Prior to filing an application for Medicaid, my client, Jo Carol Alford, filed a petition in Chancery Court to increase the CSRA and the MMMNA pursuant to 42 U.S.C. § 1396r-5. Her husband suffered from multiple sclerosis, and residency in a nursing home would have been  immanent had he lived.  The uncontroverted evidence at the hearing showed that, due to her young age, the default CSRA limit of $109,560 was inadequate to provide for Jo Carol's support for the remainder of her life.  The Department argued that the trial court lacked jurisdiction to increase the default allowances for community spouses until Mrs. Alford exhausted her administrative remedies. The Chancery court found that it had authority to grant separate maintenance via a QDRO (conveying $400,000 in retirement assets) under state law, but that it did not have authority to grant relief under 42 USC Section 1396r-5, as I argued to the court.  Mrs. Alford appealed, but while the appeal was pending, Mr. Alford died.  The state argued that his death rendered the issue moot, but the Court found that it nonetheless had jurisdiction  because the issue involved a matter affecting an important public interest that was likely to arise again. After examining other cases from Tennessee, New Jersey, D.C., Arkansas and Missouri, as well as Mississippi law, the court concluded that under Mississippi law, where an administrative remedy exists "relief must be sought by exhausting this remedy before the courts will act." Accordingly, directly opposite to the findings of courts in Tennessee and New Jersey, and rendering moot specific language found in the Federal law, the Supreme Court agreed with the trial court that 42 USC Section 1396r-5 did not create a separate basis for trial court jurisdiction to increase the Medicaid default allowances for community spouses. 

Sadly, this case means that young Mississippi residents with seriously ill spouses like Mrs. Alford, who are faced with the difficult decision of forced impoverishment in order to obtain medical care that their spouse requires, or failing to get the help that their spouse requires in order to protect themselves, will be forced to take drastic measures to protect themselves.  The decision eliminates altogether a remedy that Federal law gives those spouses, because Medicaid admittedly takes the position that increases in the allowances are never allowed – under any circumstance.  Their own manual does not even give their administrative hearing officers authority to grant the relief that the Supreme Court says claimants must first ask them for before taking the matter to real judge.  No spouse will be willing to risk an appeal of such a matter through the Medicaid administrative hearing level, which can take as long as a year, and then to a court of law that may take as long as another year, all the while having to privately pay for their spouses' care.  The practical effect of this decision will be to force such spouses to take drastic steps to protect themselves and their spouse, including precisely the aggressive type of Medicaid planning permitted by Federal and state law but which Medicaid criticizes as an abuse of the system, or sadly in the most extreme of cases, obtaining a Medicaid induced divorce.  If you find yourself in such a circumstance, our firm is skilled in such aggressive planning and I be happy to discuss your case with you.  Please feel free to call for an appointment. 

Alford v. Mississippi Division of Medicaid, 2010 Miss. LEXIS 164 (March 25, 2010)