Posts tagged "Medicaid"

Daley v. Secretary of the Executive Office of Health and Human Services, et al.; Nadeau v. Director of the Office of Medicaid (Lawyers Weekly No. 10-092-17)

NOTICE:  All slip opinions and orders are subject to formal revision and are superseded by the advance sheets and bound volumes of the Official Reports.  If you find a typographical error or other formal error, please notify the Reporter of Decisions, Supreme Judicial Court, John Adams Courthouse, 1 Pemberton Square, Suite 2500, Boston, MA, 02108-1750; (617) 557-1030; SJCReporter@sjc.state.ma.us   SJC-12200 SJC-12205   MARY E. DALEY, personal representative,[1]  vs.  SECRETARY OF THE EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES & another.[2]   LIONEL C. NADEAU  vs.  DIRECTOR OF THE OFFICE OF MEDICAID.       Worcester.     January 5, 2017. – May 30, 2017.   Present:  Gants, C.J., Lenk, Hines, Gaziano, Lowy, & Budd, JJ.     Medicaid.  Trust, Irrevocable trust.  Real Property, Life estate, Ownership.       Civil action commenced in the Superior Court Department on February 11, 2015.   The case was heard by Dennis J. Curran, J., on a motion for judgment on the pleadings.   The Supreme Judicial Court granted an application for direct appellate review.   Civil action commenced in the Superior Court Department on December 23, 2014.   The case was heard by Shannon Frison, J., on a motion for judgment on the pleadings.   The Supreme Judicial Court on its own initiative transferred the case from the Appeals Court.     Lisa Neeley (Patrick Tinsley also present) for Lionel C. Nadeau. Brian E. Barreira for Mary E. Daley. Ronald M. Landsman, of Maryland, for National Academy of Elder Law Attorneys, Inc. Elizabeth Kaplan & Julie E. Green, Assistant Attorneys General, for Director of the Office of Medicaid & another. Patricia Keane Martin, for National Academy of Elder Law Attorneys (Massachusetts Chapter), was present but did not argue. Leo J. Cushing & Thomas J. McIntyre, for Real Estate Bar Association for Massachusetts, Inc., amicus curiae, submitted a brief.     GANTS, C.J.  These two cases require this court to navigate the labyrinth of controlling statutes and regulations to determine whether applicants are eligible for long-term care benefits under the Federal Medicaid Act (act) where they created an irrevocable trust and deeded their primary asset — their home — to that trust but retained the right to reside in and enjoy the use of the home for the rest of their life.  The Director of the Massachusetts Office of Medicaid (MassHealth) determined that the applicants in these two cases were not eligible for long-term care benefits because their retention of a right to continue to live in their homes made the equity in their homes a “countable” asset whose value exceeded the asset eligibility limitation under the act.  The applicants unsuccessfully challenged MassHealth’s determinations in the Superior Court pursuant to G. L. c. 30A, § 14.  We […]

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Posted by Massachusetts Legal Resources - May 30, 2017 at 3:13 pm

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Padmanabhan v. Centers for Medicare & Medicaid Services (Lawyers Weekly No. 10-019-17)

NOTICE:  All slip opinions and orders are subject to formal revision and are superseded by the advance sheets and bound volumes of the Official Reports.  If you find a typographical error or other formal error, please notify the Reporter of Decisions, Supreme Judicial Court, John Adams Courthouse, 1 Pemberton Square, Suite 2500, Boston, MA, 02108-1750; (617) 557-1030; SJCReporter@sjc.state.ma.us   SJC-12181   BHARANIDHARAN PADMANABHAN  vs.  CENTERS FOR MEDICARE & MEDICAID SERVICES.     January 24, 2017.     Practice, Civil, Stay of proceedings, Moot case.  Moot Question.     The petitioner, Bharanidharan Padmanabhan, appeals from a judgment of a single justice of this court denying his petition pursuant to G. L. c. 211, § 3.  We affirm.   In October, 2014, the petitioner commenced an action in the Superior Court, naming as defendants the respondent and certain individuals associated with Cambridge Health Alliance, the city of Cambridge, the Executive Office of Health and Human Services, and others.  As best as we can discern from the record before us, his complaint alleged claims of, among other things, Medicare or Medicaid fraud, which he became aware of during the course of his employment with some of the defendants; and retaliation by his employer when he spoke up about the perceived fraud.  In March, 2015, the case was removed to the United States District Court for the District of Massachusetts.  A judge in that court subsequently allowed a motion to dismiss certain Federal defendants and then remanded the case to the Superior Court.  The petitioner appealed from both the allowance of the motion to dismiss and the remand order to the United States Court of Appeals for the First Circuit, and that appeal remains pending.  Meanwhile, in the Superior Court, shortly after the remand order, the remaining defendants filed motions to dismiss, which, it appears, the petitioner opposed.  The docket further indicates that on June 7, 2016, a status conference was scheduled for July 19, 2016.   On July 11, 2016, the petitioner filed an “emergency motion to stay improper proceedings in State court” in the county court, which the single justice treated as a petition pursuant to G. L. c. 211, § 3.  He argued that the State court lacked jurisdiction because his appeal from the remand order remained pending in the Federal court, and he asked this court to stay further proceedings in the Superior Court.  He also asked the court to order that the status conference scheduled for July 19, 2016, be canceled.  While his G. L. c. 211, § 3, petition was pending, the July 19, 2016, status conference proceeded as scheduled.  A docket entry dated July 20, 2016, indicates that because the petitioner’s appeal to the First Circuit remained pending, the status conference would be continued to October […]

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Posted by Massachusetts Legal Resources - January 24, 2017 at 4:00 pm

Categories: News   Tags: , , , , , , ,

Heyn v. Director of the Office of Medicaid (Lawyers Weekly No. 11-043-16)

NOTICE: All slip opinions and orders are subject to formal revision and are superseded by the advance sheets and bound volumes of the Official Reports. If you find a typographical error or other formal error, please notify the Reporter of Decisions, Supreme Judicial Court, John Adams Courthouse, 1 Pemberton Square, Suite 2500, Boston, MA, 02108-1750; (617) 557- 1030; SJCReporter@sjc.state.ma.us 15-P-166 Appeals Court EILEEN M. HEYN, personal representative,1 vs. DIRECTOR OF THE OFFICE OF MEDICAID. No. 15-P-166. Worcester. February 5, 2016. – April 15, 2016. Present: Green, Hanlon, & Henry, JJ. Medicaid. Trust, Self-settled trust, Irrevocable trust, Distribution, Allocation of payments between principal and income, Power of appointment. Annuity. Civil action commenced in the Superior Court Department on December 12, 2013. The case was heard by William F. Sullivan, J., on a motion for judgment on the pleadings. Patrick Tinsley for the plaintiff. Daniel J. Hammond, Assistant Attorney General, for the defendant. Patricia Keane Martin, Robert P. Ford, Kathryn E. Szewczyk, & Don J.J. Cordell, for National Academy of Elder Law Attorneys (Massachusetts Chapter), amicus curiae, submitted a brief. GREEN, J. We are called upon yet again to review a determination that assets within a self-settled irrevocable 1 Of the estate of Everlenna Roche. 2 inter vivos trust should be treated as available to the trust grantor for payment of nursing home expenses (and, correspondingly, render the grantor ineligible for Medicaid benefits). We conclude that a hearing officer of the MassHealth board of hearings erroneously concluded that the trust at issue permitted its trustee to distribute proceeds from the sale of trust assets to the grantor in certain circumstances. Consequently, we reverse the judgment of the Superior Court affirming MassHealth’s termination of benefits to the plaintiff’s decedent.2 Background. From November 4, 2011, until her death on August 25, 2013, the plaintiff’s decedent, Everlenna Roche, resided at a skilled nursing facility in Westborough. Approximately eight and one-half years earlier, Roche had established the Everlenna R. Roche Irrevocable Trust (trust), and transferred to it title to her home at 10 Baker Way, Westborough, retaining a life estate.3 Upon moving into the 2 We acknowledge the amicus brief submitted by the National Academy of Elder Law Attorneys, Inc. (Massachusetts chapter). 3 The defendant makes no argument that the life estate retained by Roche might itself have a value that could affect her eligibility for benefits, stating in its brief that it is “a correct statement of the law under Cohen [v. Commissioner of the Div. of Med. Assistance, 423 Mass. 399 (1996), cert. denied sub nom. Kokoska, by Kokoska v. Bullen, 519 U.S. 1057 (1997),] and its progeny” that retention of a life estate does not render an individual ineligible for benefits. We do […]

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Posted by Massachusetts Legal Resources - April 18, 2016 at 3:53 pm

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Needham v. Director of the Office of Medicaid (Lawyers Weekly No. 11-166-15)

NOTICE:  All slip opinions and orders are subject to formal revision and are superseded by the advance sheets and bound volumes of the Official Reports.  If you find a typographical error or other formal error, please notify the Reporter of Decisions, Supreme Judicial Court, John Adams Courthouse, 1 Pemberton Square, Suite 2500, Boston, MA, 02108-1750; (617) 557-1030; SJCReporter@sjc.state.ma.us   14-P-182                                        Appeals Court   MAURICE NEEDHAM[1]  vs.  DIRECTOR OF THE OFFICE OF MEDICAID. No. 14-P-182. Essex.     January 14, 2015. – October 20, 2015.   Present:  Katzmann, Sullivan, & Blake, JJ.     Medicaid.  Administrative Law, Regulations, Agency’s interpretation of statute, Agency’s interpretation of regulation.  Probate Court, Judgment, Trust.  Trust, Reformation.       Civil action commenced in the Superior Court Department on December 28, 2012.   The case was heard by Maynard M. Kirpalani, J., on a motion for judgment on the pleadings.     Elizabeth N. Dewar, Assistant State Solicitor, for the defendant. Peter J. Caruso for the plaintiff.      SULLIVAN, J.  This is an appeal pursuant to G. L. c. 30A from a judgment of the Superior Court reversing the denial of long-term care benefits under the Commonwealth’s Medicaid program.  A judge of the Superior Court concluded that the Director of the Office of Medicaid (MassHealth)[2] was bound by an order of a judge of the Probate and Family Court reforming a trust, and was obligated to consider the reformed trust when determining countable assets for purposes of Medicaid eligibility for long-term care benefits.  We conclude that MassHealth is bound by Federal law in making eligibility determinations, that Federal law prohibits recognition of the reformation of the trust within the statutory look-back period, and that MassHealth therefore could not be compelled to consider the reformed trust in evaluating eligibility.  Accordingly, we reverse the judgment and remand for entry of judgment in favor of MassHealth. Background.  The facts of the case are undisputed.  In his February 11, 2011, application for MassHealth long-term care benefits, the plaintiff Maurice Needham[3] disclosed two trusts, one revocable and one irrevocable.  The revocable trust held only the family home valued at $ 412,400, and named the irrevocable trust, of which Needham was also the settlor, as the sole beneficiary.[4]  MassHealth reviewed this and other financial information for purposes of determining whether Needham met the financial eligibility requirements for long-term care under the Medicaid program.  See 130 Code Mass. Regs. § 520.003(A)(1) (2009) (setting an eligibility ceiling of $ 2,000 in countable assets).  The irrevocable trust, also valued at $ 412,400, was deemed countable by MassHealth because a provision of the trust instructed the trustee to accumulate principal and to use it for the settlor’s future needs without regard to the interest of the remaindermen, his children.[5]  MassHealth concluded […]

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Posted by Massachusetts Legal Resources - October 20, 2015 at 4:28 pm

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