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In Re Marilyn Clifford

November 9, 2012

IN RE MARILYN CLIFFORD


On Appeal from Secretary, Agency of Human Services

The opinion of the court was delivered by: Reiber, C.J.

In re Marilyn Clifford

(2012-114)

2012 VT 95

Supreme Court

PRESENT: Reiber, C.J., Dooley, Skoglund, Burgess and Robinson, JJ.

¶ 1. Applicant Marilyn Clifford appeals the denial of long-term home-care benefits under the Medicaid-funded Choices for Care program, arguing that a second home on an adjacent piece of property should have been excluded from the financial-eligibility calculation. We affirm.

¶ 2. Applicant applied for Choices for Care in July 2011. The program provides financial assistance for case management, personal care, adult day services, and home modifications, among other things. The Department of Children and Families determines an applicant's financial eligibility for the program based on the applicant's available resources. Under state and federal rules, the department may exclude a limited number of resources, including the applicant's home, from the calculation to protect them for personal use.

¶ 3. The state Medicaid rule governing the home exclusion for countable resources provides, in relevant part:

Home means the property in which an individual resides and has an ownership interest and which serves as the individual's principal place of residence. This property includes the shelter in which an individual resides, the land on which the shelter is located, related outbuildings, and surrounding property not separated from the home by intervening property owned by others . . . The home includes contiguous land and any other buildings located on the land.

Medicaid Rules §4241.1.

¶ 4. The department concluded that applicant's resources exceeded the permitted threshold by $85,815.94 after including in its calculation the $97,900 value of a farmhouse applicant and her husband owned on a piece of land adjacent to their primary residence. The farmhouse was listed as a separate residence for tax purposes, and applicant and her husband rented it out for $500 a month until the tenant died in August 2011. Although the department included the value of the farmhouse, it excluded the value of the piece of land on which the primary residence was situated and the other outbuildings, and specifically exempted the land associated with the farmhouse lot.

¶ 5. Applicant sought a fair hearing review by the Human Services Board. Before the board, she argued that the state rules implementing federal Medicaid policies exclude the value of an applicant's home, which, according to the board and secretary's understanding of the applicant's position, would include " 'all buildings of any type' so long as they are situated on land contiguous to the primary residence." The Human Services Board agreed with applicant and ordered the exclusion of the farmhouse.

¶ 6. The secretary of the Agency of Human Services reversed the board's decision. The secretary concluded that the board's interpretation of the home exclusion contradicted the plain language of Medicaid Rules § 4241.1, its legislative history, and ...


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