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Medicaid: Principal place of residence requirement

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Tiffany Lashmet discusses a recent court case regarding an important Medicaid qualification in her latest Texas Agricultural Law Blog.

A recent Austin Court of Appeals decision in Texas Health and Human Services Commission v. Estate of Clyde L. Burt, answers an important Medicaid qualification question.  Is an applicant required to reside in a home prior to seeking nursing care in order for the home to be considered an excludable resource under the Medicaid rules? [Read opinion here.]

Background

Clyde and Dorothy Burt bought a home in 1974 and lived there until December 2010 at which time they sold the home to their daughter, Linda Wallace, and moved into a rental property that Linda owned. In August 2017, the Burts moved into a skilled-nursing facility. Shortly thereafter, they purchased half-interest in their original home from Linda “to secure home equity in a home that they could return to if one or both of them should be able to leave the nursing home.”  The same day, they filled out a Texas Health and Human Services Commission (“Commission”) form designating that home as their principal place of residence with an intent to return.

After that purchase, they had about $2,000 left in their bank accounts and applied for Medicaid benefits beginning the next month. Their application was denied after the Commission found their resources were in excess of program limits because the Commission deemed the home a countable resource. Clyde died in November 2017 and Dorothy died in January 2018. Neither left the nursing facility and a debt to the facility of $23,479.35 remained.

Linda appealed the Commissions’ decision, which was upheld by a hearings officer and Commission Legal Services Attorney, finding that an applicant must establish prior occupancy of a principal place of residence in order to exclude the equity value of a home for Medicaid eligibility purposes.

Applicable Law

In determining the resources of an individual applying for Medicaid services, the Commission excludes the applicant’s home. See 42 U.S.C. 1382b(a)(1).  Federal law defines a “home” as “any property in which an individual (and spouse, if any) has an ownership interest and which serves as the individual’s principal place of residence.”  This includes “the shelter in which an individual resides, the land on which the shelter is located and related outbuildings.”  See 20 C.F.R. 416.1212(a).  Similarly, Texas law provides for the exclusion of a home, defined as a “structure in which a person lives” and “all adjacent land…in which the person has an ownership interest and that serves as his or her principal place of residence.”  See 1 Tex. Admin. Code 358.103(38), (69). Both federal and state law provides that a home is the principal  place of residence of the applicant or applicant’s spouse if the applicant “occupies or intends to return to the home.”  See 20 C.F.R. 416.1212; 1 Tex. Admin. Code 358.348(a)(1).

Lawsuit

Linda then filed this lawsuit arguing that the home should have been excluded from the Burts’ countable resources.

The trial court agreed with Linda and reversed the Commission’s finding. Specifically, they found the Commission’s interpretation of the rule regarding principal place of residence unreasonable and their findings based on the unreasonable interpretation not supported by substantial evidence.  Thus, the trial judge reversed the Commission’s decision and remanded the case for further proceedings.  The Commission appealed the decision.

Court of Appeals’ Decision

The Austin Court of Appeals affirmed.  [Read full opinion here.]

Wallace argued that the home should be excluded from the Burts’ countable resources because they had an ownership interest in the home and considered it their principal place of residence. The Commission claimed that because the Burts purchased the half interest after they entered the nursing facility, they could not be viewed as “intending to return” there and, it could not be considered their “home.”

The court said that it “cannot ignore that the ‘principal place of residence’ references rely on the applicant’s subjective intent.”  The federal Program Operations Manual System (“POMS”) notes that it matters where a person “considers” his or her principal home to be, and notes that an agency may not consider factors such as the applicant’s age, physical condition, or likelihood of their actual return home in determining principal place of residence.  Courts in other states have previously held that the proper standard for this evaluation is a “subjective intent standard” rather than an “objective expectations standard.”

There are no appellate decisions addressing this issue in Texas.  In light of that, the court looked to a letter ruling from a Travis County trial judge in a prior case, Estate of Seffer v. Texas Health & Human Services Commission, No. D-1-GN-08-000790, 419th District Court of Travis County, Texas (Dec. 16, 2008 letter ruling).  There, an applicant lived in an apartment when he moved into a nursing home and had no “home” at that time as defined by Medicaid.  The judge observed that the rules explain that a homeowner can sell his home and use the money to buy another home without losing the exclusion, but do not address the situation where an applicant who is renting or otherwise lacks an excludable “home” buys a home after entering a nursing facility.  The judge reasoned that an individual who is renting prior to entering a nursing facility will be just as “needy” of a home to which to return upon discharge as someone who owned a home.  He stated that, “if Congress had intended to require prior occupancy, it would have been simple to state it.”  Congress did not do so, however, and he concluded that the purposes of Medicaid are better served by allowing an applicant to claim the home exemption for a home he buys or inherits while in a nursing facility, as long as he intends to move into that home at the time of discharge.

The Austin Court of Appeals found this letter ruling persuasive, also noting that the Commission’s prior resident requirement puts at risk even childhood homesteads that could be inherited by nursing home residents.

The court did make note of an Arkansas case where the court reached the opposite conclusion, requiring prior residence in order to exclude a home from countable resources, but found that court’s reasoning unpersuasive.

Thus, the court sided with Wallace.  “Under the Commission’s argument, an applicant can exempt his home if he lives there for one day before entering a nursing facility, but an applicant living in an apartment and in the process of buying a home who, the day before closing, suffers a fall requiring nursing care cannot. Such a distinction is not supported by the language found in the various federal statutes and rules, makes no practical sense, and in no way advances the purposes behind the assistance programs in questions.”

Because the Burts bought a half interest in Wallace’s home (a home in which they lived for decades prior to selling to Wallace) and informed the Commission they considered it their principal place of residence and had an intent to return if they were released from the nursing facility, it should have been excluded from their countable resources. “The Commission’s requirement that an applicant must establish ‘prior occupancy’ of a home is incorrect.”

Thus, the trial court ruling was affirmed. The deadline to appeal has not yet passed, so it remains to be seen whether the Commission will seek review from the Texas Supreme Court.

Key Takeaways

First and foremost, Medicaid rules are extremely complex. I highly recommend working with an attorney to determine the right steps to take in order to qualify for Medicaid. I have a great podcast episode with Kristen Porter that might be a good place to get some general background. Additionally, there are certain rules and lookback periods that apply when a person seeks to qualify for Medicaid, so it is critical to plan ahead and not wait until a crisis occurs.

Second, this case is important as it is the first Texas appellate decision to determine whether a prior occupancy requirement is properly considered when determining primary residence. This case will likely impact many Medicaid applications going forward.

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