The Director of New Jersey Medicaid recently decided that, when a couple is institutionalized, the resources of the couple are not combined when determining Medicaid eligibility. Rather, the resources of each spouse must be considered separately. Therefore, when only one spouse applies for Medicaid benefits and that spuse’s resources alone do not exceed the resource limit, the applicant must be found eligible for Medicaid even when, as in this case, the non-applicant spouse owns more than $300,000 in countable resources. R.L. v. Passaic County Board of Social Services (OAL DKT NO. HMA 00849-11, June 14, 2011)
In February 2010, R.L. and her husband G.L. were admitted to a nursing home in Wayne, NJ. In August 2010, R.L. completed an application for nursing home Medicaid benefits. G.L. continued to pay privately for nursing care from his own funds. The application showed that, between 2008 and 2010, R.L. had transferred $310, 906.11 into her husband’s sole name. At the time the Medicaid application was filed, R.L. had only $2,000 titled in her own name. The Passaic County Board of Social Services denied R.L.’s Medicaid application, holding that the applicant’s resources, when combined with her husband’s resources, exceeded $3,000, the resource limit for a couple.
R.L. filed a request for a Fair Hearing. The administrative law judge (ALJ) hearing the case framed the issue as follows: “Can the combined spousal resource be transferred into one spouse’s name for the purpose of qualifying the other spouse for Medicaid benefits?” The ALJ found that, although the transfers of assets between the spouses were exempt and did not impact on R.L.’s Medicaid eligibility, the total countable resources of the couple cannot exceed $3,000 under the Medicaid rules. Since R.L.’s resources, when combined with those of her husband, exceeded the $3,000 resource limit, the ALJ affirmed the decision denying Medicaid benefits.
R.L. filed exceptions to the ALJ’s decision and the case was reviewed by the Director of the Division of Medical Assistance and Health Services, New Jersey’s State Medicaid agency. In a written opinion dated September 12, 2011, the Director reversed. The Director held that, in the “unusual case” such as this one in which both members of the couple are institutionalized but only one spouse applies for Medicaid, “the couple is treated as two separate individuals whose assets are not commingled” in determining Medicaid eligibility. Since R.L.’s resources when considered separately do not exceed the resource limit for an individual applicant, R.L. is eligible for Medicaid even though her spouse owned more than $300,000 in countable resources.
The decisions of the ALJ and the Director of Medicaid agency are annexed here – R.L. v. Passaic County Board of Social Services
(Congratulations to my colleagues, Don McHugh and Vince Macri, who represented the petitioner in the R.L. case on this significant victory.)