The asset limit for Institutional MA is $2,000. In this case, the petitioner misidentified a savings account as life insurance on her application. The county worker, who was “simply scanning the application” at the time, advised the petitioner’s daughter that life insurance had a $1,500 exemption, not discovering the error until the following month. ALJ Brian Schneider concluded the county worker had not misled the petitioner and, even if the worker had, there was no remedy.
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 January 11, 2001, under Wis. Stat., §49.45(5), to review a decision by the Winnebago County Dept. of Social Services to deny Medical Assistance (MA), a hearing was held on February 21, 2007, at Neenah, Wisconsin.
The issue for determination is whether petitioner’s assets were over the MA limit prior to December, 2006.
There appeared at that time and place the following persons:
PARTIES IN INTEREST:
Petitioner:
—
Respondent:
Wisconsin Department of Health and Family Services
Division of Health Care Financing
1 West Wilson Street, Room 250
P.O. Box 309
Madison, WI 53707-0309
By: Mary Beth Gehrke, ESS
Winnebago County Dept Of Human Services
211 N. Commercial Street
Neenah, WI 54956-2616
ADMINISTRATIVE LAW JUDGE:
Brian C. Schneider
Division of Hearings and Appeals
Findings of Fact
- Petitioner (CARES # —) is a resident of Winnebago County.
- An application for MA was filed on petitioner’s behalf on November 15, 2006. On the application petitioner listed bank accounts totaling approximately $3,900, and “life insurance” at Community First Bank with a balance of $1,603. A worker from the county advised petitioner’s daughter that assets had to be below $2,000, and that life insurance had a $1,500 exemption.
- Petitioner’s daughter met with her processing worker on December 12. At that meeting the worker discovered that the account listed as life insurance was actually a savings account with a death benefit.
- Petitioner’s accounts, less her social security received each month, totaled $4,572 at the end of October, 2006, and $2,578 at the end of November.
- Assets were reduced below $2,000 on December 12, 2006, and institutional MA opened effective December 1, 2006.
- By a notice dated December 19, 2006, the county informed petitioner that MA was granted effective December 1, but denied for October and November because assets were over the limit.
Discussion
The MA asset limit for an individual is $2,000. Wis. Stat., §49.47(4)(b)3m. If assets are above that limit, the person is not eligible for MA. The statute does not allow for outstanding debts to be deducted from assets, nor does it provide any exceptions for unusual situations.
Petitioner’s daughter complained that the worker who spoke with her in November did not inform her that the Community First account was not a life insurance policy. The worker testified that it was listed on the application as life insurance, and at that point she was simply scanning the application. It was not until the county actually received a copy of the bank statement that it became apparent that the account was a savings account, not a life insurance policy. I cannot find that the county misled petitioner’s daughter (I note that there likely would be no remedy even if the worker had misled petitioner’s daughter).
Petitioner also argues that she likely will be evicted from the nursing home due to the non-payment of bills, and the eviction would be a hardship. There is nothing in state MA law that allows the Division of Hearings and Appeals to make an exception to the asset limit rule for cases of hardship.
Petitloner provided copies of two Elder Law News bulletins with highlighted portions suggesting that unpaid nursing home bills from the period prior to eligibility could be used to offset petitioner’s monthly cost of care. Prior Division of Hearings and Appeals decisions have held that Wisconsin does not allow preexisting nursing home bills to be used as an offset against cost of care requirements. See, e.g., case no. MED-14/72307, dated March 17, 2006.
Conclusions of Law
The county correctly determined that petitioner’s assets were over the MA limit in October and November, 2006.
THEREFORE, it is
Ordered
That the petition for review herein be and the same is hereby dismissed.
[Request for a rehearing and appeal to court instructions omitted.]
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