James Davis is a resident of a nursing home. In 1999, the Pennsylvania Department of Public Welfare notified Mr. Davis' wife, Betty, that it would be reducing the amount that Mr. Davis is allowed to provide her from his monthly income from $226.29 to $93.77 in order for her to achieve her minimum monthly maintenance needs allowance (MMMNA). The main reason for the change was an increase in the pensions that both Mr. and Mrs. Davis receive. At a hearing, Mrs. Davis testified that in 1998 she had $5,000 in unreimbursed medical expenses. The hearing officer increased Mrs. Davis' monthly spousal allowance from her husband's income to $118.81. However, the hearing officer held that Mrs. Davis had failed to demonstrate the 'exceptional circumstances resulting in significant financial duress' required to increase her MMMNA. 55 Pa. Code §181.452 (d)(2)(ix). 'An exceptional circumstance,' the hearing officer wrote, 'would necessarily be something the Legislature and Department would not consider usual for a spouse residing in the community.' Since health expenses are considered usual for someone of advancing age, the hearing officer ruled that while such expenses may be considerable, they do not constitute exceptional circumstances warranting an increase in the MMMNA. Mrs. Davis appealed.
The Commonwealth Court of Pennsylvania rules that the hearing officer improperly interpreted the meaning of 'exceptional circumstances' that may give rise to expenses causing 'significant financial duress' in the regulation at issue. 'This language,' the court writes, 'does not require that the expenses themselves be exceptional, but rather that the circumstances and the necessity of the expenses be exceptional. Under the Hearing Officer's interpretation, there are few, if any, expenses which the legislature might not have considered . . . To fail to ease the financial burden of a community spouse, and to deny additional support in the face of exceptional circumstances, would be an affront to the conscience of the court, and would certainly very soon require that the community spouse herself become a public charge.'
Subscribe to the Knowledge Bank.
