Justia Public Benefits Opinion Summaries

Articles Posted in Minnesota Supreme Court
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The Supreme Court affirmed the decision of the court of appeals affirming the judgment of the district court reversing a transfer penalty imposed by the Commissioner of the Minnesota Department of Human Services on David Pfoser, a disabled Medicaid recipient who resided in a long-term care facility, after he transferred partial proceeds from the sale of a house into a pooled special-needs trust, holding that Pfoser made a satisfactory showing that he intended to receive valuable consideration for his transfer of assets.State and federal law impose a penalty on recipients, like Pfoser, of Medical Assistance for Long-Term Care benefits if they transfer assets for less than fair market value, but no penalty is imposed if the recipient makes a satisfactory showing that he intended to dispose of the assets either at fair market value or for other valuable consideration. See Minn. Stat. 256B.0595, subd. 4(a)(4). The Commissioner affirmed the transfer penalty imposed on Pfoser. The district court reversed, concluding that Pfoser received adequate compensation in the form of his vested equitable interest in the trust assets. The Supreme Court affirmed, holding that substantial evidence did not support the Commissioner's decision to uphold the penalty. View "Pfoser v. Harpstead" on Justia Law

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The Supreme Court reversed the decision of the court of appeals affirming the order of the district court that non-homestead life estates should not be included in Marvin Schmalz's assets, holding that the term "individual" in Minn. Stat. 256B.056, subd. 4a applies only to the applicant for medical assistance.Esther Schmalz was living at a long-term-care facility when she submitted an application for medical assistance for long-term-care benefits. As part of the assessment of her husband Marvin's assets, Renville County Human Services (RCHS) included Marvin's portion of several non-homestead life estate interests that he and Esther owned. Esther appealed, arguing that the life estates should not be included in the total amount of assets that Marvin may retain. The human services judge concluded that RCHS properly denied Esther's application for medical assistance based on the inclusion of the life estate assets owned by Marvin. The Commissioner of Minnesota Department of Human Services adopted the human services judge's recommendation. The district court concluded that the non-homestead life estates should not be included in Marvin's assets, ruling that the term "individual" in section 256B.056, subd. 4a included Marvin. The Supreme Court reversed, holding that an "individual" in the statute refers to the medical assistance applicant and not a community spouse. View "In re Schmalz" on Justia Law

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The Supreme Court affirmed the decision of the court of appeals affirming the determination of Scott County that Consumer Directed Community Support (CDCS) money that Cindy Ali, whose son was disabled, had allocated to herself as wages to care for her child was not excluded from the annual income calculation for the purpose of Section 8 eligibility, holding that amounts allocated to a parent to care for her disabled child are not excluded as income under 24 C.F.R. 5.609(c)(16).This dispute arose from the interplay between two public welfare programs, the state CDCS option for families with disabled members, and Section 8, an income-based federal housing program. Ali participated in the Section 8 housing program until Scott County, the local housing administrator, determined that the amounts Ali paid herself under the CDCS option were not excluded from her income when calculating her eligibility for Section 8 housing. As a result, Ali lost her Section 8 eligibility. The court of appeals affirmed. The Supreme Court affirmed, holding that the CDCS amounts Ali received as compensation for her services in caring for her child were correctly included as annual income when calculating Ali's Section 8 eligibility. View "In re Cindi Ali" on Justia Law

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In this personal injury action, the Supreme Court affirmed the judgment of the court of appeals reversing the judgment of the district court deducting from a damages award to Respondent the amount of discounts negotiated by Respondent's managed-care organizations, holding that the discounts were payments made pursuant to the United States Social Security Act under Minn. Stat. 548.251, subd. 1(2).After her car struck a school bus that failed to yield at an intersection, Respondent brought this action against the driver and the owner of the bus (collectively, Appellants). The medical expenses of Respondent, a medical-assistance enrollee, were covered by two managed-care organizations that contracted with Minnesota's Prepaid Medical Assistance Plan under the state's Medicaid program. The jury awarded damages, but the district court deducted from the award the discounts negotiated by the managed-care organizations. The court of appeals reversed. The Supreme Court affirmed, holding that the negotiated discounts were "payments made pursuant to the United States Social Security Act" under section 548.251, subd. 1(2), and therefore, Appellants could not offset the damages award for those payments. View "Getz v. Peace" on Justia Law

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The Supreme Court affirmed in part and reversed and remanded in part the decision of the Workers’ Compensation Court of Appeals (WCCA) upholding the decision of the compensation judge ordering that Atlas Staffing, Inc. and its insurer, Meadowbrook Claims Services, pay workers’ compensation benefits to Anthony Gist. The compensation judge found that Gist’s exposure to silica, a known cause of end stage renal disease (ESRD), during his employment with Atlas was a substantial contributing factor to his kidney disease.In the consolidated appeals brought by Appellants and Fresenius Medical Care, which treated Gist after Appellants denied coverage and accepted payments from Medicaid and Medicare for the costs of that treatment, the Supreme Court held (1) the compensation judge did not abuse her discretion by relying on a certain medical report to find that work-related silica exposure was a substantial contributing factor to Gist’s kidney failure; (2) under 42 C.F.R. 447.15, a provider cannot recover payment from third parties for any services billed to Medicaid after the provider has accepted payment from Medicaid for those services; and (3) the WCCA erred when it dismissed Fresenius’s cross-appeal as untimely. View "Gist v. Atlas Staffing, Inc." on Justia Law