Differences Amongst County Boards Regarding Medicaid Issues

Although we have two federal statutes that basically govern Medicaid eligibility, OBRA ’93 and the Deficit Reduction Act, the State does not often honor pre-emption and that the rules of the federal government are to govern. Further, County Boards have different interpretations of various issues.

It is my policy to consult with a Medicaid supervisor before submitting an application so that I can review any issues and get the benefit of their expertise. For example, Post 6 indicates that in certain circumstances if a child resides with an applicant and the care by the child allows the applicant to remain at home, the home can be transferred to the child without penalty. However, each County Board has its own interpretation of the necessary care to be provided by the child.

Posts 27 and 28 discuss the effect of inheritance on the community spouse and the applicant, respectively. Basically, an inheritance is deemed to be an “inaccessible resource.” However, each County treats a delay in distributing an inheritance differently since once an inheritance is distributed it becomes a resource. The Internal Revenue Code in discussing the fiduciary income tax for the estate treats an estate closed and distributed after an unreasonable delay.

Another related area is Post 42 which discusses assets transferred to a disabled child. To qualify as a disabled child, the individual need not have an eligibility letter from Social Security. The State will make an independent determination. This does not exactly comply with the title of different approaches of each County Board, but I think the importance of the issue is relevant.

A very common issue is the exemption from the transfer rules for a transfer for purposes other than to qualify for Medicaid. It is particularly difficult to show that a transfer by an elderly person was solely for another purpose. However, I have succeeded in this area by pointing out the uniqueness of the situation of the transfer, the health of the elderly person at the time and the need of funds by the transferee. Generally, County Boards will not consider this exemption.

Of course, what one County Board may consider an “inaccessible resource” might be considered available by another County Board. For example, a parcel of land that is too small to meet the zoning requirements should be treated as “inaccessible.” I have had different County Boards treat this differently. My personal opinion is, that if a potential resource cannot be “converted to money,” it is “inaccessible.”

Post 53 discusses the fact that allowable expenses and such expenditures are limited by the concept of reasonableness. Obviously, this area and the decision made with respect to such expenditures would vary from County Board to County Board.

The above examples are for illustrative purposes and this article could be extended into a book as the differences by the County Boards are infinite.


Disclaimer: This article does not constitute legal advice and each person may have unique facts for which legal consultation may be necessary.

© April 2009, Post 65