Comis v. Bullen

No. 94-4513-H (Mass. Super. Ct. Suffolk County filed Apr. 3, 1995) ; Clearinghouse Number: 50722

Description

Community Spouses of Institutionalized Medicaid Recipients Challenge Massachusetts Rule Deeming Income to Them Before Determining Their Resource Allocation

Abstract

The parties have filed their motions for summary judgment in this class action challenging a rule promulgated by defendant Commissioner of the Massachusetts Division of Medical Assistance that impoverishes the surviving spouses of nursing-home residents. Plaintiffs, community spouses of Medicaid applicants who reside in nursing homes, allege that, when a nursing-home resident applies for Medicaid, the state agency computes a monthly minimum maintenance needs allowance (MMMNA) for the applicant’s community spouse. In addition, the agency determines the community spouse resource allocation (CSRA) or that portion of the couple’s assets that the community spouse may keep. If the CSRA is insufficient to bring the community spouse’s income up to his or her MMMNA, either spouse may request a fair hearing to revise the CSRA. Finally, after the institutionalized spouse attains Medicaid eligibility, the community spouse maintenance income allowance (CSMIA) may be applied to shift income from the institutionalized spouse to the community spouse if the latter’s income does not meet his or her MMMNA. Plaintiffs allege that the challenged rule requires hearing officers to deem to the community spouse an amount equal to the CSMIA deduction at the hearing to revise the CSRA. Plaintiffs claim that, in effect, this rule applies the CSMIA deduction before the revised CSRA procedure, in violation of 42 U.S.C. § 1396r-5. Plaintiffs argue that the regulation militates against the policy objectives of the Medicare Catastrophic Coverage Act, which was intended to prevent permanent impoverishment of community spouses of institutionalized Medicaid recipients. Plaintiffs also claim that the challenged rule violates state law, which requires the Division of Medical Assistance to notify each applicant for nursing-home benefits that additional assets must be awarded in order to close the gap between the community spouse’s MMMNA and his or her “actual income.”

Additional Information

Attorney Information
Plaintiffs represented by John Ford, Neighborhood Legal Services, 37 Friend St., Lynn, MA 01902, (617) 599-7730; Daniel Bartley; Harry Margolis; Peter Macy.
Docket Date
1995-04-03 00:00:00+00:00