An individual is financially eligible for EBD Medicaid if the total value of all non-exempt liquid assets does not exceed $2,000 at the end of the month. In this case, the petitioner owned countable assets of $2,015.27 as of the last day of October. Although the petitioner’s daughter complained the family was not given good advice by the ADRC, ALJ Teresa Perez concluded the denial of Institutional MA for October was correct.
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 17, 2024, under Wis. Stat. § 49.45(5), and Wis. Admin. Code § HA 3.03(1), to review a decision by the Marinette County Health & Human Services regarding Medical Assistance (MA), a hearing was held on January 30, 2025, by telephone.
The issue for determination is whether the agency correctly found that Petitioner was not eligible for Institutional Medical Assistance in October 2024 as a result of owning countable assets in excess of $2,000.
There appeared at that time the following persons:
PARTIES IN INTEREST:
Petitioner:
—
Petitioner’s Representative:
—
Respondent:
Department of Health Services
1 West Wilson Street, Room 651
Madison, WI 53703
By: Kelly Bruette
Marinette County Health & Human Services
Entrance B
1925 Ella Court
Marinette, WI 54143
ADMINISTRATIVE LAW JUDGE:
Teresa A. Perez
Division of Hearings and Appeals
Findings of Fact
- Petitioner (CARES # —) was formerly a resident of Marinette County. She died on November 30, 2024 at which time she was unmarried.
- Petitioner filed an application for Institutional Medical Assistance on October 24, 2024.
- Petitioner owned combined countable assets of $2,015.27 as of the last day of October 2024. As of the last day of November 2024, that amount was reduced to less than $2,000.
- By notice dated October 30, 2024, the agency informed Petitioner’s daughter, who was acting as her power of attorney, that Petitioner was not eligible for Nursing Home Long-Term Care for October 2024 because her assets exceeded the program limit.
- By notice dated November 18, 2024, the agency informed Petitioner’s daughter that Petitioner was eligible for Nursing Home Long-Term care for the month of November 2024.
- Petitioner filed an appeal.
Discussion
To be eligible for “Elderly / Blind / Disabled Medicaid” (“EBD Medicaid”), a category that includes Institutional Medical Assistance (also referred to as “Nursing Home Long Term Care”), an unmarried individual 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.
The agency here contended that Petitioner was not eligible for Institutional Medicaid in October 2024 because her countable assets exceeded $2,000 as of the last day of that month and provided documentation of Petitioner’s savings account which demonstrated that to be true.
Petitioner’s surviving daughter, who appeared at hearing, did not dispute that Petitioner’s countable assets exceeded $2,000 as of October 31, 2024. Rather, she argued that her mother, whose monthly income was $889, who died with less than $2,000 in countable assets, and who had set aside a modest amount for burial was in a demographic of people who the Medical Assistance program is intended to serve. She also testified that she believes Petitioner’s family was not given the best advice by the Aging and Disability Resource Center. I cannot comment on the adequacy of the advice the family received. However, I understand the frustration of Petitioner’s daughter.
I understand that the circumstances in this case have caused additional stress at an already difficult time for Petitioner’s family. I also understand that this decision will likely result in the skilled nursing facility not receiving full payment for care provided to Petitioner in the month of October 2024. However, as an administrative law judge, I am required to apply the laws and regulations as they are written. The relevant law here provides no leeway and I thus have no discretion to order the agency to find Petitioner eligible in a month that her assets exceeded the program limit by any amount.
Conclusions of Law
Petitioner’s countable available assets, as of October 31, 2024, exceeded $2,000; the agency thus correctly found that she was not eligible for Institutional Medical Assistance in that month.
THEREFORE, it is
Ordered
That Petitioner’s appeal is dismissed.
[Request for a rehearing and appeal to court instructions omitted.]
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