At the beginning of June, the Connecticut Supreme Court handed down a ruling that presented another blow to already suffering Medicaid applicants. In a recent case the Connecticut Supreme Court held that the state government and its officials had the right to deny Medicaid coverage for nursing care services when the applicant has a spouse with a trust fund that amounts to the financial coverage required for the requested services. This decision of the Connecticut Supreme Court applies even if the trust fund was never intended to be used for the benefit of the trust beneficiary’s future spouse.
Medicaid is the state insurance program that is funded by the federal government. While all states do not have to provide Medicaid, Connecticut extends Medicaid coverage to young children, as well as low income adults, seniors, and those with disabilities. Here in Connecticut Medicaid enrollment has reached record highs since the implementation of the Affordable Care Act (“ACA”). Recent years have also seen a decrease in coverage for children, and a contrasting increase in older applicants looking for insurance coverage under Connecticut’s Medicaid system.
The Case of the Medicaid Benefit Denial
The now deceased plaintiff was a citizen of Connecticut who, in 2009, applied for Medicaid after depleting all of his personal resources paying for his nursing home care. However, his application was denied because his wife was the beneficiary of a trust of over $500,000. His wife received this fund after the death of her first husband in 1968, and adamantly maintains that the trust’s distinct purpose was to provide for her and her children’s well being. Under the trust the assets were to be used as the trustee deemed necessary to provide for the maintenance, comfort, care, and support of the beneficiary’s children. This very specific purpose would have been violated if funds from the trust had been used to provide nursing home care for the wife’s second husband, who was obviously not an actual or intended beneficiary of the trust.
In this specific situation the spouse was left in a situation where either decision would have unfortunate results. If she had utilized the trust funds to pay for the nursing home care of her most recent husband, she would have been violating the purposes of the trust fund, and could have faced penalties. Since she did not do this, her now deceased husband was unable to receive funds to help him pay for his nursing home care. It is difficult to say how such situations could be avoided. However, it could be argued that if the trust fund had been discretionary in nature, as a opposed to a “support” trust fund, the wife may have had some lenience in how, and in what way, the funds could have been applied. The existing trust could have also included a specific provision outlining the parties that could receive funds from the trust. Such a provision could specifically include the future spouses and family members of the beneficiary.
Interested in gaining professional legal assistance with receiving approval for Medicaid benefits? Contact the elder law attorneys at Greenberg & Krieger LLP in Fairfield County, Connecticut.