Case Law: Providing Documentation for Medicaid Eligibility

In the case of Poindexter v. Ohio Dept. of Job & Family Services, an Ohio appeals court affirmed the lower court and Department of Job and Family Services’ denial of the appellant’s request for long-term care Medicaid benefits.

The Medicaid applicant (“Appellant”) was admitted to a nursing facility in 2017. In August 2018, she applied for Medicaid benefits, but her application was denied in September because she had too many resources to meet the financial eligibility criteria. She applied a second time in October 2018. At that time, she owned a home valued at $36,900, subject to a bank mortgage. The Medicaid eligibility limit was $2,000.

The bank mortgage was $48,023 in 2011. In December 2018, the county requested the Appellant verify the current mortgage balance. She did not provide this information, despite several requests and language advising the Appellant to contact the County if she had difficulty obtaining the verification. Throughout this time, Appellant had two authorized representatives and a power of attorney.

In January 2019, the County denied the Appellant’s application for Medicaid benefits. Appellant appealed by requesting a state hearing, in which the County’s decision was affirmed. She again appealed, and again the decision was affirmed, this time by the director of the Ohio Department of Job and Family Services. The trial court likewise affirmed the denial of Appellant’s application. The Appellant then appealed to the Fairfield County Court of Appeals.

The Appellant argued that the trial court abused its discretion in denying her request because she does not own available resources which exceed the eligibility limit, because the mortgage balance of the home she owns exceeds its valuation and so it is not a countable resource. However, the $36,900 value was current as of 2018, whereas the $48,023 mortgage balance was dated 2011. The agency had no evidence to determine the balance of the mortgage at the time of the application, and so the agency could not determine the value of the property at the time of request. The Court of Appeals therefore held that the trial court did not err in affirming the denial of Appellant’s claim for Medicaid assistance based on her failure to provide the information necessary for the agency to verify her financial eligibility.

The Appellant also argued that the court improperly placed the burden to provide evidence on the balance of the mortgage on her. Nothing in 42 C.F.R. 435.948 prevents the County from requesting mortgage balance information from the Appellant. Nor was there evidence in the record demonstrating that the County had access to the current mortgage balance. The Appellant argued that the requested information was unavailable to her, but the evidence that she offered to support this claim was an email written after the state hearing, indicating that her power of attorney was “uncooperative” in obtaining the mortgage balance. This would not render the information unavailable. She claims also that she requested the assistance of the County in obtaining the information, but again, the record did not support that claim.

For the above reasons, the Court of Appeals once again affirmed the denial of Appellant’s application for Medicaid benefits. This case highlights the need to respond accurately and timely to requests for information when applying for Medicaid. It also is a reminder to carefully pick who our agent under a power of attorney will be, someone who will act when needed.

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