New York's highest court affirms lower court rulings in the case of a New Jersey man who sustained incapacitating injuries while working in New York and was placed in a New York facility. The New York Court of Appeals rules that the man is a New York resident for Medicaid purposes and that his wife, acting as his guardian, may take advantage of New York's 'spousal refusal' provisions and transfer all of his assets to herself for her support and to qualify him for Medicaid.
Bipin Shah, a New Jersey resident, sustained serious brain damage while working in New York State. Mr. Shah has been comatose since the accident and is being cared for in a Rockland County facility operated by the New York State Department of Health at a cost of more than $1,000 per day. On January 16, 1997, Mr. Shah''s wife, Kashmira, executed a form exercising her right of "spousal refusal" under New York''s Medicaid law, refusing to contribute to the cost of her husband''s care. Soon thereafter she applied for Medicaid coverage in New York State on her husband''s behalf and sought court appointment as her husband''s guardian. In her guardianship petition, Mrs. Shah requested authorization to transfer her husband''s assets to herself for her support and that of her two children, and to qualify Mr. Shah for medical assistance. The hospital opposed the guardianship petition, arguing, inter alia, that Mr. Shah''s application for Medicaid benefits would ikely be rejected because at the time of his injury he was a New Jersey resident. On March 28, 1997, while the guardianship proceeding was pending, the Rockland County Department of Social Services denied the Medicaid application on the ground that Mr. Shah was not a resident of Rockland County. This determination was upheld by New York''s Department of Health.
In separate rulings, the New York Supreme Court, Appellate Division, found that Mr. Shah is a New York State resident for purposes of Medicaid coverage and that his wife, acting as his guardian, may transfer his assets to herself to qualify him for Medicaid. Both the state and the hospital appealed. On the transfer question, the Department of Health argued that the "spousal refusal" safeguard applies to assets that the refusing spouse already possesses but was not meant to allow a community spouse to receive even more assets from her institutionalized spouse in order to shield them.
Combining the two cases, the New York Court of Appeals rules that 1) Mr. Shah qualifies as a New York resident for purposes of Medicaid benefits; and 2) the powers of a guardian in New York State permit Mrs. Shah to transfer her husband''s assets to herself, without regard to the purpose for the transfer, and to simultaneously refuse to have those assets included in the calculation of income and resources available to Mr. Shah for Medicaid assistance. The Department of Health''s position, the court observes, "advocates a different dual standard regarding how capable versus incapacitated persons would be treated for purposes of Medicaid planning."
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