In Re Kurzyniec Estate

526 N.W.2d 191, 207 Mich. App. 531
CourtMichigan Court of Appeals
DecidedNovember 21, 1994
Docket151960
StatusPublished
Cited by23 cases

This text of 526 N.W.2d 191 (In Re Kurzyniec Estate) is published on Counsel Stack Legal Research, covering Michigan Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
In Re Kurzyniec Estate, 526 N.W.2d 191, 207 Mich. App. 531 (Mich. Ct. App. 1994).

Opinion

207 Mich. App. 531 (1994)
526 N.W.2d 191

In re KURZYNIEC ESTATE
KURZYNIEC
v.
DEPARTMENT OF SOCIAL SERVICES

Docket No. 151960.

Michigan Court of Appeals.

Submitted August 3, 1994, at Lansing.
Decided November 21, 1994, at 9:20 A.M.

Erickson, Knight & Firth (by W. Bruce Knight), for the petitioner.

Frank J. Kelley, Attorney General, Thomas L. Casey, Solicitor General, and Erica Weiss Marsden, Assistant Attorney General, for the respondent.

Before: MICHAEL J. KELLY, P.J., and CAVANAGH and M.J. SHAMO,[*] JJ.

MICHAEL J. KELLY, P.J.

Respondent appeals as of right an order of the circuit court reversing the decision of a hearing referee who had ruled that petitioner was ineligible for retroactive medical assistance benefits for October and November 1989. We reverse.

I

Respondent is charged with administering federal Medicaid benefits at the state level. One of respondent's responsibilities is to formulate policies through which medical assistance benefits for the medically indigent are administered. MCL 400.105(1); MSA 16.490(15)(1). Specifically, respondent is charged with fashioning policies that are reasonable and uniform for all individuals in a covered group. 42 CFR 435.850. Respondent's policies are found chiefly in the Program Administrative Manual (PAM) and Program Eligibility Manual (PEM).

Pursuant to PEM, Item 400, an applicant for retroactive medical assistance benefits must have less then $4,000 in assets at the time of filing the application. Item 400 further provides:

*534 Asset eligibility exists when countable assets of the asset group in the month being tested are equal to, or less than, the applicable [medical assistance] asset limit....
An asset is countable if it is available and not excluded. An asset is considered available when a person has the legal right to use or dispose of it. It is assumed available unless there is evidence to the contrary. When a contract, court order, law, etc., prevents a person from disposing of an asset, it is unavailable.
For applications, [medical assistance] cannot be authorized for future months if the client has excess assets on the processing date.

This policy took effect on January 1, 1990. Under the former policy, an individual qualifying for benefits in the month of application was deemed retroactively eligible for benefits in the preceding three months, even if the individual did not meet the asset requirements in those months. The new policy allows retroactive benefits only for those months in which the applicant met the asset requirements.

II

Petitioner represents the estate of Kenneth Kurzyniec. On October 21, 1989, the deceased was admitted to Mt. Clemens General Hospital, where he remained until his death on December 19, 1989. The deceased had assets amounting to over $12,000 from October 1989 until his death in 1989, and his estate retained those assets until February 1990, when approximately $5,000 was withdrawn to pay for funeral expenses. During his hospital stay, the deceased incurred medical expenses of $150,000. A hospital social worker applied for medical assistance benefits on his behalf in October 1989, but she was unable to obtain from the *535 deceased, his family, or the hospital information needed to determine his eligibility. Consequently, the application was denied. No hearing was requested. According to petitioner, the deceased also was informed that he had to "spend down" his assets to the level that would qualify him for benefits. However, the deceased died before he was able to pay his medical bills and spend down his assets.

Before the deceased's death, the hospital referred his account to Medicaid Assistance Services, Inc., in order to obtain his medical assistance benefits. Scott McKinley, a representative of the company, had worked closely with respondent in the past, and he testified that no one informed him that the respondent's retroactive eligibility policy was scheduled to change on January 1, 1990. On January 31, 1990, an application for medical assistance benefits for October through December 1989, was filed on behalf of the deceased. The application was denied on March 29, 1990, because the deceased's assets exceeded the $4,000 asset limit in each of the months for which medical benefits were requested.

III

Following the denial of the January 31, 1990, application for medical benefits, petitioner sought administrative review. The hearing referee ruled that the Michigan probate court assumed control of the deceased's assets when he died intestate in December 1989. Accordingly, the hearing referee reasoned that the deceased's assets were not "available" in December 1989 and that petitioner's application for benefits had been denied erroneously with respect to that month. However, with respect to October and November 1989, petitioner's *536 assets were available and exceeded the limit of $4,000. Consequently, the hearing referee denied petitioner's request for retroactive benefits for those two months. In doing so, the hearing referee applied the post-January 1, 1990, eligibility policy, because the application for benefits was not filed until January 31, 1990. If the application had been filed while the prior policy was still in effect, petitioner would have qualified for benefits in October and November 1989 simply because he qualified in December 1989.

On appeal, the circuit court reversed the decision of the hearing referee on two grounds. First, it concluded that, because petitioner's claim for all three months would have been granted had the claim been filed before January 1, 1990, petitioner was penalized wrongly because of the delay of other individuals in filing the claim. The court noted that the deceased was unable to handle his affairs during the months of his hospitalization and, therefore, the new eligibility policy was unreasonable as applied to petitioner. Second, the court concluded that a "resource spend down" policy should have been used in applying the $4,000 asset limitation. In other words, the amount of the deceased's limited assets should have been offset by the amount of medical expenses incurred — regardless of whether they actually had been paid — in determining whether he fell below the $4,000 threshold.

IV

Respondent first argues that the circuit court erred in reversing the decision of the hearing referee on the basis that the new policy regarding retroactive medical benefits is unreasonable. We agree.

*537 A

When reviewing a decision of an administrative agency, a court must review the entire record to determine whether the decision is supported by competent, material, and substantial evidence. Great Lakes Sales, Inc v State Tax Comm, 194 Mich App 271, 280; 486 NW2d 367 (1992). Substantial evidence is that which a reasonable mind would accept as adequate to support a decision. Dukesherer Farms, Inc v Director of Dep't of Agriculture, 172 Mich App 524, 535; 432 NW2d 721 (1988). It is more than a mere scintilla but less than a preponderance of the evidence. Consumers Power Co v Public Service Comm, 189 Mich App 151, 187; 472 NW2d 77 (1991).

When there is sufficient evidence, a reviewing court may not substitute its discretion for that of the administrative tribunal even if the court might have reached a different result.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Wells Fargo Bank, NA v. Cherryland Mall Ltd. Partnership
812 N.W.2d 799 (Michigan Court of Appeals, 2011)
Woodman v. Kera LLC
785 N.W.2d 1 (Michigan Supreme Court, 2010)
Buckley v. Professional Plaza Clinic Corp.
761 N.W.2d 284 (Michigan Court of Appeals, 2008)
Department of Education v. Grosse Pointe Public Schools
701 N.W.2d 195 (Michigan Court of Appeals, 2005)
Henry v. Dow Chemical Company
701 N.W.2d 684 (Michigan Supreme Court, 2005)
Motycka v. General Motors Corp.
669 N.W.2d 292 (Michigan Court of Appeals, 2003)
Fritz v. St Joseph County Drain Commissioner
661 N.W.2d 605 (Michigan Court of Appeals, 2003)
Dignan v. Michigan Public School Employees Retirement Board
659 N.W.2d 629 (Michigan Court of Appeals, 2003)
Flint City Council v. State
655 N.W.2d 604 (Michigan Court of Appeals, 2003)
Evans v. Connecticut Dss, No. Cv 01 0511366s (Aug. 15, 2002)
2002 Conn. Super. Ct. 10452 (Connecticut Superior Court, 2002)
Van v. Zahorik
597 N.W.2d 15 (Michigan Supreme Court, 1999)
Van v. Zahorik
575 N.W.2d 566 (Michigan Court of Appeals, 1998)
McCready v. Hoffius
564 N.W.2d 493 (Michigan Court of Appeals, 1997)
Korzowski v. Pollack Industries
539 N.W.2d 741 (Michigan Court of Appeals, 1995)
Oakland Hills Development Corp. v. Lueders Drainage District
537 N.W.2d 258 (Michigan Court of Appeals, 1995)
Black v. Department of Social Services
537 N.W.2d 456 (Michigan Court of Appeals, 1995)

Cite This Page — Counsel Stack

Bluebook (online)
526 N.W.2d 191, 207 Mich. App. 531, Counsel Stack Legal Research, https://law.counselstack.com/opinion/in-re-kurzyniec-estate-michctapp-1994.