Income received in a month is not counted as an asset unless and until it is retained into the following month. In this case, the petitioner applied in September and requested backdating to June and July. She submitted bank statements for June and July as part of the fair hearing appeal, which showed balances of a few hundred dollars after Social Security income was deducted (there happend to be two Social Security deposits in July). In a short decision, ALJ Teresa Perez concluded she was eligible for those months.
Note that this decision does not explain whether the petitioner provided the June and July bank statements to the agency before the appeal. It does, however, clearly show the application of not counting income in the month it is received.
This decision was published with support from the Wisconsin chapter of the National Academy of Elder Law Attorneys and Krause Financial.
Preliminary Recitals
Pursuant to a petition filed on December 14, 2024, under Wis. Stat. § 49.45(5), and Wis. Admin. Code § HA 3.03(1), to review a decision by the Milwaukee Enrollment Services regarding Medical Assistance (MA), a hearing was held on February 12, 2025, by telephone. The record was held open to allow Petitioner to submit bank statements for the months of June 2024 and July 2024. Petitioner submitted those statements following the hearing on February 12, 2025 and I forwarded them to the agency. On February 13, 2025, the agency representative notified me that the agency believed those bank statements showed Petitioner’s assets were under the program asset limit in June 2024 and July 2024. She also notified me that the nursing home where Petitioner resides had been granted a “deviation” for March 2023 through July 2024.
The issue for determination is whether Petitioner is eligible for Nursing Home Long Term Care / Institutional Medical Assistance in June and July 2024.
There appeared at that time the following persons:
PARTIES IN INTEREST:
Petitioner:
—
Respondent:
Department of Health Services
1 West Wilson Street, Room 651
Madison, WI 53703
By: Stacy Green
Milwaukee Enrollment Services
1220 W Vliet St
Milwaukee, WI 53205
ADMINISTRATIVE LAW JUDGE:
Teresa A. Perez
Division of Hearings and Appeals
Findings of Fact
- Petitioner (CARES # —) is a 67-year old resident of Milwaukee County who has resided in a skilled nursing facility since March 23, 2023. She is married and her spouse also resides in a skilled nursing facility.
- Petitioner most recently filed an application for Medical Assistance (“MA”) in September 2024 at which time she requested an initial date of eligibility of June 1, 2024. The agency found her to be eligible effective August 1, 2024.
- By notice dated November 5, 2024, the agency informed Petitioner that she was not eligible for “Nursing Home Long-Term Care” Medical Assistance in June 2024 or July 2024 because she did not provide requested verification and because her assets exceeded the program limit.
- As of June 30, 2024, Petitioner had two savings accounts with balances of $7.41 (account —) and $150.18 (—) respectively and a checking account with $1,426.35 (account no. —). She had a $1,306 deposit from the Social Security Administration on June 1, 2024. Her checking account balance less that deposit was $120.35.
- As of July 31, 2024, Petitioner had two savings accounts with balances of $7.41 and $150.18 respectively and a checking account with $2,347.05. She had two deposits from the Social Security Administration in July 2024—one on July 1 and the other on July 31. Her July 31, 2024 checking account balance less those two deposits was $257.75.
Discussion
To be eligible for Nursing Home Long Term Care / Institutional Medical Assistance, an individual who does not have a community spouse, may not own countable, available assets in excess of $2,000. Medicaid Eligibility Handbook (MEH) §§16.1, 27.5.1, and 39.4.1.
Income received in a month is not counted as an asset unless and until it is retained into the following month. MEH §16.1. Thus, Social Security benefits deposited into a bank account must be subtracted from the ending balance of that account in the month the benefits were received.
In the present case, Petitioner’s representative offered, at the time of the hearing, bank statements that showed her combined bank account balances, after subtracting Social Security benefit deposits, were under $2,000 in both June 2024 and July 2024. I am therefore remanding this matter to the agency to backdate Petitioner’s Nursing Home Long Term Care Medical Assistance to include June 2024 and July 2024.
I note that following the hearing, Agency Representative Green notified me that the facility where Petitioner resides has been granted a “deviation” for the months of March through July 2024. It is my understanding that this hearing decision may require the agency to recalculate the deviation. That is essentially an accounting matter that the agency must address and outside the jurisdiction of the Division of Hearings and Appeals.
Conclusions of Law
Petitioner’s countable assets were under $2,000 in June 2024 and July 2024; she was therefore eligible for Nursing Home Long Term Care / Institutional Medical Assistance in those two months.
THEREFORE, it is
Ordered
That the matter is remanded to the agency to backdate Petitioner’s eligibility for Nursing Home Long Term Care / Institutional Medical Assistance to include June 2024 and July 2024 and to send Petitioner notice that it has done so. The agency must comply with these instructions within ten days of the date of this decision.
[Request for a rehearing and appeal to court instructions omitted.]
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