The spouses of two men and one woman who have been denied access to Medicaid benefits are suing the state Department of Social Services in U.S. District Court.
Lawyers for the three couples argued in a lawsuit filed last week, that because the spouse still living in the community has access to an annuity, doesn’t mean it should disqualify their partner from receiving Medicaid benefits. They say the state’s qualification guidelines for Medicaid are higher than the federal government’s guidelines for the Supplemental Security Income program. The lawsuit alleges this is a violation of federal law.
The Department of Social Services declined to comment on the lawsuit.
Plaintiffs, Walter Gale, 80, and his wife Patricia Gale, 78, had assets totaling $285,000. The Medicaid allowance for a community spouse is $109,560. So in September of last year Mrs. Gale took out an $174,000 annuity and named the state as the remainder beneficiary to cover at least the total amount of Medicaid paid on behalf of Mr. Gale.
The reduction in assets through the annuity would allow Mr. Gale to be qualified for Medicaid, but the Department of Social Services has failed to approve the application and the Gales have “yet to hear anything from DSS,“ about the application, according to the lawsuit.
Mr. Gale currently resides at Kimberly Hall nursing facility in Windsor, which is costing $313 per day.
The second plaintiff, Walter Ehle, 84, has lived at Ledgecrest Health Care Center in Berlin since 2009. His care cost $358 per day. His wife Gloria Ehle lives in a modest home in Plainfield and had $450,000 in excess resources that would disqualify her husband from receiving Medicaid benefits, so in December of last year she purchased two annuities and made sure they were non-transferable and named the state as the beneficiary.
“Mrs. Ehle has yet to hear from DSS,” the lawsuit says.
The third and final plaintiff, Althea Pagliaruli, 68, lives at home in New Britain, and her husband Frank Pagliaruli applied for a Medicaid home care waiver because his wife needs round the clock care and extensive medication to deal with her seizures and mental illness.
If she wasn’t married her $1,260 pension and Social Security benefits would allow her to be qualified for the Medicaid home services waiver, however, collectively her and her husband have more than $618,000 in savings. In order to qualify for the waiver, her husband took out three different annuities, all non-transferable and all naming the state as the beneficiary.
Mrs. Pagliaruli’s application was denied on May 16, 2010.
Brendan Daly of Czepiga Daly Dillman LLC, argues a similar case was heard by U.S. District Court Judge Janet C. Hall in 2010 and the court found in favor of the plaintiff. In the lawsuit he said since the Medicaid eligibility standards applied by the state for community spouses is greater than the standard used by the federal Supplemental Security Income program then the court must find the annuities are not assets which can be counted toward Medicaid income limits.
