Kimnach v. Ohio Department of Human Services

645 N.E.2d 825, 96 Ohio App. 3d 640, 1994 Ohio App. LEXIS 3957
CourtOhio Court of Appeals
DecidedSeptember 8, 1994
Docket94APE04-520.
StatusPublished
Cited by11 cases

This text of 645 N.E.2d 825 (Kimnach v. Ohio Department of Human Services) is published on Counsel Stack Legal Research, covering Ohio Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Kimnach v. Ohio Department of Human Services, 645 N.E.2d 825, 96 Ohio App. 3d 640, 1994 Ohio App. LEXIS 3957 (Ohio Ct. App. 1994).

Opinion

Tyack, Judge.

On January 25, 1993, Gale Kimnaeh submitted an application for medicaid benefits. Kimnaeh lived in a nursing home and his wife, Helen Kimnaeh, lived at home. A resource assessment was completed by the Franklin County Department of Human Services, which identified the resources of the Kimnachs. The resources totaled $152,694. The department also determined that Helen Kimnach’s minimum monthly maintenance needs allowance (“MMMNA”) was $1,158 and that the community spouse resource allowance (“CSRA”) was $70,740. On February 3, 1993, the department mailed a notice to Mr. Kimnaeh, denying his application for medicaid on the basis of excess resources.

Mr. Kimnaeh filed a notice of appeal, and a hearing was held before a department hearing officer. On April 20, 1993, the hearing officer issued a recommendation which was accepted by the hearing authority, overruling the appeal. Mr. Kimnaeh requested an administrative appeal and on May 19, 1993, the administrative appeal decision was issued, affirming the denial of medicaid. *643 Mr. Kimnach appealed to the Franklin County Court of Common Pleas, which affirmed the denial in a judgment entry filed March 22, 1994. Mr. Kimnach has appealed to this court, assigning one error for our consideration:

“The administrative agencies and the trial court erred, as a matter of law, by not revising the community spouse resource allowance as the proper revision would have resulted in Appellant not having excess resources attributed to him.”

Appellant’s assignment of error and his arguments pursuant thereto involve the construction and interpretation of federal statutes and the Ohio Administrative Code with regard to the medicaid program. At the time of his application for medicaid benefits, appellant was living in a nursing home and his wife was living at home. Under federal law and with regard to applicants for medicaid, appellant was deemed the “institutionalized spouse” and his wife was deemed the “community spouse.” See Section 1396r-5(h), Title 42, U.S.Code. In order to determine whether the institutionalized spouse is eligible for medicaid, a resource assessment is completed by the state. As stated above, such a resource assessment was completed by the department, appellee, and it was determined, and the parties on appeal agree, that appellant and his wife’s resources totaled $152,694. These resources consisted of a savings account, certificates of deposit and tax-exempt H bonds. Appellee also determined that Mrs. Kimnach’s MMMNA was $1,158 and that the CSRA was $70,740. Section 1396r-5, Title 42, U.S.Code provides that the institutionalized spouse, appellant, may transfer an amount equal to the CSRA to the community spouse, Mrs. Kimnach. However, even after taking into account the amount of resources retained by Mrs. Kimnach, appellant still had resources well above the $1,500 limit for medicaid eligibility. Appellant argues, however, that the amount of income that will be generated by the CSRA will be insufficient to meet his wife’s MMMNA.

It is undisputed that appellant received $663 a month in social security and Mrs. Kimnach received $237 a month in social security. Therefore, Mrs. Kimnach would need resources which would generate at least $921 a month in income in order to meet the MMMNA of $1,158. For purposes of this case, resources equal capital, and income is interest earned on that capital or other income such as social security benefits. Evidence presented at the hearing shows that even if all of the $152,694 in resources were transferred to Mrs. Kimnach, only $764 a month of income would be generated, which still falls short of the MMMNA. Appellant argues, therefore, that pursuant to Section 1396r-5, Title 42, U.S.Code, all of the resources must be considered as the CSRA and that they must be transferred to his wife. If this were done, appellant would have no resources attributed to him and he would, therefore, be eligible for medicaid. Appellee, on the other hand, argues that the federal statutes call first for the transfer of income, not resources. If this were done, the MMMNA would be met *644 and because no additional resources would be transferred to his wife, appellant would still have excess resources and would not be eligible for medicaid. We interpret the statutes as allowing the transfer of resources first in order to raise the initial CSRA so that the revised CSRA will generate sufficient income to meet the MMMNA.

Appellant seeks to have the CSRA revised pursuant to Section 1396r-5(e)(2)(C), Title 42, U.S.Code, which states the following:

“(2) * * * If either the institutionalized spouse or the community spouse is dissatisfied with a determination of—

« * * *

“(v) * * * the community spouse resource allowance (as defined in subsection (f)(2));

“such spouse is entitled to a fair hearing * * * with respect to such determination if an application for benefits * * * has been made on behalf of the institutionalized spouse. * * *

U % ;J; i];

“(C) Revision of community spouse resource allowance. If either such spouse establishes that the community spouse resource allowance (in relation to the amount of income generated by such an allowance) is inadequate to raise the community spouse’s income to the minimum monthly maintenance needs allowance, there shall be substituted, for the community spouse resource allowance under subsection (f)(2), an amount adequate to provide such a minimum monthly maintenance needs allowance.” (Emphasis added.)

Appellee argues that such a revision of the CSRA and transfer of resources does not occur until the institutionalized spouse is determined to be eligible for medicaid and only if the transfer of income is insufficient. Appellee contends that income, in the form of a 'community spouse monthly income allowance (“CSMIA”), not resources, is transferred first in order to meet the MMMNA and only after one is determined eligible for medicaid. Therefore, if appellee’s interpretation is correct, neither income nor resources would be transferred in this case because appellant was determined not to be eligible for medicaid. We cannot find support for this interpretation under a plain reading of the federal provisions.

Appellee agrees that Section 1396r-5, Title 42, U.S.Code, calls for the computation of the MMMNA, CSRA and CSMIA upon the application for medicaid benefits. Appellee contends, however, that they are not implemented until after one is determined to be eligible. Appellee is correct, however, only as *645 to the implementation of the CSMIA. Section 1396r-5(d), Title 42, U.S.Code, states:

“(1) Allowances to be offset from income of institutionalized spouse. After an institutionalized, spouse is determined or redetermined to be eligible for medical assistance, in determining the amount of the spouse’s income that is to be applied monthly to payment for the costs of care in the institution, there shall be deducted from the spouses’s monthly income the following amounts in the following order:

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Bluebook (online)
645 N.E.2d 825, 96 Ohio App. 3d 640, 1994 Ohio App. LEXIS 3957, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kimnach-v-ohio-department-of-human-services-ohioctapp-1994.