State Improperly Denied Medicaid Application Because Applicant Was Unable to Manage Her Own Affairs

A Delaware trial court determines that the state Medicaid agency improperly denied a Medicaid application for insufficient information when it knew the applicant had dementia and couldn't manage her own affairs. Green Valley SNF, LLC v. Delaware Dept. of Health and Social Services (Del. Super. Ct., No. 13A-02-002 (RBY), Dec. 31, 2013).

When Pauline Bryner entered Green Valley nursing home, she suffered from dementia and was unable to manage her own affairs, but had no family to act for her. The nursing home applied for Medicaid on her behalf, and a guardianship proceeding was started. The state requested information about property owned by Ms. Bryner. The nursing home provided some information, but the state determined the information was insufficient, and it denied Ms. Bryner's Medicaid application. The court eventually appointed a guardian for Ms. Bryner.

After the trial court determined the nursing home had standing to appeal the Medicaid denial, the state denied the appeal. The nursing home appealed to court and argued that since the Ms. Bryner was incapacitated during the pendency of the Medicaid application and did not have a guardian until after the Medicaid application was denied, she did not have any way to sell her property, so it should not be a countable asset.

The Delaware Superior Court reverses the state’s denial, holding that while a Medicaid applicant has the burden to prove eligibility for Medicaid, the reviewing caseworker has the burden to establish why a piece of property is not being sold. According to the court, the caseworker knew Ms. Bryner suffered from dementia and could not manage her own affairs and that a guardianship was pending, so "the result was a denial of benefits, which decision was not on the merits of all of known or accessible information"

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