Estate of Atkinson v. Ohio Dept. of Job & Family Servs. (Slip Opinion)
144 Ohio St. 3d 70
| Ohio | 2015Background
- Marcella Atkinson entered a nursing facility on April 25, 2011; Ohio took a "snapshot" of the couple’s resources that day for CSRA purposes.
- The Atkinsons had a house in a revocable trust valued at $53,750; their combined resources at snapshot produced a CSRA of $49,160 for Raymond (community spouse).
- The couple applied for Medicaid on June 16, 2011. On August 8–9, 2011, title to the home was moved (trust → Marcella → Raymond), transferring $53,750 to Raymond before Medicaid eligibility was determined.
- The agency approved Marcella for Medicaid effective August 1, 2011, but delayed payment and imposed a transfer penalty, treating the August transfer as improper and calculating a period of ineligibility under 42 U.S.C. §1396p penalty rules.
- The estate argued transfers of the marital home between spouses are exempt from penalty and that federal CSRA law permits transfers before eligibility; the state argued transfers above the CSRA are improper and that the CSRA cannot be increased without a hearing.
- The Ohio Supreme Court affirmed in part (CSRA limits apply) but remanded because the agency may have applied incorrect penalty provisions and should instead follow the CSRA enforcement procedures in 42 U.S.C. §1396r-5 and Ohio Adm.Code 5160:1-3-36.1(E).
Issues
| Issue | Plaintiff's Argument (Atkinson) | Defendant's Argument (State) | Held |
|---|---|---|---|
| Whether federal law permits unlimited transfers of assets from an institutionalized spouse to a community spouse between institutionalization and Medicaid eligibility | Transfers of the home between spouses before eligibility determination are exempt under 42 U.S.C. §1396p(c)(2)(A)(i) and thus not penalizable | Transfers exceeding the CSRA after snapshot are improper; §1396r‑5 governs and limits transfers to the CSRA | Transfers between spouses are limited by the CSRA; §1396r‑5 controls and §1396p penalties do not allow unlimited transfers |
| Whether Ohio regulation permits unlimited spouse-to-spouse transfers pre-eligibility | Ohio Adm.Code 5160:1-3-07(E) exempts spousal home transfers from penalty | Ohio Adm.Code 5160:1-3-07(G) and 5160:1-3-36.1 require CSRA limits and a hearing to increase CSRA | State rules consistent with federal CSRA limits; transfers above CSRA are improper absent hearing; agency must follow 5160:1-3-36.1(E) procedures |
| Proper remedy and penalty framework to address transfers above CSRA | Transfer of home should be treated as exempt; no §1396p penalty | Agency may enforce collection/make resources above CSRA available; penalties under §1396p were applied | Court held agency erred to apply §1396p(c)(1)(E) confiscatory penalty here; remand to apply §1396r‑5(c)(2)(B) and Ohio Adm.Code 5160:1-3-36.1(E) and adjust remedy accordingly |
| Applicability of Hughes (6th Cir.) on annuities and pre-eligibility transfers | Hughes supports allowing pre-eligibility transfers to community spouse free of penalty | Hughes is distinguishable (annuity context) and does not authorize exceeding CSRA | Court found Hughes inapposite to allow unlimited transfers; CSRA constraint controls, though Hughes influenced analysis of timing issues |
Key Cases Cited
- Schweiker v. Gray Panthers, 453 U.S. 34 (U.S. 1981) (background on Medicaid program expansion)
- Wisconsin Dep't of Health & Family Servs. v. Blumer, 534 U.S. 473 (U.S. 2002) (interpreting CSRA and that transfers fund only the community spouse’s CSRA share)
- Hughes v. McCarthy, 734 F.3d 473 (6th Cir. 2013) (annuity-transfer decision on timing of transfers; considered but distinguished)
- Morris v. Oklahoma Dept. of Human Servs., 685 F.3d 925 (10th Cir. 2012) (temporal analysis of §1396p and §1396r-5; cited in timing argument)