse’s income to be available to the institutionalized spouse, id. § 1396r-5(b)(1), and the healthy spouse may exclude a portion of the couple’s assets, capped by statute, from consideration when determining Medicaid eligibility, see Hughes v. McCarthy, 734 F.3d 473, 475-76 (6th Cir. 2013).

To prevent people from evading these requirements by, say, giving their assets away to their children, the Medicaid statute requires each State to “look back” at an institutionalized individual’s financial history to see if he- or his spouse has disposed of any assets for less than fair market value in the past three years. In the event a couple makes any such dispositions, the State must strip the patient of Medicaid eligibility to a proportionate extent. See 42 U.S.C. § 1396p(c)(1).

The statute nevertheless permits individuals and married couples to dispose of their assets by purchasing a specific type of annuity. Section 1396p(c)(1)(F) says that “the purchase of an annuity shall be treated as the disposal of an asset for less than fair market value unless [] the State is named as the remainder beneficiary in the first position for at least the total amount of medical assistance paid on behalf of the institutionalized individual.” By purchasing an annuity structured in this way, a healthy spouse may convert assets that would be counted against the institutionalized spouse’s Medicaid eligibility into an uncountable- stream of income to the healthy spouse. If the healthy spouse passes away before the full value of the annuity is paid out, however, the State receives the remainder, up to the full value of the care provided to the institutionalized spouse. ,

In drafting (and passing) this provision, Congress initially made a mistake. As first enacted, § 1396p(c)(l)(F) allowed the State to recover only “the total amount of medical assistance paid on behalf of the annui tant,” Pub. L. No. 109-171, 120 Stat. 4, 63 (2006) (emphasis added). That amount‘is typically zero for married couples, because a healthy spouse will take out an annuity in her own name so that the income is not attributed to the institutionalized spouse. Just ten months later, as a result, Congress retroactively amended the provision to change “the annuitant” to “the institutionalized individual.” Pub. L. No. 109-432, 120 Stat. 2922, 2998 (2006).

In March 2007, four months after this amendment fixed the drafting problem, the Kentucky Department of Medicaid Services promulgated an annuity regulation that reflected the pre-amendment version of § 1396p(c)(1)(F). 907 Ky. Admin. Regs. 1:650 § 2(8)(b)(l) (2007). That regulation sat on the books for over seven years until the Department .finally replaced “annuitant” with “institutionalized individual” in April 2014. 907 Ky. Admin. *241 Regs. 20:030 § l(9)(d)(l) (2014). The Department, however, never enforced the regulation as written. In her capacity as the Branch Manager for Eligibility Policy of the Department, Carmiele took the position that the state agency would strip eligibility only if the couple took out an annuity that did not comply with the federal rule.

In September 2009, Mary and Claude Singleton sought Medicaid benefits to.support Claude’s full-time residence in a nursing home. They engaged an elder care law firm to advise them on purchasing an annuity in order to gain eligibility. Mary allegedly wanted to name the State as a beneficiary for the value of care provided to her, rather than Claude, as the Kentucky regulation seemed to permit. But Mary’s lawyers informed her that the Department was enforcing the federal annuity rule, prompting her to purchase a $220,000 annuity that complied with the federal requirement. (The Singletons do not claim that Mary relied on the text of the Kentucky regulation to her detriment.)

Claude obtained Medicaid eligibility after the purchase of the annuity, and the Department paid $98,729.01 in medical expenses on his behalf before his death. Mary passed away in February 2014, leaving $118,238.41 in the annuity. Because the annuity was structured in accordance with the federal rule, the Department.was entitled to reclaim the full amount it paid for Claude’s care, with $19,509.40 left over for the secondary beneficiaries.

The Singleton children, acting as. co-administrators of their mother’s estate, filed a § 1983 action against the Secretary of the Kentucky Cabinet of Health and Human Services, seeking an injunction and a declaratory judgment that the State has no right to the funds remaining in the annuity and that the funds remain the property of the Singletons. They also filed a damages action under § 1983 and state law against Carmiele, whom they accuse of adopting an annuity policy that violates Kentucky and federal law. Carmiele filed a motion to dismiss the complaint under Civil Rule 12(b)(6), claiming that the Kentucky annuity regulation was void and that the claim against her should be dismissed on the basis of qualified immunity. The district eourt determined that qualified immunity should be addressed at summary judgment after both parties had an opportunity for discovery. In response, Carmi-ele, but not the state agency, filed this interlocutory appeal.

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843 F.3d 238, 2016 U.S. App. LEXIS 21694, 2016 WL 7093989, Counsel Stack Legal Research, https://law.counselstack.com/opinion/dale-singleton-v-commw-of-ky-ca6-2016.