Shaak v. Pennsylvania Department of Public Welfare

707 A.2d 1199, 1998 Pa. Commw. LEXIS 141
CourtCommonwealth Court of Pennsylvania
DecidedMarch 2, 1998
StatusPublished
Cited by1 cases

This text of 707 A.2d 1199 (Shaak v. Pennsylvania Department of Public Welfare) is published on Counsel Stack Legal Research, covering Commonwealth Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Shaak v. Pennsylvania Department of Public Welfare, 707 A.2d 1199, 1998 Pa. Commw. LEXIS 141 (Pa. Ct. App. 1998).

Opinion

COLINS, President Judge.

Betty Shaak has filed a petition for review with this Court presenting the question whether the corpus of an irrevocable trust1 is an available resource to be considered when determining eligibility for medical assistance benefits as set forth in 55 Pa.Code § 178.4(c). The matter comes to the Court by way of an appeal from the final order on the merits entered by the Secretary of the Department of Public Welfare (DPW) on February 12, 1997. The final order on the merits affirmed the final administrative order entered by DPW, Office of Hearings and Appeals, denying Shaak’s appeal of the decision of the Lebanon County Assistance Of[1200]*1200fice. In denying Shaak’s appeal, the hearing officer concluded that the corpus of an irrevocable trust created by Shaak in 1988, of which Shaak became a subsequent beneficiary, was an available resource under 55 Pa. Code § 178.4(c) that was in excess of the resource limits established in 55 Pa.Code § 178, Appendix A. Thus, concluded the hearing officer, Shaak was ineligible for continued medical assistance benefits. We reverse and remand for proceedings consistent with this opinion.

Shaak raises the applicability of 55 Pa.Code § 178.4(c) to the resource at issue, contending that the regulation was not effective at the time the trust was created. We reject this contention on the basis that the relevant date is not the date the trust was created but rather the date of application for medical assistance benefits. We reject both petitioner’s and respondent’s pre-OBRA ’93 analysis (a brief discussion on pre-OBRA ’93 legislation is included for historical purposes) and review the matter in light of OBRA ’93 and current DPW regulations.

This result affects the dispositive issue questioning whether DPW correctly applied its regulation pertaining to available resources considered in determining eligibility for medical assistance. In substance, Shaak asserts that the hearing officer erred as a matter of law when concluding that she was ineligible for medical assistance benefits because of countable resources.2 Shaak argues she is not the owner of the trust, and DPW is without authority to impute ownership of a trust to an applicant/reeipient of medical assistance benefits. Lang v. Department of Public Welfare, 515 Pa. 428, 528 A.2d 1335 (1987); Park v. Department of Public Welfare, 135 Pa.Cmwlth. 457, 582 A.2d 1138 (1990).

Respondent DPW does not contradict petitioner’s contention and asserts instead, that ownership of the trust is vested in petitioner since petitioner is a trust beneficiary. Such a conclusion, respondent contends, is mandated under federal and state law, in particular the Social Security Act,3 42 U.S.C. §§ 1396a, 1396k, and 55 Pa.Code § 178.4(c). Respondent’s argument brings into focus the federal Omnibus Budget Reconciliation Act of 1993 (OBRA ’93) which added new requirements regarding the treatment of trusts. Respondent posits that under both pre-OBRA ’93 law and OBRA ’93 law the trust at issue contained available resources. As stated, we disagree.

Title XIX of the Social Security Act established the Medicaid program in 1965. Its purpose is to “provide federal financial assistance to States that choose to reimburse certain costs of medical treatment for needy persons.” Schweiker v. Hogan, 457 U.S. 569, 571, 102 S.Ct. 2597, 2600, 73 L.Ed.2d 227 (1982) (citing Harris v. McRae, 448 U.S. 297, 301, 100 S.Ct. 2671, 2680, 65 L.Ed.2d 784 (1980)). Participating States in the Medicaid program must establish eligibility standards for the optional coverage provided to the medically needy. Id. at 574, 102 S.Ct. at 2601-02.

Pre-OBRA ’93 there was no direct discussion of trusts in the federal regulations. Trust related issues manifested resulting in a series of policy interpretations by the Social Security Administration, called the Program Operations Manual System (“POMS”), which were relied upon in making eligibility determinations. The POMS provision regarding trusts states: “If the claimant/beneficiary’s access to the trust principal is restricted (e.g., only the trustee or court, etc., can invade the principal), the principal is not a resource to the claimant.” Miller v. Ibarra, 746 F.Supp. 19, 25-26 (D.Colo.1990). Hosts of decisions nationwide have determined that resource availability is the central issue to resolve when determining eligibility for medical assistance benefits. See Zeoli v. Commissioner of Social Services, 179 Conn. 83, 425 A.2d 553 (1979) (trust funds subject to [1201]*1201trustee’s sole discretion not available for Medicaid purposes under 42 U.S.C. § 1396a(17)(B)).

The Commonwealth of Pennsylvania is a participating State and through Section 5 of the Public Welfare Code, 62 P.S. § 442.1,4 has authorized DPW to establish standards of financial eligibility for the medically needy. Bemowski, 582 A.2d at 103. DPW’s rules governing eligibility state that a medically needy person may not have resources in excess of $2000.00 and still be eligible for benefits. 55 Pa.Code § 178, Appendix A Prior to the changes to the current regulations, trusts were not specifically discussed in DPW’s regulation. In turning to the courts for guidance, the guiding principle was set forth in Lang, wherein Mr. Justice Hutchinson wrote that the State may not impute ownership of an asset to an applican/recipient of medical assistance benefits. While Lang is factually distinct from the case herein,5 we are guided by its concern that ownership of the asset be established rather than imputed. Our position is buttressed by the current regulations promulgated by DPW.

The regulations define resources as “real or personal property which a person has or can make available for partial or total support, including equitable interests and partial interests.” 55 Pa.Code § 178.2. “Resources held in a trust established prior to July 30, 1994, are considered resources to the appli-canVrecipient to the extent that the trust permits use of those resources for the applicant’s/recipient’s food, clothing, shelter or medical care, regardless of whether the trust is in fact used for food, clothing, shelter or medical care.” 55 Pa.Code § 178.4(c). “Establishing the type of ownership is required to determine the availability and the value of the applieant’s/recipient’s resources.” 55 Pa. Code § 178.4(d). Thus, DPW regulation predicates medical assistance eligibility on ownership of an available resource.

Ownership of the trust and availability of a resource aré essential components to determining whether a resource is deemed “countable” under DPW’s regulations. 55 Pa.Code § 178.4 provides in pertinent part:

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Related

Shaak v. Pennsylvania Department of Public Welfare
747 A.2d 883 (Supreme Court of Pennsylvania, 2000)

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