A Massachusetts court rules that a community spouse's refusal to provide all the financial information requested in a Medicaid application is not grounds for the denial of benefits to the institutionalized applicant. Rossetti v. Waldman (Mass. Sup., Essex, No. 04-1418, Aug. 17, 2005).
Ralph Rossetti, who suffered from significant dementia, was admitted to a nursing home in 2003 and applied for Medicaid coverage shortly thereafter. In the application, Mr. Rossetti assigned to the Division of Medical Assistance any rights to seek support from his wife, Arlene, who he stated refused to cooperate in his application. Mrs. Rossetti in turn invoked her right to refuse to support her husband financially and stated that she would cooperate with his application only to the extent necessary for him to secure Medicaid benefits. She supplied information on certain assets but refused to provide any information regarding bank accounts. The Division denied Mr. Rossetti's application due to missing information. A hearing officer upheld the denial, claiming that Mr. Rossetti could have provided information on a bank account he held jointly with his wife. Following Mr. Rossetti's death in June 2004, Mrs. Rossetti appealed.
In a case dealing with what it calls "spousal noncooperation," the Massachusetts Superior Court reverses. The court finds that a community spouse's refusal of support or of cooperation is not grounds for denial of benefits to the institutionalized spouse, provided the applicant has made an assignment to the Division of his right to spousal support. The court goes on to find no backing for the suggestion that a community spouse's selective cooperation is grounds for denial. While noting that the applicant himself had a duty to cooperate with the application process, the court finds that given Mr. Rossetti's level of competence, there was no evidence that he or his representative could have provided more information about the bank accounts without Mrs. Rossetti's cooperation. Thus, Mr. Rossetti did not fail in his duty to cooperate and should not have been denied Medicaid coverage.
ElderLawAnswers member Stephen Spano was the attorney for Mr. Rossetti.