This month, the Marion County Superior Court issued an important ruling affecting residents of skilled nursing facilities in the state of Indiana, specifically residents applying for Medicaid who have uncooperative spouse residing in the community (aka community spouses). When determining Medicaid eligibility for married residents, the Indiana Family and Social Services Administration (“FSSA”) requests the financial records of both the resident and the resident’s community spouse. Problems arise when the community spouse is estranged, or otherwise uncooperative, and fails to respond to efforts to secure his/her financial records in support of their spouse’s Medicaid application.
In the matter before the Court, the nursing home facility resident was unable to secure the records of his community spouse. The resident prepared and provided a statement to the FSSA detailing that he was estranged from his community spouse and assigned all rights to spousal support to the State of Indiana. Despite these actions, the FSSA denied the resident’s application for Medicaid benefits on the basis that the information the agency requested regarding spousal income was not provided. The matter was appealed to the Office of Administrative Law Proceedings, which upheld the denial. A Petition for Judicial Review was then filed before the Marion County Superior Court which granted the Petition and ruled in the resident’s favor.
Among the notable holdings from the Marion County Superior Court:
- If there is evidence that the couple are estranged and/or not living together, consistent with federal and state Medicaid regulations, the resources of the community spouse cannot be examined in the Medicaid resource assessment of the Medicaid beneficiary;
- Regardless of issues pertaining to estrangement or breakdown of the marriage, if the Medicaid applicant executes a valid assignment of spousal support rights to the state, the Medicaid agency cannot deny eligibility to the Medicaid applicant by reason of resources available to the Medicaid applicant from the community spouse, consistent with 42 U.S.C. § 1396r–5(3).
This ruling will have a huge impact on Indiana Medicaid applicants with uncooperative or uncommunicative spouses, which unfortunately is not uncommon.
If you would like to discuss this ruling further, secure a copy of the ruling, or would like additional information on what constitutes a valid assignment of spousal support rights, please reach out to us!