731 N.E.2d 1154 | Ohio Ct. App. | 1999
We conclude that the retirement account and the proceeds therefrom were properly included as a countable resource under the Medicare Catastrophic Coverage Act of 1988,
In response to the application, MCDHS proceeded to perform a resource assessment. The assessment showed that Mannix and her husband had total resources [assets] in excess of $45,000. Pursuant to relevant regulations, one-half of the assets were allocated to Mannix and one-half were allocated to her husband. Since Mannix's share of the resources exceeded the maximum allowable amount of resources permitted by regulation, MCDHS ruled that Mannix was ineligible for benefits through December, 1997.
In the meantime, Mannix had filed a second application for Medicaid benefits. An updated resource assessment was completed, which showed that Mannix's husband had received a lump-sum payment from his retirement account. The account was not included in the original resource assessment. MCDHS determined that, with the retirement account proceeds, Mannix had resources in excess of $183,000, and denied her Medicaid eligibility.
Mannix again requested a hearing on the denial of both applications. The denial was upheld in May, 1998. Thereafter, Mannix took an administrative appeal regarding both denials. The Hearing Examiner denied the appeal; however, *597 the examiner ordered MCDHS to include the retirement account in the original assessment.
Mannix perfected an administrative appeal to the Montgomery County Court of Common Pleas. On appeal, Mannix claimed that the denial of benefits was erroneous, and that the proceeds from the retirement account should not have been included in the original assessment. The Common Pleas Court denied Mannix's appeal. Mannix now appeals from the judgment of the Common Pleas Court.
The denial of appellant's application for Medicaid benefits and the decision of the common pleas court affirming this denial is contrary to law since appellant has met all eligibility criteria.
Mannix contends that the Montgomery County Common Pleas Court erred by affirming the denial of her application for Medicaid benefits. Specifically, she argues that the retirement account must be excluded from consideration in the resource assessment pursuant to
Medicaid was enacted in 1965 as Title XIX of the Social Security Act. Its purpose was to make assistance available to individuals classified as "categorically needy." Martin v. OhioDepartment of Human Services (Nov. 20, 1998), Champaign App. No. 98 CA 7, unreported. The Act also provides for assistance to people who are not eligible for welfare benefits but whose resources are too low to meet their medical expenses. Id.
In 1988, Congress enacted the Medicare Catastrophic Coverage Act, codified at
In Martin, Judge Brogan discussed how the purpose of the MCCA is effectuated:
The MCCA permits the spouse living outside the nursing home (designated the "community spouse") to keep half of the couple's resources, generally, without affecting the eligibility of the spouse within the nursing home (designated the "institutionalized spouse"). After the equal division, the community spouse's share must fit within certain minimum and maximum amounts that are indexed to inflation. The adjusted amount is designated the Community Spouse Resource Allowance (CSRA). Section 1396r-5(f)(2). Any of the couple's resources that are not part of the CSRA, and are not otherwise excluded from consideration, are deemed available to the institutionalized spouse. The institutionalized spouse may then spend down any amount in excess of the eligibility levels to receive Medicaid benefits. Id. at 518-519, 720 N.E.2d at 581.
The MCCA specifically defines "resources" as excluding items excluded pursuant to
We turn first to Mannix's ERISA argument. As previously stated, Mannix's husband received a lump-sum payment from his retirement account and converted the proceeds into an Individual Retirement Account. Therefore, the account was no longer subject to protection pursuant to ERISA. As set forth in our opinion inMartin, IRA's are includable resources for purposes of determining Medicaid eligibility. However, even if the account had not been converted, we would find the account to be an includable asset.
Mannix argues that exclusion is mandated by 42 U.S.C. § 1056 [ERISA] because of the regulation set forth at 20 C.F.R. § 416.1210(j). We note that 20 C.F.R. § 416.1210 was promulgated to implement
Payments or benefits provided under a Federal statute other than title XVI of the Social Security Act where exclusion is required by such statute.
Mannix argues that the retirement plan is a payment or benefit provided under a Federal statute; specifically the ERISA statute. She also argues that ERISA requires exclusion because the ERISA statute provides that pension plan benefits "may not be assigned or alienated." *599
We are not persuaded by this argument. First, the mere inclusion of a pension plan in a resource assessment to determine Medicaid eligibility does not constitute the assigning or alienating the benefits. Second, a closer examination of the applicable regulations reveals that, for purposes of 20 C.F.R. § 416.1210(j), "payments or benefits" do not include pension-retirement plans protected by the ERISA statute. See 20 C.F.R. 416.1236(a).
We next turn to Mannix's argument that exclusion is mandated by 20 C.F.R. § 416.1202(a). Mannix contends that by including the retirement plan in the resource assessment, the purpose of 20 C.F.R. § 416.1202(a) is nullified. We need not address this argument, since it has already been rejected by our opinion inMartin, supra, wherein we determined that the MCCA directly supersedes any conflicting provisions of the Federal Code.
Mannix also argues that when a community spouse refuses to use resources held solely in his own name to support the institutionalized spouse, eligibility must be granted if the resources of the institutionalized spouse fall within the eligibility limits. She argues that she is therefore eligible based upon her husband's refusal to support her. The trial court found that this issue was not raised at the administrative level and was not, therefore, preserved for review. Mannix contends that this issue was properly raised; however, she fails to refer to any portion of the record in support of this contention. Moreover, from our review of the record, it does not appear that this issue was ever raised at the administrative level. Therefore, we find that Mannix has not properly preserved this issue for review on appeal. See, Loyal Order of Moose Lodge No.1473, Celina v. Ohio Liquor Control Comm. (1994),
We finally address Mannix's claim that the trial court was authorized to grant the community spouse a larger share of the combined spousal resources. She relies upon
Neither of these provisions permits a common pleas court to enter the type of order requested by Mannix.
Likewise, the provision of the Ohio Administrative Code cited by Mannix does not provide any authority for a common pleas court to enter an order of spousal support upon administrative review. Instead, it merely indicates the method for determining the amount of resources that may be transferred to the community spouse.
Finally, we find that by ordering that the retirement plan proceeds shall be included in the original assessment, the Hearing Examiner ensured that the community spouse will be granted a larger share of the resources. Specifically, the original assessment only included approximately $45,000 in resources. Therefore, Mannix's husband was only entitled to roughly one-half, or $22,500, of that amount as his Community Spouse Resource Allowance. When the assessment update was performed, Mannix's husband was limited to the original $22,500 spousal allowance and thus, the bulk of the retirement plan was allocated to Mannix. By amending the original resource assessment to include that retirement plan, the includable resources will be higher and the community spouse will be awarded aproximately one-half of that greater amount.
After review of all issues raised by Mannix on appeal, we conclude that the trial court did not abuse its discretion by affirming the decision of the administrative agency. Accordingly, Mannix's sole Assignment of Error is overruled.
WOLFF and YOUNG, JJ., concur. *601