Spousal Refusal Should Have Been Considered in Medicaid Eligibility Determination

A New York appeals court rules that the state Medicaid agency properly found that a community spouse can meet her minimum income needs by increasing withdrawals from her annuity, but that after denying her an increased CSRA the agency should have considered her spousal refusal when deciding her husband's Medicaid eligibility. Matter of Lopez (N.Y. App. 3rd , No. 501939, July 5, 2007).

Concetta Lopez filed a Medicaid application on behalf of her husband, Felix, seeking assistance with nursing home care expenses. At the same time, she filed a spousal refusal form, refusing to make her income and resources available for Mr. Lopez' care. In addition, Mrs. Lopez also sought an increased community spouse resource allowance (CSRA) because her income was below her minimum monthly maintenance needs allowance (MMMNA),. The state determined Mr. Lopez was ineligible for Medicaid due to excess resources. It also found that Mrs. Lopez was not entitled to an increased CSRA because she could withdraw additional funds from an annuity to raise her income to the MMMNA.

Mrs. Lopez appealed, arguing that she could not be compelled to withdraw additional funds from the annuity because it would force her to draw down the principal, and also that the agency improperly disregarded the spousal refusal form. The trial court dismissed, and Mrs. Lopez appealed again.

The Appellate Division of the Supreme Court of New York agrees that there is no evidence that withdrawing additional funds from the annuity would invade the principal. However, the court remands for a determination of Mr. Lopez' eligibility taking into account the spousal refusal.

To download the full text of this decision in PDF format, go to: https://decisions.courts.state.ny.us/ad3/decisions/2007/501939.pdf.
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