Connecticut Superior Court

Issue: Equitable Estoppel

This is a case of equitable estoppel against the Department of Social Services (“DSS”). In a letter to the Medicaid Applicant, the DSS had told appellant it had everything it needed to grant Medicaid and then three months later the application was denied because funeral plan was revocable. The Judge found that the Department of Social Services was estopped from denying the appellant’s Title XIX application because she had relied on the April letter and did nothing to make her prepaid funeral plan irrevocable. Results: $192,000 Medicaid payment paid retroactively to the nursing home.

Social Security Administrative Hearing

Issue: Condition Not Meeting Listing Found to be Disability

After being denied Social Security Disability on her initial application, we represented the claimant at her Administrative Appeal. Claimant was severely impaired due to chronic Lyme Disease with neurological complications which did not meet any of the listings in the Social Security Appendix of Impairments. We were able to prove to the Administrative Law Judge that the claimant was impaired sufficiently so that she could not return to her past work nor could she find other employment that met her residual functional capacity, her age, education and work experience. Results: $240,000 in claimant’s lifetime disability benefits

Issue: Waiver of Overpayment

After being denied her request for a waiver of collection of an overpayment of Social Security Disability insurance, we represented the claimant at her Administrative Appeal. We were able to prove to the Administrative Law Judge that recovery of the overpayment should be waived because the claimant was without fault in causing and accepting the overpayment and repayment would defeat the purpose of Title II in that the claimant needs substantially all of her current income to meet ordinary and necessary living expenses. Result: $36,500 in overpayment waived from collection, and claimant’s disability benefits of $1250 per month, $600,000 over her 42 year life expectancy, were restored.

DEPARTMENT OF SOCIAL SERVICES MEDICAID FAIR HEARING - NEW YORK

Issue: Income of Medicaid Recipient Placed in Supplemental Needs Trust is not Countable Income

Due to the fact that the Medicaid recipient’s income was placed into a supplemental needs trust drafted by our firm, the Administrative Law Judge found that the Medicaid recipient’s excess income should be reduced to zero ($0.00) retroactive to the time the supplemental needs trust was established and recipient’s income was deposited into the trust.  Result: $303,000 lifetime income, which under medicaid regulations are generally required to be “spent down” on medical care, were ordered to be held in trust for sole benefit of Medicaid recipient’s non-medical needs.

Issue: IRA not a Countable Resource after Owner has begun Taking Distributions

We were able to prove (1) that the request for the fair hearing was timely made since it was mailed before the 60 days statute of limitations expired but was not received until 3 days after the 60 days expired due the religious holidays and weekend; and (2) the DSS should have found the resources of the community spouse unavailable to the appellant as of the date of his spousal refusal and it should have found the community spouse’s IRA not a countable resource since he had begun taking income distributions from the IRA.  Result: $115,500 or all of couple’s resources kept by community spouse.

Issue: Return of Principal Portion of Loan Repayment Not Income

The community spouse had loaned money and was receiving monthly payments, part of which was return of principal and part of which was interest on the loan.  The Administrative Law Judge correctly found that the return of principal from the loan was a resource while the interest was income in the month received.  Result: $1,684 of Medicaid recipient’s monthly income was kept by community spouse which totaled $101,040 over a five year payment period.

Issue: IRA held by Community Spouse Not a Countable Resource

Result: $304,000 in IRA’s held by a community spouse were not a countable resource in determining her husband’s financial eligibility to receive Medicaid.

DEPARTMENT OF SOCIAL SERVICES MEDICAID FAIR HEARING - CONNECTICUT 

Issue: An Annuity that is Actuarially Sound is Not Improper Transfer of Assets

The Administrative Law Judge found that an annuity that is actuarially sound is not an improper transfer of assets.  However, if an individual is not reasonably expected to live longer than the guarantee period of the annuity, the individual will not receive fair market value of the annuity based on its projected return. Then the annuity is actuarially unsound and there is an improper transfer of assets.  In this case, the community spouse purchased an annuity worth $48,700 for his life and the Administrative Law Judge found that there was no improper transfer of assets.  Result: The community spouse’s wife was eligible to receive nursing home Medicaid retroactive to the purchase of the annuity and the annuity annual payment paid for lifetime long term care insurance for the community spouse, allowing the community spouse to preserve all of his $79,000 community spouse resource allowance.

Please contact our family and elder law attorneys today. For immediate assistance call us at 203-557-0850 or 914-481-5555.

We welcome clients in Fairfield County, CT and Westchester County, NY, including Stamford, Harrison, White Plains, Greenwich, New Canaan, Darien, Westport, Bedford, Katonah, New Rochelle and Scarsdale.