Lewis v. Ohio Department of Human Services

738 N.E.2d 1264, 137 Ohio App. 3d 458
CourtOhio Court of Appeals
DecidedApril 3, 2000
DocketNo. 98-L-240 ACCELERATED.
StatusPublished
Cited by6 cases

This text of 738 N.E.2d 1264 (Lewis 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
Lewis v. Ohio Department of Human Services, 738 N.E.2d 1264, 137 Ohio App. 3d 458 (Ohio Ct. App. 2000).

Opinions

Christley, Judge.

This is an accelerated appeal taken from a final judgment of the Lake County Court of Common Pleas. Appellant, Ann Lewis, executrix of the estate of William W. Lewis, appeals from the judgment of the common pleas court upholding the decision of appellee, the Ohio Department of Human Services, to deny the May 2, 1997 Medicaid application filed by the decedent.

William W. Lewis (“Lewis”) began to reside in St. Augustine Manor Nursing Home in Cleveland, Ohio, on October 1, 1995. This date represented the first continuous period of institutionalization of Lewis as the institutionalized spouse. Appellant, his wife, continued to live on her own as the community spouse. In the nursing facility, Lewis was able to receive skilled care, which included the use of a ventilator and attendance by respiratory therapists.

For purposes of Medicaid eligibility, the couple’s total countable resources at the time of Lewis’s institutionalization were $304,798. As the community spouse, appellant’s spousal share was $152,399, or one-half of the total countable resources.

On May 2, 1997, Lewis applied for Medicaid benefits through the Cuyahoga County Department of Human Services (“CCDHS”). During the interval between Lewis’s initial institutionalization and the filing of the Medicaid application, the couple had expended a portion of their assets such that their total countable resources on May 2, 1997, was determined to be $172,455. In order to ascertain Lewis’s eligibility for Medicaid benefits, CCDHS calculated appellant’s community spouse resource allowance (“CSRA”) to be $79,020. The CSRA represented the maximum amount that could be transferred to appellant as the community spouse from the joint spousal resources. When the CSRA was deducted from the total countable resources, $93,435 in resources remained attributable to Lewis.

Under Ohio law, the Medicaid resource limitation for an individual is $1,500. Since Lewis’s assets of $93,435 were well above $1,500, CCDHS determined that he had excess countable resources and was, therefore, not eligible for Medicaid *461 benefits. Notice of the CCDHS decision was mailed to the couple on December 10,1997.

In arriving at its decision, CCDHS had calculated that appellant was entitled to a minimum monthly maintenance needs allowance (“MMMNA”) of $1,724. Since appellant had gross countable monthly income of only $519, CCDHS determined that she should receive a monthly income allowance (“MIA”) of $1,205 in order to meet the MMMNA.

Pursuant to R.C. 5101.35(B), Lewis requested a state hearing on the denial of his Medicaid application by CCDHS. The state hearing was held on March 24, 1998. In this proceeding, Lewis sought a recalculation of the $79,020 CSRA on the ground that appellant’s monthly income, coupled with the income generated by the CSRA, was inadequate to raise appellant’s income to the level of the MMMNA. Lewis asked that the CSRA be increased by transferring to appellant a portion of the total countable resources previously attributed to him as the institutionalized spouse. This would leave appellant, as the community spouse, with greater resources by which to generate sufficient income to meet the MIA of $1,205.

Upon reviewing the financial data, the state hearing officer determined that a reallocation of resources was warranted. Lewis had provided three estimates demonstrating that $124,314 was the average cost of a single premium lifetime immediate monthly payment annuity which would produce monthly payments of $1,205. Consequently, the state hearing officer transferred $45,294 in resources from Lewis to appellant. When added to the original CSRA of $79,020, the adjusted CSRA after the reallocation of resources was $124,314.

When $45,294 was deducted from Lewis’s original total countable resources of $93,435, however, he was left with $48,141. This still exceeded the $1,500 resource limitation for Medicaid applicants as provided for by Ohio law.

During the course of the state hearing, Lewis’s counsel maintained that St. Augustine did not properly bill Lewis for services rendered after he began to reside in the nursing facility in October 1995. Apparently, the nursing home was experiencing difficulty with its accounting procedures during this time period. As a result, while Lewis was accruing expenses at St. Augustine, he claimed to be unable to pay the costs associated with his care in a timely fashion (ie., contemporaneously with the rendering of the services). Thus, Lewis’s counsel asserted that the couple was not able to spend down its countable resources prior to filing the Medicaid application on May 2, 1997. 1

*462 It was uncontroverted that St. Augustine finally submitted proper bills to Lewis in January 1998, which resulted in payments totaling $52,000 to the nursing home in February and March 1998. Lewis’s counsel argued that these expenditures should be subtracted from the $48,141 in resources still attributed to Lewis after the adjustment to the CSRA.

In essence, counsel was requesting that Lewis’s total countable resources as of May 2, 1997, be reduced by the payments made to St. Augustine in February and March 1998 because these payments were made in satisfaction of nursing home debts that were incurred prior to the filing of the Medicaid application. If this were done, then Lewis presumably would have been eligible for Medicaid benefits retroactive to May 2, 1997, because his total countable resources at that time would have been less than the resource limitation of $1,500.

In a written decision rendered on March 26, 1998, the state hearing officer concluded that there was no provision for reducing an institutionalized spouse’s resources by an amount of expenditures that were made after the Medicaid application was submitted, regardless of when or how the expenses were actually incurred. Instead, the pertinent date for resource determination is the date of the Medicaid application. In Lewis’s case, although an unbilled liability to St. Augustine for services rendered may have existed as of May 2, 1997, the uncontroverted findings of fact demonstrated that Lewis’s resources were not applied toward that liability until almost ten months after the Medicaid application was filed. In other words, Lewis’s resources were not encumbered by a legally binding debt to the nursing home at the time of the Medicaid application. As such, the state hearing officer determined that CCDHS correctly denied the May 2, 1997 application for Medicaid benefits due to Lewis’s excess resources.

Pursuant to R.C. 5101.35(C), Lewis appealed the state hearing decision to the Director of the Ohio Department of Human Services (“ODHS”). On April 21, 1998, the designee of the Director of ODHS issued an administrative appeal decision affirming the state hearing decision to the effect that CCDHS properly denied Lewis’s Medicaid application on the basis that his assets exceeded the $1,500 resource limitation.

The issue before ODHS was again whether the unbilled debt owed to St. Augustine at the time of the May 2, 1997 Medicaid application constituted an “encumbrance” because it restricted Lewis from using those funds for his support and maintenance.

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Cite This Page — Counsel Stack

Bluebook (online)
738 N.E.2d 1264, 137 Ohio App. 3d 458, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lewis-v-ohio-department-of-human-services-ohioctapp-2000.