LORRAINE L. PENTUIK, AS PERSONAL REPRESENTATIVE OF THE ESTATE OF EDWARD MACKEY, APPELLANT,
v.
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES, APPELLEE

Fla. 1st DCA | 1991-08-16
No. 91-221
ZEHMER and KAHN, JJ., concur.
584 So. 2d 1098 Florida District Court of Appeal, First District (1991) Positive Treatment
Cited by 4 cases

AI-generated. These summaries, headnotes, and key points are machine-generated and may contain errors or omissions. Always verify against the full opinion text below. Not legal advice.

Synopsis

Edward Mackey transferred his savings to family members shortly before prostate surgery, then applied for Medicaid institutional care benefits after becoming incontinent and unable to care for himself. The Florida appellate court reversed the denial of benefits, finding that Mackey proved the transfer occurred exclusively for reasons other than to qualify for Medicaid, as he expected to return home if he survived the surgery.


Holding

Yes. The court reversed the denial of benefits, holding that Mackey proved the transfers occurred exclusively for reasons other than to become Medicaid eligible. The evidence established that Mackey expected to resume living with his daughter if he survived surgery, there was no anticipation he would become incontinent or unable to ambulate post-operatively, and the joint account could have been transferred at any time by his grandson, undermining any inference that the transfer was motivated by Medicaid planning.


Headnotes

[1] A transfer of assets for less than fair market value by an individual applying for Medicaid nursing facility services creates a period of ineligibility unless the individ…

[2] The burden is on the applicant to prove that a transfer of assets occurred exclusively for a reason other than to become eligible for Medicaid benefits.

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Key Quotes

“If an individual who is applying for ... nursing facility services ... transfers assets within 30 months of application [and after July 1, 1988] without fair compensation, ineligibility for these services will exist for the number of months determined by dividing the total uncompensated value of the transferred assets by the statewide average monthly private-pay amount at the time of application”

Sets forth the statutory framework for asset transfer penalties under Florida Administrative Code Rule 10C-8.0181(1)

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Facts & Procedural History

Edward Mackey, who had suffered a heart attack in 1968, lived with his daughter Lorraine for 22 years while managing with assistive devices. In Februa…

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Opinion of the Court
SHIVERS, Judge.

SHIVERS, Judge.

This appeal is from a final order entered by a Client Appeal Hearings Officer affirming the Department of Health and Rehabilitative Services’ denial of Medicaid benefits under the Institutional Care Program. We reverse.

Edward Mackey suffered a heart attack in 1968. He could no longer take care of himself as his wife had died, so he moved in with his daughter — Lorraine Pentuik. At his daughter’s he had a walker, a wheelchair, and a hospital bed. He could manage to get from the bed to the bathroom and to the dining room table. A trapeze had been installed over the hospital bed. Beginning in 1968, Mackey lived with his daughter Lorraine for the next twenty two years. During that time Mackey received income from social security and a pension. His expenses were minimal, and a substantial amount of his savings was deposited in an account held jointly by Mackey and his grandson Ronald.

Mackey’s health began deteriorating in 1985. In January 1990 Mackey was hospitalized for two weeks with breathing problems. After his release, he learned he needed prostate surgery. He was hospitalized again on February 6, 1990. On February 7 — at Mackey’s request — Ronald withdrew his half of the savings account and wrote six checks for the remaining half made out to Mackey’s two daughters, Ronald and three other grandchildren. Mackey signed the checks. The prostate surgery was performed on February 8. The children and grandchildren spent all the money-

Following the prostate surgery, Mackey became incontinent. He lost control of his bowels and bladder and the use of his limbs. His arthritis worsened so that his daughter could not lift him to get a diaper under him. He was released from the hospital into a nursing home as a “total care” patient on March 5, 1990. On May 14, 1990, Ronald applied for Institutional Care Program (ICP) benefits on Mackey’s behalf. ICP is a Medicaid program run by the Department of Health and Rehabilitative Services (HRS). On July 23, 1990, HRS denied the application on the ground Mackey transferred the savings account assets without receiving compensation. A period of ineligibility for ICP benefits was imposed from February 1990 through April 1991. The nursing home notified Mackey and his family that Mackey might be evicted unless the nursing home bills were paid.

Mackey appealed the denial of ICP benefits. An administrative hearing was convened at the nursing home on November 29, 1990. Ronald testified he transferred the money out of the savings account under Mackey’s instructions; but since it was a joint account, Ronald acknowledged he could have transferred the entire account at any time. Ronald said Mackey gave away the money because Mackey “was afraid that he was going to die in this operation and it would ease his mind to disburse it.” Lorraine testified that Mack-ey planned on giving away the money for years because Mackey was afraid of dying. She said her father was sure the prostate operation would kill him. Lorraine expected Mackey to return to her home if he lived through the operation; but Mackey’s incontinence and inability to ambulate after the operation made it impossible for Lorraine to care for him.

The hearing moved to Mackey’s room. Mackey said he gave away the money “Cause I don’t think I was going to live through it and I wanted them to enjoy it while I was alive.” Mackey said he expected to live with Lorraine again if he survived the operation. Mackey was asked if he thought the state would take care of him if he gave away his money. He answered, “No, I didn’t think the state had anything to do with it.”

The hearing officer denied the appeal on the ground that Mackey did not carry his burden of proving that the transfer occurred exclusively for a reason other than to become Medicaid eligible pursuant to F.A.C. Rule 10C-8.0181(l)(b). Mackey died three weeks after the hearing officer’s order was entered. Lorraine was appointed as Mackey’s personal representative.

Florida Administrative Code Rule 10C-8.0181 deals with the effect of a transfer of assets for the purpose of establishing Medicaid eligibility. Subsection (1) states that If an individual who is applying for ... nursing facility services ... transfers assets within 30 months of application [and after July 1, 1988] without fair compensation, ineligibility for these services will exist for the number of months determined by dividing the total uncompensated value of the transferred assets by the statewide average monthly private-pay amount at the time of application, as determined by the department for care in a skilled facility.

Subsection (l)(b) states that with certain exceptions (not applicable in this case), “the department must assume the transfer occurred to become Medicaid eligible unless the individual can prove otherwise_ If the client can successfully prove that the transfer occurred exclusively for a reason other than to become Medicaid eligible, no penalty will be imposed.”

Rule 10C-8.0181 implements 42 U.S.C. § 1396p, which deals with the effect of a transfer of assets on an application for a medical assistance grant under the Social Security Act. See generally, Crider v. Department of Health and Rehabilitative Services, 555 So. 2d 408, 409 (Fla. 1st DCA 1989) (explaining in detail why HRS must adopt rules to implement Florida’s voluntary participation in subchapter XIX of the Social Security Act, 42 U.S.C. § 1396 et seq.). Subsection 1396p(c)(l) states

the State plan must provide for a period of ineligibility for nursing facility services ... in the case of an institutionalized individual who ... at any time during or after the 30-month period immediately before the date the individual becomes an institutionalized individual or, if the individual is not so entitled, the date the individual applies for such assistance while an institutionalized individual disposed of resources for less than fair market value.

Subsection (c)(2) states

An individual shall not be ineligible for medical assistance by reason of [subsection (c)(1) ] to the extent that ... (C) a satisfactory showing is made to the State that (i) the individual intended to dispose of the resources either at fair market value, or for other valuable consideration, or (ii) the resources were transferred exclusively for a purpose other than to qualify for medical assistance; or (D) the State determines that denial of eligibility would work an undue hardship.

Under Florida Administrative Code Rule 10C-8.0181(l)(b) and 42 U.S.C. § 1396p(c)(2)(C)(ii), a burden is placed upon the client to prove any transfer of funds without fair compensation occurred exclusively for a reason or purpose other than to become eligible for Medicaid benefits. In reviewing a denial of benefits based on a failure to meet that burden, the standard of review is whether the hearing officer’s decision is supported by competent substantial evidence. See Health Care and Retirement Corp. of America, Inc. v. Department of Health and Rehabilitative Services, 559 So. 2d 665 (Fla. 1st DCA 1990).

In the case before us, we find that Mackey proved the transfers of funds to his children and grandchildren occurred exclusively for reasons other than to become eligible for Medicaid benefits; and the hearing officer’s finding to the contrary is not supported by competent substantial evidence. The evidence showed that Mackey expected to resume living with his daughter Lorraine if he survived the operation. There is no evidence Mackey or his family had reason to anticipate that Mackey would become incontinent or unable to ambulate following the operation. Further, the monies in the money market account had been held jointly by Mackéy and his grandson since 1986 and the grandson could have transferred the account at any time. Accordingly, we reverse and remand for payment of ICP benefits from May 14, 1990, which is the date of application for benefits, through January 7, 1991, which is the date of Mackey’s death.

REVERSED and REMANDED.

ZEHMER and KAHN, JJ., concur.


Cases With Similar Vibessemantic neighbors from the corpus


Citator

Cited By

  • Rainey v. Guardianship OF Myrtle MacKey, 773 So. 2d 118 (Fla. 4th DCA 2000)
    …lusively for a reason or purpose other than to become eligible for Medicaid benefits. Longhi v. State, Dept. of Health and Rehabilitative Services, 691 So. 2d 583, 584 (Fla. 1st DCA 1997); Pentuik v. Department of Health and Rehabilitative Services, 584 So. 2d 1098, 1100 (Fla. 1st DCA 1991). If the applicant does not meet that burden, Florida law, presumes that the gratuitous transfer occurred to make the applicant eligible for Medicaid and, as a result, a penalty may be imposed. Fla. Admin. Code r. 65A-1.712(…
  • Longhi v. State, 691 So. 2d 583 (Fla. 1st DCA 1997)
    …ient can successfully prove that the transfer occurred exclusively for a reason other than to become Medicaid eligible, no penalty will be imposed.” Fla. Admin. Code R. 10C-8.0181(l)(b). See Pentuik v. Department of Health and Rehabilitative Servs., 584 So. 2d 1098 (Fla. 1st DCA 1991). In its Manual 165-22, HRS concedes that the post-transfer “traumatic onset of disability” or diagnosis of a “previously undetected disabling condition” “may indicate that assets were transferred exclusively for some purpose othe…

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