Medicaid Agency Cannot Count Resource that Medicaid Applicant Is Making Reasonable Effort to Sell

An Ohio appeals court rules that the Medicaid agency must apply the reasonable-efforts exclusion from Social Security law to Medicaid recipients and must determine whether an applicant is making a reasonable effort to sell a resource before counting it. Gardner v. Ohio Dept. of Job and Family Services (Ohio Ct. App., 1st Dist., No. C-210376, June 15, 2022).

Dianna Gardner owned property in West Virginia that she had been attempting to sell since 2018. She entered a nursing home in 2019 and applied for Medicaid. The Medicaid agency rejected her application due to excess resources.

Ms. Gardner appealed, arguing the property in West Virginia should be excluded from her resources because she was attempting to sell it. The Medicaid agency denied her appeal, and the trial court agreed. Under federal Social Security law, a Supplemental Security Income (SSI) applicant can collect conditional benefits for up to nine months while making reasonable efforts to sell a resource. Ms. Gardner appealed, arguing that Ohio Medicaid law requires that Ohio use resource eligibility criteria that are no more restrictive than SSI eligibility criteria. The Medicaid agency argued the conditional benefits would be too hard to implement and would violate Ohio Medicaid law.

The Ohio Court of Appeals, First District, reverses, holding that the reasonable-efforts exclusion applies to Medicaid applicants. According to the court, “the primary purpose of requiring the nine-month conditional-benefits period is to evaluate whether the efforts to sell have been reasonable and unsuccessful. SSI benefits paid because of the reasonable-efforts exclusion are not inherently conditional benefits.” The court remands the case to the trial court to determine whether Ms. Gardner met the requirements of the reasonable-effort exclusion.

For the full text of this decision, go to: https://www.supremecourt.ohio.gov/rod/docs/pdf/1/2022/2022-Ohio-2021.pdf

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