Timm v. Montana Department of Public Health & Human Services

2008 MT 126, 184 P.3d 994, 343 Mont. 11, 2008 Mont. LEXIS 185
CourtMontana Supreme Court
DecidedApril 21, 2008
DocketDA 06-0507
StatusPublished
Cited by9 cases

This text of 2008 MT 126 (Timm v. Montana Department of Public Health & Human Services) is published on Counsel Stack Legal Research, covering Montana Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Timm v. Montana Department of Public Health & Human Services, 2008 MT 126, 184 P.3d 994, 343 Mont. 11, 2008 Mont. LEXIS 185 (Mo. 2008).

Opinions

JUSTICE COTTER

delivered the Opinion of the Court.

¶1 Appellants John and Linda Timm (Timms) appeal an order of the First Judicial District, Lewis and Clark County, affirming a decision of the Board of Public Assistance of the State of Montana (Board). We affirm in part, reverse in part, and remand for further proceedings.

FACTUAL AND PROCEDURAL BACKGROUND

¶2 In July of 2002 appellant Linda Timm entered the Roosevelt Memorial Nursing Home in Culbertson, Montana. Linda was forty-seven years old at the time and in an advanced stage of multiple sclerosis. Her husband, appellant John Timm, was a truck driver for J & R Transportation, Inc., a closely-held family transportation business. On November 1,2002, Linda and John applied for Medicaid assistance with the Roosevelt County Office of Public Assistance (OPA) of the Montana Department of Public Health and Human Services (DPHHS). In this application, the Timms requested Medicaid assistance with Linda’s nursing home costs.

¶3 Medicaid is a joint state and federal program created by Congress in 1965 under Title XIX of the Social Security Act, 42 U.S.C. § 1396. Medicaid is administered by “the Secretary of Health and Human Services (HHS), who in turn exercises his authority through the Centers for Medicare and Medicaid Services (CMS).” Ark. Dept. of Health and Human Servs. v. Ahlborn, 547 U.S. 268, 275, 126 S. Ct. 1752, 1758 (2006). One of the purposes of Medicaid is to “enabl[e] each State, as far as practicable under the conditions in such State, to furnish ... medical assistance on behalf of families with dependent children and of aged, blind, or disabled individuals, whose income and resources are insufficient to meet the costs of necessary medical services” and provide funds to the states to furnish medical assistance to those in need. 42 U.S.C. § 1396. States are given “substantial [13]*13discretion” in determining how federal funds from the Medicaid program are administered. Pharmaceutical Research and Mfrs. of Am. v. Walsh, 538 U.S. 644, 665, 123 S. Ct. 1855, 1868-69 (2003). Each participating state has the responsibility for developing “a plan containing reasonable standards for determining eligibility for medical assistance, and an individual becomes eligible for Medicaid if he or she meets the state’s criteria.” Hofer v. Mont. Dept. of Pub. Health & Human Servs., 2005 MT 302, ¶ 32, 329 Mont. 368, ¶ 32, 124 P.3d 1098, ¶ 32 (citing Schweiker v. Gray Panthers, 453 U.S. 34, 36-37, 101 S. Ct. 2633, 2636 (1981)).

¶4 The Medicaid program in Montana is administered by DPHHS in a maimer consistent with federal law. Sections 53-6-101 and 111(1), MCA. The “reasonable standards” governing the Montana Medicaid program are contained in the Montana State Medicaid Plan (Montana Medicaid Plan). The Montana Medicaid Plan, like all state Medicaid plans, is subject to review by CMS for compliance with federal Medicaid law. 42 C.F.R. § 430.14 (2007).

¶5 Medicaid benefits are determined in a two-step process. The first step requires a determination whether the Medicaid applicant is eligible to receive Medicaid benefits. “Eligibility for Medicaid is dependent upon a determination of whether an applicant has ‘available’ resources, and coverage will be denied if an applicant’s resources exceed a statutory ceiling.” Hofer, ¶ 31 (citing Ramey v. Reinertson, 268 F.3d 955, 958 (10th Cir. 2001); 42 U.S.C. § 1396a(a)(10)(A)(i)(IV)). If an applicant is Medicaid eligible, then DPHHS determines how much of the Medicaid recipient’s post-eligibility income must be paid towards the cost of care, and how much of the remaining difference will be paid for by Medicaid. 42 C.F.R. § 435.725 (2007).

¶6 In a case such as this, where a married couple is seeking Medicaid benefits for an institutionalized spouse, the first step requires the couple to submit a resource assessment application. Admin. R. M. 37.82.1331 (2002). This application lists all the assets held by the married couple as of the first day of the month in which the applicants request assistance for the institutionalized spouse. DPHHS then classifies each accessible asset as either excludable or countable. These classifications are based upon federal Medicaid law. Admin. R. M. 37.82.903 (2002); 42 U.S.C. § 1382b. If an asset is excludable, it will not be counted towards the total financial resources available to the couple. Excludable assets include the following: the home, one car, prepaid burial plans, term life insurance, and property essential to self-[14]*14support. Countable assets include those assets not falling into the excludable category. After DPHHS determines which assets are “countable,” they are valued. DPHHS then uses this figure to calculate what is known as the community spouse resource maintenance allowance (CSRMA). The CSRMA is equal to one-half of all the countable assets, and represents the amount of available assets that the “community spouse” — i.e., the spouse still living in the community-is permitted to keep under Medicaid eligibility standards. Admin. R. M. 37.82.1336 (2002). The CSRMA has a lower limit of $19,908.00 and an upper limit of $99,540.00.1 If the CSRMA is less than lower limit, the community spouse can keep up to the lower limit, and if the CSRMA exceeds the upper limit, then the spouse can keep only up to the upper limit amount. The institutionalized spouse is given an allowance of up to $2,000.00 in countable assets.

¶7 The CSRMA plus the $2,000.00 allowance for the institutionalized spouse is referred to as the “spend down target”; that is, the amount of countable resources that a married couple may keep while retaining Medicaid eligibility for the institutionalized spouse. If the couple has countable resources which exceed this figure, then they must “spend down” their countable resources until they reach this target. Once they have done so, the institutionalized spouse is Medicaid eligible. Accordingly, an institutionalized spouse is Medicaid eligible when the couple has left only the following financial resources: (1) excludable resources; (2) the institutionalized spouse’s $2,000.00 allowance; and (3) the community spouse’s CSRMA. After these eligibility requirements have been satisfied, the couple has ninety days to effectuate the transfers necessary to give the institutionalized spouse the $2,000.00 allowance and put the remaining resources into the community spouse’s name. Admin. R. M. 37.82.1338 (2002).

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Timm v. Montana Department of Public Health & Human Services
2008 MT 126 (Montana Supreme Court, 2008)

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Bluebook (online)
2008 MT 126, 184 P.3d 994, 343 Mont. 11, 2008 Mont. LEXIS 185, Counsel Stack Legal Research, https://law.counselstack.com/opinion/timm-v-montana-department-of-public-health-human-services-mont-2008.