O'Callaghan v. Commissioner of Social Services

729 A.2d 800, 53 Conn. App. 191, 1999 Conn. App. LEXIS 182
CourtConnecticut Appellate Court
DecidedMay 11, 1999
DocketAC 16870
StatusPublished
Cited by18 cases

This text of 729 A.2d 800 (O'Callaghan v. Commissioner of Social Services) is published on Counsel Stack Legal Research, covering Connecticut Appellate Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
O'Callaghan v. Commissioner of Social Services, 729 A.2d 800, 53 Conn. App. 191, 1999 Conn. App. LEXIS 182 (Colo. Ct. App. 1999).

Opinion

Opinion

LAVERY, J.

The defendant commissioner of social services appeals from the judgment of the trial court [193]*193rendered in favor of the plaintiff, Ann O’Callaghan.1 As a threshold matter, we conclude that the plaintiffs death during the pendency of this administrative appeal did not render the appeal moot because there is practical relief that we can grant to the parties. The dispositive issue on appeal is whether, pursuant to 42 U.S.C. § 1396r-5 (e) (2) (C),2 the defendant should have allocated to the plaintiffs community spouse resource allowance (resource allowance) certain spousal resources that generated only capital gains at the time that the plaintiffs husband was institutionalized. Such allocation would allow the plaintiff to generate her minimum monthly maintenance needs allowance (minimum needs allowance).3The defendant claims that the trial [194]*194court improperly determined that the resources in question were income producing within the meaning of § 1396r-5 (e) (2) (C). We conclude that the trial court improperly determined that those resources generated income. As an alternative ground for affirming the decision of the trial court, the plaintiff claims that the defendant should have authorized the conversion of the resources into income producing resources and allocated to her resource allowance an amount of the converted resources sufficient to enable her to generate her minimum needs allowance. We agree with the plaintiff and conclude that, pursuant to § 1396r-5 (e) (2) (C), the defendant should have authorized a conversion of the resources and allocated to the resource allowance an amount of the converted resources sufficient to enable the plaintiff to generate her minimum needs allowance.

Prior to a recitation of the facts and procedural history of this appeal, it is necessary to provide a brief overview of the relevant federal medicaid laws and corresponding state regulations. Our Supreme Court has referred to this statutory scheme as a “ ‘Serbonian bog.’ ”4 Ross v. Giardi, 237 Conn. 550, 554, 680 A.2d 113 (1996); see Friedman v. Berger, 409 F. Sup. 1225, 1226 (S.D.N.Y.) (describing statutory scheme as “aggravated assault on the English language, resistant to attempts to understand it”), aff'd, 547 F.2d 724 (2d Cir. 1976), cert. denied, 430 U.S. 984, 97 S. Ct. 1681, 52 L. Ed. 2d 378 (1977). “The medicaid program, established in 1965 as Title XIX of the Social Security Act, and codified at 42 U.S.C. § 1396 et seq., is a joint federal-state venture providing financial assistance to persons whose income and resources are inadequate to meet the costs of necessary medical care. . . . States participate voluntarily in the medicaid program, but participating states must develop a plan, approved by the [195]*195secretary of health and human services, containing reasonable standards . . . for determining eligibility for and the extent of medical assistance .... Connecticut has elected to participate in the medicaid program and has assigned to the department [of social services] the task of administering the program. General Statutes [§ 17b-260]. . . . The department, as part of its uniform policy manual, has promulgated regulations governing the administration of Connecticut’s medicaid system. See General Statutes § 17b-260.” (Citations omitted; internal quotation marks omitted.) Burinskas v. Dept. of Social Services, 240 Conn. 141, 148, 691 A.2d 586 (1997).

In 1988, Congress enacted the Medicare Catastrophic Coverage Act of 1988 (MCCA). Pub. L. No. 100-360,102 Stat. 683 (1988), codified at 42 U.S.C. § 1396r-5. “The objective of the MCCA was to protect married couples when one spouse is institutionalized in a nursing home, so that the spouse who continues to reside in the community is not impoverished and has sufficient income and resources to live independently. See H.R. Rep. No. 100-105 (II), 100th Cong., 2d Sess. at 65 (1988), reprinted in 1988 U.S.C.C.A.N. 857, 888. Prior to 1988, Medicaid eligibility rules required couples to deplete their combined resources before the institutionalized spouse5 was eligible for benefits, often leaving the community spouse6 financially vulnerable. The MCCA [196]*196attempted to strike a balance between preventing impoverishment of the community spouse by excluding minimum amounts of resources and income for that spouse from eligibility considerations, and preventing a financially solvent institutionalized spouse from receiving Medicaid benefits by ensuring that income was not completely transferred to the community spouse.” Chambers v. Dept. of Human Services, 145 F.3d 793, 798 (6th Cir.), cert. denied, 525 U.S. 964, 119 S. Ct. 408, 142 L. Ed 2d 331 (1998); see Burinskas v. Dept. of Social Services, supra, 240 Conn. 148-49.

For purposes of determining if a married applicant is eligible to receive medicaid benefits, the defendant will calculate the total value of the couple’s resources7 as of the date of the applicant’s institutionalization and allocate a share of the resources to each spouse. 42 U.S.C. § 1396r-5 (c) (1); Department of Income Maintenance, Uniform Policy Manual (1989) § 1507.05 (Uniform Policy Manual); Thomas v. Commissioner of the Division of Medical Assistance, 425 Mass. 738, 740, 682 N.E.2d 874 (1997). “For purposes of determining eligibility, the amount [of resources] allocated to the community spouse is called the community spouse resources allowance . . . ,8 42 U.S.C. § 1396r-5 (c) (2) (B).” Thomas v. Commissioner of the Division ofMedical Assistance, supra, 740. The resource allowance is the greatest of (1) $12,000 (adjusted annually), (2) the lesser of one half of total joint resources or $60,000 [197]*197(adjusted annually), (3) an amount established pursuant to a lair hearing under § 1396r-5 (e) (2), or (4) an amount transferred under court order. 42 U.S.C. § 1396r-5 (f) (2) (A); Thomas v. Commissioner of the Division of Medical Assistance, supra, 740-41. “The resource allowance is protected from the institutionalized applicant’s health care obligations and does not count against the applicant’s financial eligibility. In addition, under the [MCCA], a community spouse is entitled to a ‘minimum monthly maintenance needs allowance’ ... .9 42 U.S.C.

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Bluebook (online)
729 A.2d 800, 53 Conn. App. 191, 1999 Conn. App. LEXIS 182, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ocallaghan-v-commissioner-of-social-services-connappct-1999.