A Medicaid recipient's guardianship and conservator fees are not "medically necessary" and so are not deducted from his share of Medicaid costs. Day v. Arizona Health Care Cost Containment System Administration (Arizona Ct. App., No. 1 CA-CV 04-0315, March 31, 2005).
James Day, who was incapacitated, received long-term care benefits from the Arizona Health Care Cost Containment System, Arizona's Medicaid program. Mr. Day had a court-appointed guardian and conservator, who received fees. When Mr. Day's Social Security income increased, his monthly share of the cost of Medicaid benefits also increased. Mr. Day argued that his guardianship and conservator fees should be deducted from his share of the costs because they were medically necessary.
The administrative law judge denied Mr. Day's claim. The superior court affirmed the administrative decision, and Mr. Day appealed.
The Court of Appeals of Arizona affirms, holding that the fees are not medically necessary because the guardian and conservator do not perform a medical service. According to the court, to be medically necessary under state law, a service must be provided by a physician or other medical personnel.
To download the full text of this decision in PDF format, go to: https://www.cofad1.state.az.us/opinionfiles/CV/CV040315.pdf.
(If you do not have the free PDF reader installed on your computer, download it here.)
Did you know that the ElderLawAnswers database now contains summaries of more than 800 fully searchable elder law decisions dating back to 1993? To search the database, click here.
Subscribe to the Knowledge Bank.
