Pandemic Doesn’t Excuse Failure to Establish QIT to Qualify for Medicaid

An Ohio appeals court upholds denial of Medicaid where the applicant alleged the pandemic prevented him from complying with verification and eligibility requirements. In Herubin v. Ohio Dept. (Ohio Ct. App., 21-MA-0109, September 14, 2022).

In June 2020, Joseph Herubin authorized his son to help him process a Medicaid application for long-term care benefits while he was residing in a nursing home. After an interview with the county’s Department of Job and Family Services, Mr. Herubin’s son was informed of the verification and eligibility requirements to qualify his father for benefits.

A checklist was mailed to him, listing the verification requirements with a due date in April 2020 and warning that failure to submit the requested information could result in denial of the application. It also stated that a Qualified Income Trust (QIT) was required for eligibility and encouraged him to consult with an attorney.

After providing some verifications, the agency mailed Mr. Herubin’s son a letter listing the outstanding verifications required by July 22, 2020. Given Mr. Herubin’s monthly income of $4,160, the requirements included the establishment of a QIT and a deposit of $1,811 in a qualified bank account. The agency also asked for life insurance cash values.

A letter from Mr. Herubin’s son responding to the QIT requirement advised the agency that he had contacted several banks in the area and was told a QIT was a matter handled by the courts. Accordingly, he said he had called the hotline to get documents to complete and submit to Chase Bank.

On July 22, 2020, Mr. Herubin died. Eight days later, on July 30, 2020, the agency issued its denial of the Medicaid application because Mr. Herubin failed to provide the requested verifications. Mr. Herubin’s wife, through an attorney, asked for a hearing to review the denial.

At a hearing in November 2020, Mr. Herubin’s attorney testified the family told him they had submitted all the needed documents and advised that he was only advising the family about property transfers and deeds. The record was left for several days for the submission of additional documents. When no further evidence on life insurance or a QIT was received, the state hearing affirmed the agency’s denial. An administrative appeal from the state hearing was requested, and in December 2020 the state hearing decision was affirmed.

That decision was timely appealed to the common pleas court in January 2021. Mr. Herubin’s wife, now the executor of his estate, alleged the agency’s decision was “procedurally defective” because Mr. Herubin’s son had made every effort to comply with the verification requirements but was prevented from complying by COVID-19 closures, as his affidavit demonstrated.

The agency’s response brief argued the decision was supported by reliable, probative, and substantial evidence because the applicant failed to show a QIT had been established and funded.

The common pleas court agreed with the agency and affirmed the administrative denial, waiving the son’s affidavit because the claim of hardship in establishing a QIT was not raised in the administrative hearing.

The appeals court affirms, upholding the denial of Mr. Herubin’s Medicaid application. No QIT or trust account was established. Without them, Mr. Herubin never became eligible for Medicaid before he died because his income exceeded the eligibility limits, as the estate’s argument on appeal concedes.

The lower court did not abuse its discretion in finding the administrative decision was supported by reliable, probative, and substantial evidence.

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