Hughes v. Colbert

872 F. Supp. 2d 612, 2012 U.S. Dist. LEXIS 74044, 2012 WL 1933702
CourtDistrict Court, N.D. Ohio
DecidedMay 29, 2012
DocketCase No. 5:10CV1781
StatusPublished
Cited by4 cases

This text of 872 F. Supp. 2d 612 (Hughes v. Colbert) is published on Counsel Stack Legal Research, covering District Court, N.D. Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hughes v. Colbert, 872 F. Supp. 2d 612, 2012 U.S. Dist. LEXIS 74044, 2012 WL 1933702 (N.D. Ohio 2012).

Opinion

MEMORANDUM OF OPINION AND ORDER [Resolving ECF Nos. 6 and 15 ]

BENITA Y. PEARSON, District Judge.

This action is before the Court upon Defendant’s Motion to Dismiss (ECF No. 6), filed on November 5, 2010.2 Defendant moves the Court to abstain from deciding this case or, in the alternative, dismiss the Complaint (ECF No. 1) pursuant to Fed.R.Civ.P. 12(b)(6). For the reasons set forth below, Defendant’s Motion is granted.

This action is also before the Court upon Plaintiffs’ Motion for Injunction (ECF No. 15), filed on May 3, 2012.3 Plaintiffs move the Court to enjoin Defendant from violating and continuing to violate federal law under Title XIX of the Social Security Act, including 42 U.S.C. §§ 1382a(a)(2)(B), 1396p(c)(l)(A), (F) and (G), as enacted, as interpreted by the courts, and as interpreted by the United States Department of Health and Human Services. In the alternative, Plaintiffs request that the Court issue a decision on the merits based on the stipulations of Counsel offered during the telephone conference held on June 21, 2011. See ECF No. 15 at 10.4 For the [615]*615reasons set forth below, Plaintiffs’ Motion is denied.

I. Background

Plaintiff Carole L. Hughes is a resident at Hanover House Nursing and Rehabilitation Center, a long-term care nursing facility located in Massillon, Ohio. ECF No. 15-2. Plaintiff Harry Hughes is the spouse of Carole Hughes. ECF No. 1 at Ml. Plaintiff Lester J. Bardin is a resident of ManorCare-Belden Village nursing center located in Canton, Ohio. ECF No. 15-3. Plaintiff Thelma Bardin is the spouse of Lester Bardin. ECF No. 1 at 15.

In November 2005, Mrs. Hughes was admitted to the nursing facility in Massillon. ECF No. 1 at 5. The countable resources of Mr. and Mrs. Hughes at the date of institutionalization were $518,380.81. Of this amount, $471,419.35 consisted of Mr. Hughes’s IRA. ECF No. 1 at 6. After Mrs. Hughes entered into the nursing home, Mr. Hughes paid for nursing home care for three years and eleven months. ECF No. 1 at 8.

On May 31, 2009, the amount in Mr. Hughes’s IRA was $272,450.14. ECF No. 1 at 9. On June 9, 2009, three months before Mrs. Hughes applied for Medicaid, Mr. Hughes used $175,000 of the couple’s combined resources from his IRA account to purchase an IRA annuity for himself (ECF No. 1-2), being an immediate single premium annuity and guaranteed for nine years, shorter than his life expectancy. Mr. Hughes is the owner of the annuity and income recipient, Mrs. Hughes is the contingent beneficiary, and the State of Ohio is the second contingent beneficiary. ECF No. 1-2 at 2. The IRA annuity pays $1,728.42 each month to Mr. Hughes. The annuity was effective on June 28, 2009 and the guaranteed payment period expires January 28, 2019. ECF No. 1 at ¶¶ 10 and 12.

On September 5, 2009, Mr. Bardin was admitted to the nursing facility in Canton. ECF No. 1 at 16. The combined resources of Mr. and Mrs. Bardin at the date of institutionalization were $539,483.60. ECF No. 1 at % 17. In January 2010, several weeks after Mr. Bardin applied for Medicaid, Mrs. Bardin used $373,583.84 of the couple’s combined resources to purchase an annuity for herself (ECF No. 1-1), being an immediate single premium annuity and guaranteed for five years, shorter than her life expectancy. Proceeds used to purchase the annuity were from the sale of U.S. Savings Bonds in the amount of $362,810 and the surrender value of a life insurance policy in the amount of $10,773.84. Mrs. Bardin is the owner of the annuity and recipient of the income until her death. After Mrs. Bardin’s death, Mr. Bardin is the primary beneficiary, and the State of Ohio is the contingent beneficiary. ECF No. 1-1 at 9. The annuity provides Mrs. Bardin a monthly income of $3,397.17. The annuity was effective on January 4, 2010. ECF No. 1 at ¶¶ 19 and 21.

When a couple seeks Medicaid eligibility for a spouse that is in a nursing home, otherwise known as the “institutionalized spouse,” the Medicaid rules specify how much of the couple’s assets the other spouse — the “community spouse” — is allowed to retain for her own use. This is called the “community spouse resource allowance” (“CSRA”). Wisconsin Dept. of Health and Family Services v. Blumer, 534 U.S. 473, 482-83, 122 S.Ct. 962, 151 L.Ed.2d 935 (2002); see also Ohio Admin. Code § 5101:1-39-36.1(C)(3). Congress enacted the CSRA provisions in order to “protect community spouses from ‘pauperization’ while preventing financially secure couples from obtaining Medicaid assistance.” 534 U.S. at 480, 122 S.Ct. 962; see also 42 U.S.C. § 1396r-5.

The CSRA maximum at the time both Mrs. Hughes and Mr. Bardin applied for [616]*616Medicaid was $109,560. Ohio Admin. Code § 5101:1-89-36. The remainder of the couple’s assets are to be used for the institutionalized spouse’s care until that spouse has less than $1500 — at which point Medicaid eligibility is possible. If the community spouse utilizes resources above the amount allocated to her as the CSRA, then it is called an “improper transfer” because resources have been transferred away from the institutionalized spouse’s share.

When an individual applies for Medicaid nursing home payment, one of three conclusions is reached by the agency: (1) her resources are below the limit and she is eligible; (2) her resources are above the limit and she is not eligible (she is deemed to have “excess resources”), or (3) within the past five years she had too many resources but divested herself of enough of those resources to be below the limit now (¿a, she made an “improper transfer” which results in Medicaid eligibility but temporary denial of nursing home coverage). See Ohio Admin. Code §§ 5101:1-39-05 and 5101:1-39-07,5 An improper transfer can be found only after the applicant has been determined eligible for Medicaid (and eligibility means that she has resources at or under the individual resource limit).

As previously stated, Mr. Hughes and Mrs. Bardin (the community spouses) each bought an annuity for themselves. Plaintiffs contend that the annuities complied with federal Medicaid law. ECF No. 18 at 2. Defendant contends that the purchases were made with assets in excess of their CSRA’s. According to Defendant, Mr. Hughes and Mrs. Bardin exceeded their CSRA by $65,440 and $274,797, respectively. ECF No. 6 at 6 and 7. The Stark County Department of Job and Family Services (“County”) determined these were “improper transfers” because Mr. Hughes had used $65,440 from the pool of resources that were to remain available for Mrs. Hughes’s care, ECF No. 1 at lk, and Mrs. Bardin had used $274,797 from the pool of resources that were to remain available for Mr. Bardin’s care, ECF No. 1 at 22.

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Cite This Page — Counsel Stack

Bluebook (online)
872 F. Supp. 2d 612, 2012 U.S. Dist. LEXIS 74044, 2012 WL 1933702, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hughes-v-colbert-ohnd-2012.