Mannix v. Ohio Department of Human Services

731 N.E.2d 1154, 134 Ohio App. 3d 594, 1999 Ohio App. LEXIS 3219
CourtOhio Court of Appeals
DecidedJuly 9, 1999
DocketC.A. Case No. 17720. T.C. Case No. 98-2236.
StatusPublished
Cited by4 cases

This text of 731 N.E.2d 1154 (Mannix 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
Mannix v. Ohio Department of Human Services, 731 N.E.2d 1154, 134 Ohio App. 3d 594, 1999 Ohio App. LEXIS 3219 (Ohio Ct. App. 1999).

Opinion

*596 Fain, Judge.

Patricia Mannix appeals from a judgment of the Montgomery County Court of Common Pleas affirming an administrative determination that she was ineligible for Medicaid benefits. The common pleas court held that the Ohio Department of Human Services correctly determined that a retirement account held by Mannix’s husband should have been included in the determination of Mannix’s eligibility for nursing-home Medicaid benefits.

We conclude that the retirement account and the proceeds therefrom were properly included as a countable resource under the Medicare Catastrophic Coverage Act of 1988, Section 1396r-5, Title 42, U.S.Code. The judgment of the trial court is affirmed.

I

Patricia Mannix entered a nursing facility as a resident in February 1997. At that time, she filed an application for Medicaid benefits. The application was denied. According to the Montgomery County Department of Human Services (“MCDHS”), the denial was based upon the fact that Mannix had failed to provide sufficient information necessary to verify her resources. In December 1997, Mannix requested a state hearing on the denial. Following an administrative hearing, a decision was rendered requiring MCDHS to reopen the original application.

In response to the application, MCDHS performed a resource assessment. The assessment showed that Mannix and her husband had total resources in excess of $45,000. Pursuant to relevant regulations, one-half of the assets was allocated to Mannix and one-half was allocated to her husband. Since Mannix’s share of the resources exceeded the maximum allowable amount of resources permitted by regulation, MCDHS ruled that Mannix was ineligible for benefits through December 1997.

In the meantime, Mannix had filed a second application for Medicaid benefits. An updated resource assessment was completed, which showed that Mannix’s husband had received a lump-sum payment from his retirement account. The account was not included in the original resource assessment. MCDHS determined that with the retirement account proceeds, Mannix had resources in excess of $183,000, and denied her Medicaid eligibility.

Mannix again requested a hearing on the denial of both applications. The denial was upheld in May 1998. Thereafter, Mannix took an administrative appeal regarding both denials. The hearing examiner denied the appeal; howev *597 er, the examiner ordered MCDHS to include the retirement account in the original assessment.

Mannix perfected an administrative appeal to the Montgomery County Court of Common Pleas. On appeal, Mannix claimed that the denial of benefits was erroneous, and that the proceeds from the retirement account should not have been included in the original assessment. The common pleas court denied Mannix’s appeal. Mannix now appeals from the judgment of the common pleas court.

II

In her sole assignment of error, Mannix states as follows:

“The denial of appellant’s application for Medicaid benefits and the decision of the common pleas court affirming this denial is contrary to law, since appellant has met all eligibility criteria.”

Mannix contends that the Montgomery County Common Pleas Court erred by affirming the denial of her application for Medicaid benefits. Specifically, she argues that the retirement account must be excluded from consideration in the resource assessment pursuant to Section 1056, Title 29, U.S.Code, the Employee Retirement Income Security Act (“ERISA”), and Section 416.1202(a), Title 20, C.F.R. She further claims that since her husband has refused to use the retirement plan to support her, she must be determined to be eligible for benefits. Mannix also contends that'the trial court erred by ruling that it did not have the authority to issue an order permitting Mannix’s husband to retain the proceeds from his retirement account.

Medicaid was enacted in 1965 as Title XIX of the Social Security Act. Its purpose was to make assistance available to individuals classified as “categorically needy.” Martin v. Ohio Dept. of Human Serv. (1998), 130 Ohio App.3d 512, 720 N.E.2d 576. The Act also provides for assistance to people who are not eligible for welfare benefits but whose resources are too low to meet their medical expenses. Id.

In 1988, Congress enacted the Medicare Catastrophic Coverage Act (“MCCA”), codified at Section 1396r-5, Title 42, U.S.Code. For a detailed discussion of this Act, we refer to Judge Brogan’s opinion in Martin, supra. Prior to the enactment of the MCCA, “a married person in a nursing home had to ‘spend down’ all of the family assets to the relevant eligibility limits before he or she could become eligible for assistance. Both husband and wife could be reduced to poverty by medical expenses before either one of them could receive Medicaid assistance to pay for nursing home care.” Id. at 518, 720 N.E.2d at 581. The *598 MCCA was enacted in order to prevent the impoverishment of the community spouse (the noninstitutionalized spouse). Id.

In Martin, Judge Brogan discussed how the purpose of the MCCA is effectuated:

“The MCCA permits the spouse living outside the nursing home (designated the ‘community spouse’) to keep half of the couple’s resources, generally, without affecting the eligibility of the spouse within the nursing home (designated the ‘institutionalized spouse’). After the equal division, the community spouse’s share must fit within certain minimum and maximum amounts that are indexed to inflation. The adjusted amount is designated the Community Spouse Resource Allowance (‘CSRA’). Section 1396r-5(f)(2). Any of the couple’s resources that are not part of the CSRA, and are not otherwise excluded from consideration, are deemed available to the institutionalized spouse. The institutionalized spouse may then spend down any amount in excess of the eligibility levels to receive Medicaid benefits.” Id. at 518-519, 720 N.E.2d at 581.

The MCCA specifically defines “resources” as excluding items excluded by Section 1382b, Title 42, U.S.Code. That section lists resources that are to be excluded, e.g., the residence and funds set aside for burial expenses. However, pension plans are not included in the list.

We turn first to Mannix’s ERISA argument. Mannix’s husband received a lump-sum payment from his retirement account and converted the proceeds into an Individual Retirement Account. Therefore, the account was no longer subject to protection pursuant to ERISA. As set forth in our opinion in Martin, IRAs are includable resources for purposes of determining Medicaid eligibility. However, even if the account had not been converted, we would find the account to be an includable asset.

Mannix argues that exclusion is mandated by Section 1056, Title 29, U.S.Code (ERISA) because of the regulation set forth at Section 416.1210(j), Title 20, C.F.R. We note that Section 416.1210 was promulgated to implement Section 1382b, Title 42, U.S.Code in regard to exclusions.

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Bluebook (online)
731 N.E.2d 1154, 134 Ohio App. 3d 594, 1999 Ohio App. LEXIS 3219, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mannix-v-ohio-department-of-human-services-ohioctapp-1999.