Colonial Park Care Center, LLC v. Department of Public Welfare
123 A.3d 1094
| Pa. Commw. Ct. | 2015Background
- Colonial Park petitions for review of two DPW Chief ALJ orders affirming an ALJ decision in consolidated MA/LTC appeals.
- Matjasic, institutionalized at Colonial Park, and his community spouse received transfers totaling $125,218.44 with $10,000 acknowledged as fair consideration; transfers occurred within a five-year look-back to Nov 1, 2007.
- DPW found a LTC ineligibility period due to transfers for less than FMV; the August 2013 determination set ineligibility through March 4, 2014, based on $135,218.44 transferred, with stipulation affecting the amount.
- The August 2014 ALJ decision denied in part Colonial Park’s transfer-penalty appeal, holding the transfers were made to qualify for MA and rejecting estate-planning or unfixed-anticipated-event defenses; UV calculation corrected to reflect actual $118,000 transferred.
- The Chief ALJ affirmed; Colonial Park challenged both the transfer-penalty and undue-hardship determinations, arguing the seizure was unforeseen and gifting was estate planning.
- The court ultimately affirms both orders, applying the presumption that transfers during the look-back were for MA and upholding DPW’s interpretation of undue-hardship criteria.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether transfers were made to qualify for MA rather than estate planning. | Colonial Park argues transfers were preplanned estate planning unrelated to MA eligibility. | DPW contends transfers were for MA qualification, carrying a presumption that they were to qualify for MA. | Transfers were for MA qualification; presumption upheld; substantial evidence supports DPW. |
| Whether there was an undue hardship warranting waiver despite transfers. | Colonial Park asserts unexpected seizure post-transfer constituted undue hardship. | DPW and Chief ALJ found seizure not unexpected and no undue hardship occurred. | Undue hardship waiver denied; seizure not sufficiently unexpected; no grounds for waiver. |
Key Cases Cited
- Godown v. Department of Public Welfare, 813 A.2d 954 (Pa.Cmwlth.2002) (presumption of MA eligibility and transfer purpose analysis)
- Lancashire Hall Nursing & Rehab. Ctr. v. Dep’t of Pub. Welfare, 995 A.2d 540 (Pa.Cmwlth.2010) (counting combined resources under MA eligibility rules)
- Novitsky v. Dep’t of Pub. Welfare, 42 A.3d 1165 (Pa.Cmwlth.2012) (payers of last resort; DPW as payer of last resort)
- Ptashkin v. Dep’t of Pub. Welfare, 731 A.2d 238 (Pa.Cmwlth.1999) (principles on MA eligibility and penalties)