A divestment does not make a person ineligible for Medicaid if the resource was transferred exclusively for some purpose other than to become eligible. In this case, the petitioner’s daughter transferred $7,064.85 to herself so she could pay his bills. ALJ Michael O’Brien concluded this was not a divestment, but also concluded: “if the transferred funds are not considered a divestment, they remain attributed to him,” putting him over the $2,000 resource limit.
This decision was published with support from the Elder Law & Special Needs Section of the State Bar of Wisconsin and the Wisconsin chapter of the National Academy of Elder Law Attorneys. Thanks also to Attorney Andy Falkowski, who donated this decision from his file.
Preliminary Recitals
Pursuant to a petition filed July 09, 2009, under Wis. Admin. Code § HA 3.03(1), to review a decision by the Price County Department of Social Services in regard to Medical Assistance, a hearing was held on September 01, 2009, at Phillips, Wisconsin.
The issue for determination is whether the petitioner’s assets made him ineligible for medical assistance in January 2009.
There appeared at that time and place the following persons:
PARTIES IN INTEREST:
Petitioner:
—
Respondent:
Department of Health Services
1 West Wilson Street, Room 651
Madison, Wisconsin 53702
By: Dawn Anderson, ESS
Price County Department of Social Services
PO Box 88
Normal Bldg., 104 S. Eyder Avenue, Rm. 1
Phillips, WI 54555
ADMINISTRATIVE LAW JUDGE:
Michael D. O’Brien, Attorney
Division of Hearings and Appeals
Findings of Fact
- The petitioner (CARES # —) resides in Price County.
- The petitioner applied for medical assistance on April 27, 2009, requesting eligibility
retroactive to January 1, 2009. - On January 13, 2009, the petitioner’s daughter had closed his bank account and transferred its $7,064.85 into an account in her name so that she could pay his bills.
- The county agency determined that the transfer was a divestment that left the petitioner ineligible for medical assistance for 34 days.
- When the transferred money is considered, the petitioner’s assets exceeded $2,000 until after January 2009.
Discussion
Medical assistance eligibility can be made retroactive to “the first day of the month 3 months prior to the month of application.” Wis. Adm. Code § DHS 103.08(1). A person cannot receive institutional medical assistance if his assets exceed $2,000. See Wis. Stat. §§ 49.46(1) and 49.47(4). Generally, a person cannot reach this limit by giving away his assets. This is considered a divestment, which occurs when a person seeking medical assistance “disposes of resources at less than fair market value.” Wis. Adm. Code, § DHS 103.065(4)(a). If the person improperly divests his assets, he is ineligible for institutional medical assistance for the number of months obtained by dividing the amount given away by the statewide average monthly cost to a private pay patient in a nursing home at the time he applied. Wis. Adm. Code, § DHS 103.065(5)(b). However, a divestment does not make a person ineligible if the “resource was transferred exclusively for some purpose other than to become eligible for MA.” DHS 103.065(4)(d)2.b.
The petitioner applied for medical assistance on April 27, 2009, requesting eligibility retroactive to January 1, 2009. On January 13, 2009, his daughter had closed his bank account and transferred the $7,064.85 in it into an account in her name so that she could pay his bills. The county agency determined that this transfer was a divestment that left the petitioner ineligible for medical assistance for 34 days. I disagree because the money was not transferred to make the petitioner eligible for medical assistance. However, he must still show that his assets did not exceed $2,000, and if the transferred funds are not considered a divestment, they remain attributed to him. His daughter submitted bank records showing that she did not pay any of the petitioner’s bills until February 2009. Although the petitioner probably had enough bills in January to bring his assets below $2,000, debts are not subtracted from assets when determining medical assistance eligibility. Therefore, I find that although the petitioner did not divest assets, he was ineligible for medical assistance in January 2009.
Conclusions of Law
- The petitioner did not improperly divest funds when he transferred the money in his bank account to his daughter’s account because he did not do so to become eligible for medical assistance.
- The petitioner was ineligible for medical assistance in January 2009 because his assets exceeded $2,000 that month.
THEREFORE, it is
Ordered
That the petitioner’s appeal is dismissed.
[Request for a rehearing and appeal to court instructions omitted.]