In three consolidated cases,
Hegadorn v DHHS,
No. 329508, the court
looked at the individual funding of long-term care under Medicaid deciding that
assets placed by an institutionalized individual’s spouse into a “Solely for
the Benefit of” Trust (“SBO Trust”) are countable assets for determining
whether the institutionalized individual is eligible for Medicaid benefits.
FACTS:
The
facts in each case are identical. Mary Ann Hegadorn, Dorothy Lollar and Roselyn
Ford began receiving long-term care at nursing homes. Within a short time after
receiving care, their spouses established “Solely for the Benefit” (SBO)
trusts. After the trusts were established, the women applied for Medicaid
benefits. The Department of Health and Human Services (the Department) denied
their applications determining that each had countable assets, including those
placed in the SBO trusts, exceeding the applicable Medicaid benefits
eligibility.
Each
appealed to an Administrative Law Judge and in each case, the ALJ affirmed the
Departments initial asset assessment that because the assets of the parties
were in existence when the women entered long-term care, they must be counted
in determining eligibility.

In
each case, the plaintiffs appealed the ALJ’s decision to the circuit court. Livingston
Circuit Judge Michael P. Hatty reversed the ALJ's decisions to affirm the
Department’s denial of Mrs. Hegadorn’s and Mrs. Lollar’s applications. Judge Hatty
explained that as of the date of the filing of the request for benefits, the
assets placed in an SBO trust were not countable to the institutionalized
spouse. Later, the Department made a change in policy which would include the
assets, adversely affecting the parties. Relying on Hughes v McCarthy, 734 F.3d 473 at 480, he set aside the order of
the ALJ on both files. Washtenaw Circuit Judge Timothy P. Connors, relying on
Judge Hatty’s reasoning also reversed the ALJ’s decision in the third case.
The
MCOA concluded that the circuit courts did not apply the correct legal
principles in these appeals, reversing the circuit court’s orders and
reinstating the decisions reached by the ALJs.
ANALYSIS:
According
to the MCOA, each trust at issue in this case was a Medicaid trust. Using the
guidance of Bridges Eligibility Manual which stated that the amount of the
principal of a trust that is a countable asset depends on the terms of the
trust.
Thus,
the issue before the court is whether “there is any condition under which the
principal could be paid to or on behalf of the institutionalized person from an
irrevocable trust.”
After
reviewing the sections of each trust title “Distribution of Assets,” the court
concluded that the trust assets placed into each trust shortly before the
Medicaid applications were filed are to be “use[d] up” during the husbands’
lifetimes. Similarly, all three trusts included language that instructs the
trustees to distribute the assets “on an actuarially sound basis,” which means
that the “spending must be at a rate that will use up all the resources during
the party’s lifetime.”
Thus,
the court concluded, because there was a “condition under which the principal
could be paid to or on behalf of the person from an irrevocable trust,” the
assets in the trusts were properly determined to be countable assets by the
Department.”
The MCOA disagreed with the plaintiff’s argument
re: the following:
The
Department didn’t impermissibly change its policy—the change was a
clarification of the way it had treated SBO trust assets for
Medicaid-eligibility purposes, explaining that the change was required in order
to comply with federal mandates, but that is not a change in law or policy.
Retroactive
application---plaintiffs argue that the change was inapplicable to them
because the change cannot be retroactively applied. The court disagreed. First, there could be severe
consequences statutorily imposed on the Department should it choose not to
comply with the federal requirements. Second,
the plaintiffs and amicus do not cite, and we are unable to find, any authority
to support the proposition that individuals who are not entitled to Medicaid
benefits should nevertheless receive them based on an alleged change in
interpretation of applicable state and federal authority.
After
a review of federal statutes and related administrative manuals, the court
concluded that the clear legislative language that Congress intended that when
making an initial eligibility determination, states are to consider assets held
by the institutionalized spouses—in this case, the plaintiffs—and the community
spouses—in this case, the plaintiffs’ husbands.
Accordingly,
the court held the assets were countable and reversed the circuit courts’
orders providing otherwise and reinstate the decisions reached by the ALJs.
Keep
watching—this matter has been appealed to the Michigan Supreme Court. We’ll
keep you posted.
Labels: countable asset, elder law appeal, long-term care, medicaid benefits, medicaid trust, SBO trust, Soley for the Benefit Trust, trust assets