Genser v. Thomas

Ethel Genser, 85, has been in a nursing home since October 18, 1997. Her 89-year-old husband, Maurice, lives in an assisted living retirement community nearby. Mr. Genser is frail, depressed, and has extensive hearing loss and suffers from bouts of confusion. Mrs. Genser applied for Medicaid coverage effective December 1, 1997. As of October 18, 1997, she had non-exempt assets of $321,312.28. Subtracting Mr. Genser''s community spouse resource allowance of $79,020, Mrs. Genser was left with $242,292.28. Her application was denied on the basis of excess assets. Claiming that her husband''s condition constituted exceptional circumstances for purposes of determining Medicaid eligibility, Mrs. Genser requested a fair hearing to increase

Mr. Genser''s community spouse resource allowance. The hearing officer found that Mr. Genser''s condition was symptomatic of the normal process of human aging and denied the request. Mrs. Genser appealed.

The Superior Court of Connectict agrees with the hearing officer that "symptoms typical of the normal process of human aging are not ''exceptional circumstances.''" In reaching its decision, the court reviews the 1988 Medicare Catastrophic Coverage Act''s conference report, which states that examples of such expectional circumstances "would include, but not be limited to the financial burden of caring for a disabled child, sibling or immediate relative." (H.R. Rep. # 661, 100 Congress 2d Sess. 261 (1988)). The court finds that these examples, while not exhaustive, are consistent with the hearing officer''s decision.