Martin v. Ohio Department of Human Services

720 N.E.2d 576, 130 Ohio App. 3d 512, 1998 Ohio App. LEXIS 5475
CourtOhio Court of Appeals
DecidedNovember 20, 1998
DocketNo. 98 CA 7.
StatusPublished
Cited by20 cases

This text of 720 N.E.2d 576 (Martin 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
Martin v. Ohio Department of Human Services, 720 N.E.2d 576, 130 Ohio App. 3d 512, 1998 Ohio App. LEXIS 5475 (Ohio Ct. App. 1998).

Opinion

Brogan, Judge.

Appellant, the Ohio Department of Human Services (“ODHS”), appeals from a judgment of the Champaign County Court of Common Pleas reversing an administrative determination that appellee, Richard Martin, was ineligible for Medicaid benefits. The common pleas court held that an IRA owned by appellee’s spouse should not have counted in the determination of appellee’s eligibility for nursing-home Medicaid benefits. The lower court also held that ODHS erred in retroactively applying a regulation that related to eligibility calculations. On appeal from that judgment, we hold that a spouse’s IRA is a countable resource under the Medicare Catastrophic Coverage Act of 1988, Section 1396r-5, Title 42, U.S.Code. Thus, we reverse the lower court’s judgment in that regard. We agree, however, that the retroactive application of regulations was improper. Thus, we affirm the judgment in part and remand this cause to the agency to reconsider appellee’s eligibility for Medicaid benefits.

I

The facts of this case are not in dispute. Richard Martin resides in a nursing home. His wife, Mary Jo Martin, does not live in the nursing home, but lives nearby. On August 7, 1994, on behalf of her husband, Mrs. Martin applied to the Champaign County Department of Human Services (“CCDHS”) for Medicaid Benefits. The application was denied for the reason that Mr. Martin had resources in excess of the eligibility requirements. The Martins applied a second time on July 31, 1995, and that application was also denied, for the same reason. The couple did not appeal from either of these determinations of ineligibility.

A third application for Medicaid benefits was filed on December 29, 1995. The CCDHS sent the Martins a notice of denial on March 21,1996. The Martins then challenged that denial and asked for a hearing before ODHS. Besides appealing from the most recent denial of benefits, the Martins also asked ODHS to consider *515 granting benefits retroactively for the two previously denied applications. A hearing was held on May 29, 1996. The state hearing officer overruled the appeal on all issues in a decision issued on July 16,1996.

On July 31, 1996, the Martins took an administrative appeal. The administrative hearing examiner reversed the decision of the hearing officer on the grounds that the denial of benefits was not accompanied by proper notice required under Ohio Adm.Code 5101:6-7-01. The hearing examiner did agree with the officer, however, that Mrs. Martin’s IRA had to be counted as part of the couple’s total resources for the purposes of Mr. Martin’s eligibility determination.

On September 13, 1996, Mr. Martin filed a notice of appeal to the Champaign County Court of Common Pleas. The common pleas court held that ODHS had erred by including Mrs. Martin’s IRA among the couple’s countable resources. The court held further that ODHS had erred by applying regulations that went into effect on January 1, 1996, to Mr. Martin’s December 29, 1995 application. Finally, the court ruled that Mr. Martin was prejudiced by a lack of proper notice on his two prior applications. Accordingly, the court remanded the case to the ODHS with instructions to recalculate Mr. Martin’s eligibility as of his first application for benefits.

The ODHS now appeals from the common pleas court’s judgment.

II

Appellant’s second assignment of error is as follows:

“The funds held by the community spouse in an Individual Retirement Account (IRA) are countable resources for purposes of determining the institutionalized spouse’s eligibility for Medicaid.”

We consider appellant’s second assignment of error first because the issue raised is the one that lies at the heart of this appeal, namely, whether a spouse’s IRA should be counted as a resource when determining a married person’s eligibility for Medicaid benefits to pay for nursing-home care. ODHS argues that the common pleas court erred when it concluded that Mrs. Martin’s IRA was not a countable resource. Full consideration of this argument requires that we review how the Medicaid program operates, generally throughout the nation, and particularly in the state of Ohio.

A. The Medicaid Program

Medicaid was enacted in 1965 as Title XIX of the Social Security Act. For states that choose to participate, the program provides federal funds to pay for the medical treatment of needy persons. State plans must comply with the both . the act itself and the requirements of the Secretary of Health and Human *516 Services. Schweiker v. Gray Panthers (1981), 453 U.S. 34, 36-37, 101 S.Ct. 2633, 2636, 69 L.Ed.2d 460, 465.

The Social Security Act requires states participating in the Medicaid program to make assistance available to individuals classified as “categorically needy.” These are persons qualified to receive certain federal welfare benefits under the act. In 1972, Congress substantially expanded the welfare benefits available under the Social Security Act by replacing several state-run programs with a new federally administered program: Supplemental Security Income for the Aged, Blind, and Disabled (“SSI”), Section 1381 et seq., Title 42, U.S.Code. The adoption of SSI proportionally expanded the class of persons who would be classified as “categorically needy” under the Medicaid program. Congress feared that this expansion might cause some states to withdraw from Medicaid altogether. Thus, Congress offered what has become known as the “209(b) option,” now codified at Section 1396a(f), Title 42, U.S.Code. See Schweiker, 453 U.S. at 38, 101 S.Ct. at 2637, 69 L.Ed.2d at 466-467.

If a state elects the 209(b) option, it is permitted to restrict the availability of Medicaid benefits. The restrictions, however, may not exclude individuals who would have been eligible under the state regulations in effect in 1972. Moreover, if an individual in that state is eligible for SSI benefits, but not Medicaid benefits, as that person encounters medical expenses, he must be permitted to “spend down” his resources to the eligibility levels adopted by the state. As a consequence of the 209(b) option, states may be classified, for the purposes of the Medicaid program, as either “SSI states” or “209(b) states” depending on how they make benefits available. Schweiker, 453 U.S. at 38-39, 101 S.Ct. at 2637-2638, 69 L.Ed.2d at 466-467. Ohio is a 209(b) state.

In addition to providing federal funds for the “categorically needy,” the Social Security Act also permits states to receive federal funds for aiding people who are not eligible for welfare benefits but whose resources are too low to meet their medical expenses. See Sections 1396a(a)(10)(C) and 1396d(a), Title 42, U.S.Code. This class of persons is designated as the “medically needy.” See Atkins v. Rivera (1986), 477 U.S. 154, 157, 106 S.Ct. 2456, 2459, 91 L.Ed.2d 131, 138. States are not required to provide Medicaid benefits to the medically needy. Gandenberg v. Barry (S.D.Ohio 1988), 687 F.Supp. 346, 350. However, when states opt to provide such benefits, they are required to use standards that are “reasonable” and “comparable” for all groups.

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720 N.E.2d 576, 130 Ohio App. 3d 512, 1998 Ohio App. LEXIS 5475, Counsel Stack Legal Research, https://law.counselstack.com/opinion/martin-v-ohio-department-of-human-services-ohioctapp-1998.