MGE 175523 (09/27/2016)
Over-verification of annuity after appeal, and divestment hunting

Preliminary Recitals

Pursuant to a petition filed on July 12, 2016, under Wis. Stat. § 49.45(5), and Wis. Admin. Code § HA 3.03(1 ), to review a decision by the Barron County Department of Human Services regarding Medical Assistance (MA), a hearing was held on August 17, 2016, by telephone.

The issue for determination is whether the petitioner adequately verified his assets.

There appeared at that time the following persons:

PARTIES IN INTEREST:

Petitioner:
—

Petitioner’s Representative:
Attorney Peter E. Grosskopf
Grosskopf Law Office LLC
1324 W Clairemont Ave Ste 10
Eau Claire, WI 54701

Respondent:
Department of Health Services
1 West Wilson Street, Room 651
Madison, WI 53703
By: Sue Pruzek
Barron County Department of Human Services
Courthouse Room 338
335 E Monroe Ave
Barron, WI 54812

ADMINISTRATIVE LAW JUDGE:
Michael D. O’Brien
Division of Hearings and Appeals

Findings of Fact

1. The petitioner (CARES # —) is a resident of Barron County.
2. The petitioner applied for medical assistance on January 19, 2016, seeking benefits retroactive to December 1, 2016. The county agency denied his application because he did not adequately verify his assets.
3. The county agency requested disclosure of an annuity on February 10, 2016.
4. The petitioner through his attorney, who is competent in elder law matters, sought clarification on the requested annuity information multiple times from the CDPU. The CDPU never responded to these requests.
5. The Division of Hearings and Appeals concluded in an earlier decision concerning this matter that the county agency could not deny the petitioner’s medical assistance application for failing to verify an annuity because the Central Data Processing Unit did not respond to requests from the petitioner’s attorney that it clarify the information it sought. That decision also determined that the county agency now had all of the information it needed concerning the petitioner’s annuity to determine his eligibility. Decision No. MGE/172823.
6. In Decision No. MGE/172823, the Division of Hearings and Appeals ordered the county agency to continue processing the petitioner’s application and determine within 10 days whether he is eligible for benefits retroactive to December 1, 2015. That decision also gave him the right to file a new appeal if he disagreed with the decision.
7. The department did not appeal Decision No. MGE/172823.
8. The petitioner’s assets have not exceeded $2,000 since before January 1, 2016.

Discussion

This is the second appeal concerning the petitioner’s request for medical assistance eligibility retroactive to December 1, 2016. The earlier decision involved the department’s denial of benefits because the petitioner failed to verify various assets. The Division of Hearings and Appeals determined that the denial was incorrect because the petitioner requested clarification from the Central Data Processing Unit concerning exactly what was requested but the CDPU never provided that help. Decision No. MGE/172823. Although medical assistance applicants must verify relevant information within 10 days of when the information is requested, an agency cannot deny benefits if the recipient is incapable of obtaining the verification or needs help getting it. Wis. Admin. Code, § DHS 102.03(1). In addition, workers are instructed: “Assist the member in obtaining verification if he or she requests help or has difficulty in obtaining it.” Medicaid Eligibility Handbook, § 20.1.4.

The earlier decision determined that the county agency now had all of the information it needed concerning the petitioner’s annuity to determine his eligibility. It ordered the agency to make this determination within 10 days and allowed the petitioner to file a new appeal if he disagreed with the decision. That decision was never appealed. Nevertheless, the agency continued to deny the application because the petitioner failed to verify his annuity; it also added a few more items he failed to verify.

The original decision should have been clearer. The intent was that the agency would determine the petitioner’s financial eligibility based upon the information it had and not that it would continue to seek additional verification. The latest denial appears to be because the agency is concerned that at some point in the last five years the petitioner may have divested some assets. The previous decision was meant to indicate that the petitioner had submitted enough information to prove that this was unlikely. While I understand the agency’s need to be careful, I am not going to allow it to relitigate this point. There is sufficient information to determine his eligibility. Assuming there has not been a divestment, no one is questioning that he has been under the medical assistance limit since at least December 2015. I will order the agency to begin his benefits as of then.

Conclusions of Law

The petitioner has met the eligibility criteria for institutional medical assistance since December 2015.

THEREFORE, it is

Ordered

That this matter is remanded to the county agency with instructions that within 10 days of the date of this decision it take all steps necessary to ensure that the petitioner is financially eligible for institutional medical assistance retroactive to December 1, 2015.

[Request for a rehearing and appeal to court instructions omitted.]