The Supreme Judicial Court of Massachusetts holds that a Medicaid applicant must establish a complete marital breakdown to be exempt from reporting spousal income and assets. In Freiner v. Secretary of the Executive Office of Health and Human Services (Mass. No. SJC-13514, June 14, 2024).
Costa and Mary Tingos lived together since they married in 1957 until Mr. Tingos moved into a nursing home in May 2015. During the marriage, Mr. Tingos had a gambling problem, which strained the relationship. After considering divorce but deciding to remain together for their religion and children, they maintained separate finances, though they filed joint tax returns and shared expenses.
Despite their complex relationship, Mrs. Tingos helped her husband coordinate his long-term care and, under his power of attorney, managed his financial affairs as his attorney-in-fact.
When Mr. Tingos applied for Medicaid, he represented that his wife did not want to support him financially or cooperate with his application.
Although 130 Code Mass. Regs. § 517.011 allows an institutionalized spouse to receive benefits when the community spouse is unwilling to cooperate with the application, MassHealth denied his application. Since he only disclosed her tax return, MassHealth cited a lack of information about his wife’s finances.
He initiated an administrative appeal, which the board denied, finding he failed to show by a preponderance of the evidence that his wife would not cooperate. A Superior Court vacated the decision and remanded the case, which the board once again denied. The board found that Mr. Tingos failed to make reasonable efforts to access information about his wife’s income and assets. Although his wife averred that she was refusing to cooperate, he represented that he had not spoken to his wife about her finances; rather, he went through his attorney. On appeal, a second Superior Court judge vacated and remanded the decision, finding he had not gotten sufficient notice that he would be required to show he attempted to get his wife’s financial information.
On the third review, the board once again denied benefits. It found a longstanding pattern of spousal cooperation that outweighed Mrs. Tingos’ refusal to supply information.
A new Superior Court affirmed, concluding substantial evidence supported the board’s decision. Mr. Tingos appealed for review by the Supreme Judicial Court of Massachusetts.
The relevant statute, 130 Code Mass. Regs. § 517.011, permits a spouse to qualify for Medicaid without full disclosure of marital resources in two instances. One is when the spouse refuses to cooperate. The second is when the spouse cannot be found. Reading these two together suggests that the marriage must have completely broken down. Allowing eligibility for nondisclosing couples absent a total marital breakdown would drain the Commonwealth’s limited resources and potentially create a loophole for wealthy couples to qualify.
The record shows a certain degree of spousal cooperation, as they lived together for over 50 years, contributed to household expenses, and filed taxes jointly. Additionally, Mrs. Tingos cooperated with her husband by being his financial agent. For these reasons, the denial of benefits was reasonable, not arbitrary and capricious.
Supreme Judicial Court of Massachusetts affirms the Superior Court Judge’s decision. Mr. Tingos failed to show a complete marital breakdown that would cause his wife to refuse to participate in his application.
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