SJC decision reversing the MassHealth board of hearings in two cases concerning eligibility for nursing facility care. In both cases the applicants had transferred ownership of their homes to an irrevocable trust. in one case retaining a life estate and in the other retaining the right to use and occupy the property. The transfers occurred outside the 5-year look back period. MassHealth said under its rules, & federal guidance, the equity of the homes was still a countable resource of the applicant. However, the court ruled that the agency had misinterpreted the applicable state and federal law and reversed. It remanded back to the agency for determination of several other issues in this "labyrinth" of Medicaid trust law.
Aside from the ruling on the trust issue, the decision includes several discussions that may be useful in other MassHealth cases including: a general discussion of Medicaid including citations to data in several reports and news stories from the Kaiser Foundation, a discussion of conflit between state and federal law (the legislature intended that MassHealth comply with the federal rule), a discussion of the degree of deference owed the CMS State Medicaid Manual (entitled to respect but not Chevron deference), and the meaning of "availability" (preventing the conjuring of fictional income & resoruces). The court does not discuss deference to the state agency, but far from deferring to MassHealth, the court finds that it misinterpreted its own regulations.
|Daley v Sec SJC 5-30-17.pdf||188.77 KB|