Even In Ohio, A Medicare Recipient's 'Family' Includes a Spouse

The State of Ohio Department of Medicaid has a unique arrogance interpreting federal law without regard to its meaning or intent. As a result, the Sixth Circuit Court of Appeals was recently forced to hold that a state's definition of family when determining whether a Medicare recipient is eligible for Medicaid benefits to assist with premiums must include the Medicare recipient's spouse. Wheaton v. McCarthy (6^th Cir., No. 14-4023, Sept. 1, 2015).  Yes, the State of Ohio actually refused to consider a spouse a member of an applicant's family in order to deny the applicant benefits.

Joe Turner is a married Medicare beneficiary whose monthly income is around $1,300. Mr. Turner applied for extra assistance from Medicaid to help pay his Medicare premiums. Under federal law, the state compares the beneficiary's income to the federal poverty line for a family of the size involved to determine whether a beneficiary is eligible for assistance. The larger the size of the "family involved," the greater the income a beneficiary can earn and still be eligible for assistance. The Ohio Department of Medicaid did not count Mr. Turner's spouse as part of his family and denied him benefits.

Mr. Turner sued the state, arguing the state should have included his spouse in the definition of family and that, if it had, he would have been eligible to receive Medicaid benefits. The district court rejected Mr. Turner's claim, holding that because federal Medicaid law did not define "family," the state was free to define the term as it wanted. Mr. Turner appealed.

The United States Court of Appeals for the Sixth Circuit reversed, holding that the state's definition of family should include the beneficiary's spouse. The court looked at the ordinary definition of family and noted that "to ask whether the ordinary meaning of 'family' includes a person’s resident spouse, one might say, is like asking whether our solar system includes the planet Venus."  Fortunately, the reliability and predictability of the science of astronomy doesn't rely upon the State of Ohio to interpret and implement.  The court concluded that federal law requires the state to use a family-need standard, not an individual-need standard, when considering the Mr. Turner's application for Medicaid benefits, as federal law, plainly reads and intends.

For the full text of this decision, go here.