Cecil Gruber, a nursing home patient, applied for Medicaid in 1992. The Ohio Department of Human Services (DHS) determined that Mr. Gruber and his wife, Mary, had $126,570 in resources. DHS also determined that Mrs. Gruber's community spouse resource allowance (CSRA) was $62,285 and that her MMMNA was $1,149. Mrs. Gruber's monthly income was $555, while Mr. Gruber's was $1,099. Mr. Gruber's Medicaid application was denied because he had resources exceeding the asset limit of $1,500.
On administrative appeal, Mr. Gruber unsuccessfully argued that since his wife did not receive enough income to satisfy her MMMNA, he should be permitted to transfer his resources to her so that Mrs. Gruber could earn sufficient interest to satisfy her MMMNA. The hearing officer agreed with the DHS that Mr. Gruber should transfer his income to his wife before transfering resources. On judicial review, the court found that the Medicare Catastrophic Coverage Act (MCCA) permits Mr. Gruber to transfer his resources before he transfers his income to his wife. DHS appealed this decision, basing its argument on Chicago Region State Letter No. 51-93 by the Chicago Region of the Health Care Financing Administration (HCFA).
Holding that MCCA "is unambiguous and therefore is not open to interpretation by HCFA" on this matter, the court finds that MCCA clearly mandates a CSRA adjustment if the community spouse lacks sufficient income to meet his or her MMMNA (see 42 U.S.C. § 1396r-5(e)(2)(C)). Thus, the court rules that Mr. Gruber should be permitted to transfer his assets to his wife before he is required to transfer his income.
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