Matthews v. South Dakota Department of Social Services

2012 SD 24, 813 N.W.2d 130, 2012 S.D. 24, 2012 WL 1038644, 2012 S.D. LEXIS 23
CourtSouth Dakota Supreme Court
DecidedMarch 28, 2012
DocketNos. 25536, 25902
StatusPublished
Cited by23 cases

This text of 2012 SD 24 (Matthews v. South Dakota Department of Social Services) is published on Counsel Stack Legal Research, covering South Dakota Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Matthews v. South Dakota Department of Social Services, 2012 SD 24, 813 N.W.2d 130, 2012 S.D. 24, 2012 WL 1038644, 2012 S.D. LEXIS 23 (S.D. 2012).

Opinion

KONENKAMP, Justice.

[¶ 1.] Pooled Advocate Trust, Inc. (PATI), the managing corporation for a Medicaid pooled trust, brought a declaratory judgment action on Medicaid eligibility issues associated with the trust and named the South Dakota Department of Social Services (DSS) as a necessary party. The circuit court granted summary judgment and declaratory judgment for PATI. Fred Matthews and Gladys Matthews transferred assets to the pooled trust. When Fred and Gladys subsequently applied for Medicaid long-term care benefits, DSS imposed a penalty period because they were over age 65 at the time of the transfers. After DSS notified PATI of this policy, PATI petitioned for further relief, seeking a declaration that DSS could not impose penalty periods for transfers made by pooled trust beneficiaries age 65 or older. The circuit court granted PATI’s petition. In addition, Fred and Gladys appealed DSS’s application of a penalty period, but an administrative law judge (ALJ) upheld the decision and another circuit court affirmed the ALJ’s ruling. DSS appeals Circuit Court Judge Jeff W. Davis’s order granting PATI’s pe[134]*134tition for further relief (Appeal #25536). Fred and Gladys appeal Circuit Court Judge Janine M. Kern’s affirmance of the ALJ’s ruling (Appeal # 25902).

Declaratory Judgment

[¶ 2.] PATI is a nonprofit, South Dakota corporation created to manage the Pooled Advocate Trust dated October 28, 2004 (trust or pooled trust). An irrevocable trust created for the benefit of disabled South Dakota residents, the trust was established in an attempt to meet Medicaid’s criteria for pooled trusts under 42 U.S.C. § 1396p(d)(4)(C). Great Western Bank of Rapid City, South Dakota is the trustee.

[¶ 3.] To join the trust, a potential beneficiary completes a joinder agreement and application and pays a one-hundred-dollar fee. If the application is approved, the beneficiary’s transfers are attributed to a trust sub-account that remains separate from other beneficiaries’ sub-accounts. Funds from the sub-accounts are comin-gled for investment and management purposes. During a beneficiary’s lifetime, the trustee may distribute funds to supplement the beneficiary’s needs to the extent that Medicaid or other programs do not provide for them.

[¶ 4.] In November 2004, after executing a declaration of trust, PATI petitioned for court supervision of the trust under SDCL 21-22-9. The circuit court granted the petition and entered an order assuming supervision over the trust. At the time, the trust had no beneficiaries and was funded with one dollar.

[¶ 5.] On the same day the court granted the petition for supervision, PATI brought an action for declaratory judgment. PATI named DSS as a necessary party and sought the following relief: (1) a final judgment and decree that the trust complies with federal and state law regarding Medicaid pooled trusts and that beneficiaries’ transfers of assets or property to the trustee will not constitute transfers for purposes of Medicaid eligibility; (2) a final judgment and decree that the trust assets will not be considered an income resource available to beneficiaries for purposes of Medicaid eligibility; (3) a final judgment and decree that the income generated by the trust will not be considered an income resource available to beneficiaries for purposes of Medicaid eligibility; and (4) a final judgment and decree that DSS cannot claim a lien against the assets, property, or income of the trust by virtue of Medicaid benefits provided to the beneficiary except where a beneficiary’s sub-account is not retained by the trust. DSS answered, alleging that PATI failed to state a claim upon which relief may be granted.

[¶ 6.] In June 2005, PATI and DSS stipulated to the filing of cross motions for partial summary judgment. PATI and DSS disputed the legality of certain trust provisions concerning the disposition of sub-account funds following the death of a beneficiary. The parties reserved any other issues not addressed by the cross motions for summary judgment. After briefing, the court ruled for DSS. It concluded that DSS must be reimbursed from a deceased beneficiary’s sub-account before funds are distributed to the South Dakota Community Foundation but that funds from the sub-account may be placed back into the trust for the remaining trust beneficiaries. The court ordered reformation of the trust so that it would conform to the court’s decision.

[¶ 7.] In November 2005, PATI moved for summary judgment and declaratory judgment. PATI asserted that the court had essentially ruled on the merits of PATI’s complaint and that the only remaining contested issues were whether the complaint stated a claim upon which relief may be granted and whether PATI had [135]*135standing to bring the declaratory judgment action. In March 2006, PATI and DSS stipulated to the granting of PATI’s motions. Accordingly, the court granted PATI summary judgment and declaratory judgment in April 2006. The court ordered that “the trust, as reformed, complies with the law, that transfers to the trust will not be penalized for Medicaid eligibility purposes so long as a beneficiary meets the requirements set forth in the trust as reformed,1 and that amounts in a Trust Sub-Account will not be considered available resources for Medicaid eligibility purposes.” At this time, the trust still had no beneficiaries.

[¶ 8.] Fred, age 91, and Gladys, age 89, husband and wife, both disabled, entered a nursing home in February 2009. A few months later, Fred and Gladys sold their home to their daughter for $100,000, with an initial payment of $50,000. The couple deposited the money into their joint bank account. Fred’s monthly income totaled $5,677, comprised of social security benefits, veteran’s benefits, and pension proceeds. At that time, an individual with a monthly income exceeding $2,022 was ineligible for certain Medicaid benefits. Because Fred’s monthly income exceeded the Medicaid limit, Fred established a Medicaid income trust. Medicaid income trusts allow individuals with monthly incomes exceeding the Medicaid limit to place the income into a trust, subject to certain conditions, to avoid Medicaid ineligibility. Fred created this income trust by removing Gladys’s name from their joint bank account. Fred later deposited $8,618.05, the proceeds from his life insurance policy, into his Medicaid income trust because the cash surrender value of a life insurance policy was considered a countable resource for Medicaid eligibility purposes.

[¶ 9.] In June 2009, Fred and Gladys applied for sub-accounts with the pooled trust, and PATI granted their applications. Fred transferred $50,200 from his Medicaid income trust to PATI. PATI distributed half the funds to Fred’s pooled trust sub-account and the other half to Gladys’s pooled trust sub-account. Fred later deposited his life insurance policy cash proceeds from his Medicaid income trust into his pooled trust sub-account. In addition, Gladys deposited $6,000 from her savings account into her pooled trust sub-account.

[¶ 10.] In September 2009, Fred and Gladys separately applied for Medicaid long-term care benefits. While their applications were pending, they received the remaining proceeds from the sale of their home, $50,883.57. They divided the proceeds equally and deposited the funds into their separate pooled trust sub-accounts.

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Cite This Page — Counsel Stack

Bluebook (online)
2012 SD 24, 813 N.W.2d 130, 2012 S.D. 24, 2012 WL 1038644, 2012 S.D. LEXIS 23, Counsel Stack Legal Research, https://law.counselstack.com/opinion/matthews-v-south-dakota-department-of-social-services-sd-2012.