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On this week’s episode, Kurtis is joined by Harold Grodberg, Esq., Certified Elder Law Attorney, to discuss how to apply for Medicaid and make sure you get the coverage right for you.
Herman Vollmann received Medicaid benefits while he resided at two different nursing homes. After he died, the state filed a claim against his estate for $22,978.35 to recoup Medicaid benefits paid on his behalf. The amount was based on the per diem rate calculated under the state’s Medicaid plan.
Mr. Vollmann’s estate disallowed the claim, and the state petitioned the court. Both parties asked for summary judgment. The estate argued that the state was entitled to recover only medical expenses, which totaled $360.45. The trial court granted summary judgment to the state, and the estate appealed.
The Nebraska Supreme Court affirms, holding that the state can recover nursing home services that include non-medical expenses. According to the court, “‘medical assistance’ provided to a Medicaid recipient includes costs for his room and board and other ‘nonmedical’ expenses at nursing facilities.”
To read an article from the Omaha World Herald about the case, click here.
For the full text of this decision, click here.
Cora Sue Bell’s husband, Robert, resided in a nursing home for a few months before he died, accruing $1,678 in unpaid nursing services.
The nursing home sued Mrs. Bell under Ohio’s necessaries statute. The statute requires a married person to pay for a spouse’s necessities if the spouse is unable to support him- or herself. Mrs. Bell argued that Mr. Bell could support himself because he had 54 days of skilled nursing home Medicare coverage remaining. The trial court granted summary judgment to Mrs. Bell, ruling that the nursing home was required to pursue a claim against Mr. Bell’s estate before pursuing a claim under the necessaries statute. The nursing home appealed.
The Ohio Court of Appeals, 12th District, reverses, holding that summary judgment is not appropriate because more facts are needed to determine whether Mr. Bell could support himself. The court rules that the necessaries statute creates a separate cause of action that is not dependent on pursuing a claim against the estate. According to the court, the fact that Mr. Bell had insurance policies through Medicare that may have covered the nursing costs is not enough to affirmatively demonstrate that the nursing home “could not establish the inability to support element of its necessaries claim.”
For the full text of this decision, go to: http://www.supremecourt.ohio.gov/rod/docs/pdf/12/2017/2017-Ohio-1499.pdf
A Florida appeals court rules that the state is not required to deduct all of a Medicaid applicant’s pre-eligibility nursing home expenses from the applicant’s income when calculating the applicant’s monthly contribution to nursing home costs. Goodwin v. Florida Agency for Health Care Administration (Fla. Ct. App., 1st Dist., No. 1D12-4430, April 4, 2016).
After Gabrielle Goodwin injured her spinal cord, she entered a nursing home. She applied for Medicaid through a program that required her to contribute to her cost of care by paying a monthly co-pay that was based on her income. To calculate Ms. Goodwin’s patient responsibility amount (PRA), the state is required to deduct unpaid medical expenses from Ms. Goodwin’s income. The state calculated Ms. Goodwin’s PRA at $1,000.
Ms. Goodwin appealed, arguing that the state should have deducted all of her unpaid, pre-eligibility nursing home expenses — about $70,000 — from her income. The state denied her appeal, ruling that federal regulations require the state to deduct medical care not covered under the state’s Medicaid plan and that Ms. Goodwin’s care was covered. Ms. Goodwin appealed to court, arguing that covered care only included care the state actually paid for.
The Florida District Court of Appeal, First District, affirms, holding that the state is not required to deduct all of Ms. Goodwin’s pre-eligibility nursing home expenses. According to the court, because the state’s “Medicaid program routinely includes and covers the nursing home care that Ms. Goodwin received” before becoming eligible for Medicaid, the state considers them Medicaid-covered expenses.
For the full text of this decision, go to: https://edca.1dca.org/DCADocs/2012/4430/124430_DC05_04042016_094233_i.pdf