Couple Doesn't Qualify for Pickle Amendment Treatment Once Wife Loses SSDI

A Tennessee appeals court rules that a couple cannot qualify for Medicaid through the Pickle Amendment because one spouse stopped receiving SSDI and has no other income, and the other spouse's income exceeds the individual income standard.  Earl v. Hatter (Tenn. Ct. App., No. M2011-00914-COA-R3-CV, Nov. 19, 2012).

Rick and Wanda Earl received Supplemental Security Income (SSI) until 2002, when both began receiving Social Security Disability Income (SSDI).  Mr. Earl earned his SSDI benefits due to his disability, and Mrs. Earl received benefits as the dependent mother of the couple's child.  Mrs. Earl's SSDI benefits ended in 2008 when her daughter turned 16, and in the same year the couple's Medicaid coverage ended.  The couple claimed that they were still eligible for Medicaid under the Pickle Amendment because Mr. Earl's SSDI income, minus cost-of-living adjustments, was less than Medicaid's income standard for a couple with disabilities. 

The Tennessee Department of Human Services (DHS) disagreed, finding that Mrs. Earl was an ineligible spouse because she did not receive Social Security benefits of any kind and had no income at all.  Therefore, according to the state, Mr. Earl's income should be evaluated using an individual income standard that would render him ineligible for Medicaid.  A trial court upheld DHS's decision, and the Earls appealed, arguing that Tennessee law did not incorporate the Pickle Amendment as written in federal law, and that under the plain language of the state law, Mrs. Earl did not have to receive Social Security benefits in order to qualify for consideration under the Pickle Amendment.

The Court of Appeals of Tennessee upholds the trial court and adopts its opinion.  Quoting the trial court, the Court of Appeals finds that although the state regulation "does not reproduce the Pickle Amendment provisions verbatim [it does] reference them with the statement ‘(Commonly known as the Pickle Amendment.)’”  This reference to the Pickle Amendment, the court concludes, incorporates by reference the explicit terms of the federal Pickle Amendment, including its requirement that eligibility depends upon receipt of OASDI benefits.

For the full text of this decision, go to: https://www.tncourts.gov/sites/default/files/earl_v._dhs_opn__attachment.pdf

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