Morris v. Oklahoma Department of Human Services
2012 U.S. App. LEXIS 13971
| 10th Cir. | 2012Background
- Medicaid rules for married couples under MCCA allow the community spouse to retain a CSRA while limiting resources for the institutionalized spouse.
- Annuities that meet statutory criteria can be treated as income, not resources, for Medicaid eligibility purposes.
- Morris couple applied for Medicaid under the Advantage Program; OKDHS denied due to excess resources after CSRA.
- They purchased an annuity for Mr. Morris to spend down resources; OKDHS still denied Mrs. Morris’s eligibility.
- District court granted summary judgment for OKDHS; the Morrises appealed seeking reversal.
- Court reverses and remands, holding that a qualifying annuity may render resources unavailable and transfers are governed by timing rules set by the statute.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| When does §1396r-5(f)(1) restriction apply? | Morris argues unlimited transfers apply before eligibility is determined. | OKDHS argues transfers after initial eligibility determination must not exceed CSRA. | §1396r-5(f)(1) applies after eligibility is determined; unlimited transfers may occur pre-eligibility. |
| Does purchasing a qualifying annuity convert resources into non-countable income for the community spouse? | Annuity should convert resources to income not counted against the institutionalized spouse. | Annuity might be treated as a resource; district court’s reasoning stands. | Qualifying annuities render resources unavailable to the institutionalized spouse and income is not counted. |
| Do transfers between spouses constitute a disqualifying transfer under the MCCA when pre-eligibility? | Transfers to the community spouse should not trigger penalties if they comply with CSRA. | Transfers beyond CSRA may trigger penalties. | Pre-eligibility unlimited transfers are permitted; transfer penalties apply only post-eligibility. |
| Is the CSRA a pre- or post-eligibility ceiling on transfers? | CSRA is a planning tool, not a hard pre-eligibility ceiling. | CSRA limits transfers during eligibility processes. | CSRA acts as a ceiling after eligibility; unlimited transfers can occur before eligibility determination. |
| Does date of application vs. date of annuity purchase affect eligibility timing? | Timing disputes require remand for factual resolution. | Timing not clearly resolved; district court decision stands. | Remand to resolve timing issues consistent with this opinion. |
Key Cases Cited
- Hutcherson v. Ariz. Health Care Cost Containment Sys. Admin., 667 F.3d 1066 (9th Cir. 2012) (annuity converts assets to income not counted for eligibility)
- Via Christi Reg’l Med. Ctr., Inc. v. Leavitt, 509 F.3d 1259 (10th Cir. 2007) (agency acknowledged annuity treatment in Medicaid)
- Lorillard v. Pons, 434 U.S. 575 (1981) (administrative interpretation of statutory provisions)
- Dobbs v. Anthem Blue Cross & Blue Shield, 600 F.3d 1275 (10th Cir. 2010) (regarding administrative interpretations and statutory structure)