2014 Ohio 4646
Ohio Ct. App.2014Background
- Paul Koenig entered a nursing facility March 15, 2011; the couple had about $349,806 in countable resources and a calculated CSRA of $109,560.
- On October 26, 2011 (after institutionalization but before Medicaid eligibility was determined), Elaine Koenig paid $121,783.56 for a single-premium, irrevocable annuity that paid her monthly for five years and named Ohio as a remainder beneficiary “up to amount of benefits received by Elaine Koenig.”
- Hamilton County JFS approved Mr. Koenig’s Medicaid application but imposed a period of restricted coverage based on a finding that the annuity purchase was an improper transfer.
- Administrative hearings upheld the agency’s decision; Mrs. Koenig (as estate administrator) appealed to the common pleas court and challenged the restricted-coverage determination.
- The trial court found the agency waived a technical annuity-compliance argument and concluded the annuity was not an improper transfer; ODJFS appealed to this court.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether a community spouse’s purchase of an annuity after institutionalization but before Medicaid eligibility is an improper transfer | Koenig: pre-eligibility annuity purchase is allowed and was for spouse’s sole benefit | ODJFS: transfers exceeding CSRA after institutionalization require agency approval and may be improper | Court: follow Hughes — pre-eligibility transfers fall under the unlimited "sole benefit" provision; not an improper transfer |
| Whether the annuity failed to meet Ohio Adm.Code 5160:1-3-22.8 remainder-beneficiary technical requirements | Koenig: agency waived this argument by not raising it at administrative level | ODJFS: the annuity named Ohio incorrectly (tied to benefits received by Elaine rather than amount paid for Mr. Koenig) | Court: ODJFS waived the argument on appeal; cannot reinstate restricted coverage on that unpreserved ground |
Key Cases Cited
- Hughes v. McCarthy, 734 F.3d 473 (6th Cir. 2013) (preeligibility annuity purchases by community spouse fall under the "sole benefit" transfer provision and are not improper transfers)
- Wisconsin Dept. of Health & Family Servs. v. Blumer, 534 U.S. 473 (U.S. 2002) (states must implement Medicaid rules consistent with federal statutes protecting community spouses)
- Morris v. Oklahoma Dept. of Human Servs., 685 F.3d 925 (10th Cir. 2012) (distinction between preeligibility and posteligibility transfer rules informs harmonization of statutory provisions)
- Miller v. Dept. of Indus. Relations, 17 Ohio St.3d 226 (Ohio 1985) (standards for judicial review of administrative decisions)