A narrowly divided Ohio Supreme Court has ruled that the transfer of a  home between spouses prior to Medicaid eligibility is an improper  transfer and is subject to the community spouse resource allowance  (CSRA) cap.  Estate of Atkinson v. Ohio Department of Job and Family Services (Ohio, No. 2013–1773, Aug. 26, 2015).  One year and six days after hearing oral argument in the case, the majority ruled that "federal and state Medicaid law do not permit unlimited  transfers of assets from an institutional spouse to a community spouse  after the CSRA (Community Spouse Resource Allowance) has been set."  The court distinguished, and did not overturn,  the 2013 federal appellate court ruling in Hughes v. McCarthy, that permitted use of spousal transfers using "annuities." 
In 2000 Marcella Atkinson and her husband transferred their home into  a revocable living trust. In April 2011, Mrs. Atkinson entered a  nursing home and soon applied for Medicaid benefits. In August 2011,  following Medicaid’s “snapshot” of the couple’s assets, the home was  removed from the trust and placed in Mrs. Atkinson's name. The next day,  Mrs. Atkinson transferred the house to her husband. The state  determined an improper transfer had occurred and imposed a penalty  period.  Mrs. Atkinson passed away, and her estate appealed to court,  arguing that under federal and state statutes a spouse is not ineligible  for Medicaid for transferring a home to the other spouse and that an  institutionalized spouse may transfer unlimited assets to the community  spouse between the date the spouse is institutionalized and the date  that the spouse's Medicaid eligibility is determined. The estate lost at  both the trial court and the Ohio Court of Appeals, and the estate appealed.  
In a 4-3 decision, the Supreme Court of Ohio rules that transfers  between spouses are not unlimited after the snapshot date and before  Medicaid eligibility and that such transfers are proper only up to the  amount that fully funds the CSRA. The court rejected the estate’s  reliance on the Sixth Circuit Court of Appeals’ holding in Hughes v. McCarthy (6th Cir.,  No. 12-3765, Oct. 25, 2013) that an annuity purchased by a community  spouse before a Medicaid eligibility determination is not an improper  transfer, finding that the purchase of annuities are subject to special  rules and “not applicable under these facts.”  The court, however,  remands the case for review of the penalty imposed because the Medicaid  agency may have applied the wrong statute.  “Neither federal nor state  law,” the court wrote, “supports the agency's confiscation, after the  CSRA has been set, of the entire amount of transferred assets, some or  all of which may have already been allocated to the community spouse on  the snapshot date.”
A dissent joined by three justices states that “[w]hat this family did is and was  permitted by state and federal law. . .  the home is explicitly  excluded from the definition of 'resources' for purposes of establishing  the CSRA.” (emphasis in original).  But, the majority rejected various "exempt asset" and "timing" arguments, in effect, interpreting state and federal law in the manner that would permit  sheltering the minimum possible assets after the ill spouse's  admission to the nursing home. 
For the full text of this decision, click here.

 



