Geriatric & Medical Services, Inc. v. Department of Public Welfare

616 A.2d 746, 151 Pa. Commw. 209, 1992 Pa. Commw. LEXIS 650
CourtCommonwealth Court of Pennsylvania
DecidedOctober 21, 1992
Docket1267 C.D. 1991
StatusPublished
Cited by10 cases

This text of 616 A.2d 746 (Geriatric & Medical Services, Inc. v. Department of Public Welfare) is published on Counsel Stack Legal Research, covering Commonwealth Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Geriatric & Medical Services, Inc. v. Department of Public Welfare, 616 A.2d 746, 151 Pa. Commw. 209, 1992 Pa. Commw. LEXIS 650 (Pa. Ct. App. 1992).

Opinion

SMITH, Judge.

Geriatric and Medical Services, Inc., d/b/a Silver Stream Nursing Home (Silver Stream), on its own behalf and on behalf of its resident Josephine Miller, petitions for review of the order of the Secretary of the Department of Public Welfare (DPW) which affirmed the order of the Office of Hearings and Appeals (OHA) denying Miller’s eligibility for medical assistance benefits to pay for her care at the nursing home. The issues raised for review are whether DPW’s decision is consistent with medical assistance provisions of the Social Security Act, 42 U.S.C. §§ 1396-1396p; whether Silver Stream has waived the issue of Miller’s alleged undue hardship by failing to raise it below; and if not, whether DPW failed to consider the issue of Miller’s alleged undue hardship.

Miller is an elderly woman who lived with her daughter, Durelle Stevens, for a period of approximately twelve years. During that time, Miller received social security and pension benefits which were deposited into a joint savings account titled in the names of Josephine A. Miller or Durelle M. Stevens. Although Miller was determined to be the sole owner of the account, Stevens had total control over all withdrawals. Due to Miller’s deteriorating physical condition, she was placed at Silver Stream by Protective Services of the Montgomery County Office of Aging and Adult Services (MCOAAS) on October 14, 1990.

An application for medical assistance benefits was processed on Miller’s behalf on September 21, 1990 through the County Assistance Office (CAO) which determined that during the thirty-month period prior to the application, Stevens withdrew approximately $28,000 from the joint savings account, including several large withdrawals. During the period from July 3, 1990 through August 31, 1990, Stevens withdrew approximately $4000 from the account. These withdrawals depleted Miller’s savings to a little over $800 as of August 31, 1990.

*212 The CAO caseworker evaluating the monthly transactions, believing the large withdrawals to be improper, concluded that there was unusual activity in the account and requested that Stevens provide verification to substantiate that' Miller received fair consideration for these funds. The only receipt which Miller or Stevens could produce with respect to the withdrawals was for a health insurance payment in the amount of $208.20. The CAO rejected Miller’s application for benefits on the basis that during the thirty-month period immediately preceding her application, more than $500 were transferred to Stevens without Miller having received fair consideration for the transfer. The hearing examiner denied Miller’s appeal, and the OHA affirmed the hearing examiner. MCOAAS then requested and received reconsideration from the Secretary of DPW who affirmed the OHA. Silver Stream then petitioned this Court for review.

This Court’s scope of review of a DPW adjudication is limited to a consideration of whether an error of law was committed, whether necessary findings of fact are supported by substantial evidence, or whether constitutional rights were violated. Nelson v. Department of Public Welfare, 103 Pa.Commonwealth Ct. 21, 519 A.2d 1062 (1986). The hearing examiner is the ultimate factfinder in these matters, and must resolve conflicts in testimony and may reject the testimony of any -witness. Ross v. Department of Public Welfare, 60 Pa.Commonwealth Ct. 403, 431 A.2d 1135 (1981); Palmer v. Department of Public Welfare, 5 Pa.Commonwealth Ct. 407, 291 A.2d 313 (1972).

Both parties agree that Miller’s eligibility for medical assistance benefits is controlled by the Social Security Act and that the state plan for medical assistance is in compliance with federal requirements. 1 Under the plan adopted by Pennsylvania, an applicant for medical assistance benefits who, within *213 the requisite period preceding the date of application, has transferred real or personal property having a value of $500 or more without receiving fair consideration, is presumed to have disposed of the property with the intention of qualifying for medical assistance. See 55 Pa.Code §§ 178.171-178.172. It then becomes the applicant’s burden to present the required verification and convincing evidence that the resource was transferred solely for some purpose other than to qualify for medical assistance. Section 3 of the Public Welfare Code, Act of June 13, 1967, P.L. 31, as amended, 62 P.S. § 1404; 55 Pa.Code § 178.172; Groblewski v. Department of Public Welfare, 108 Pa.Commonwealth Ct. 102, 528 A.2d 1084 (1987). In the matter sub judice, the CAO, the hearing examiner, and the OHA determined that the presumption applied and that Miller did not meet her burden of rebutting this presumption. Silver Stream does not dispute these findings.

Of particular concern, however, is 42 U.S.C. § 1396p(c) which was added by amendment to the Social Security Act in 1988: 2

(c) Taking into account certain transfers of assets
(1) In order to meet the requirements of this subsection ... the State plan must provide for a period of ineligibility for nursing facility services ... in the case of an institutionalized individual ... who, or whose spouse, at any time during or after the 30-month period immediately before the date the individual becomes an institutionalized individual ... or ... the date the individual applies for such assistance while an institutionalized individual disposed of resources for less than fair market value. The period of ineligibility shall begin with the month in which such resources were transferred and the number of months in such period shall be equal to the lessor of—
(A) 30 months,....
*214 (2) An individual shall not be ineligible for medical assistance by reason of paragraph (1) to the extent that—
(C) a satisfactory showing is made to the State ... that (i) the individual intended to dispose of the resources either at fair market value, or for other valuable consideration, or (ii) the resources were transferred exclusively for a purpose other than to qualify for medical assistance; or
(D) the State determines that denial of eligibility would work an undue hardship.
(4) A State ... may not provide for any period of ineligibility for an individual due to transfer of resources for less than fair market value except in accordance with this subsection.

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Bluebook (online)
616 A.2d 746, 151 Pa. Commw. 209, 1992 Pa. Commw. LEXIS 650, Counsel Stack Legal Research, https://law.counselstack.com/opinion/geriatric-medical-services-inc-v-department-of-public-welfare-pacommwct-1992.