Docket No. 100841. 

IN THE 

SUPREME COURT 

OF 

THE STATE OF ILLINOIS

BETTY J. HINES, as Ex=r of the Estate of Beverly Tutinas, 

Appellee, v. THE DEPARTMENT OF PUBLIC AID, 

Appellant. 

Opinion filed May 18, 2006.

JUSTICE KARMEIER delivered the judgment of the court, 

with opinion. 

Chief Justice Thomas and Justices Freeman, McMorrow, 

Fitzgerald, and Garman concurred in the judgment and 

opinion. 

Justice Kilbride took no part in the decision. 

OPINION 
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This appeal arises from the administration of the estate of 

Beverly J. Tutinas, who died in 2001 leaving a home valued at 

$69,641.89 and an automobile worth $2,000. A single issue is 

presented for our review: May the Department of Public Aid1

assert a claim against Beverly=s estate to obtain 

reimbursement of $61,154.48 in Medicaid payments made on 

behalf of her husband, who predeceased her? The circuit court 

of Rock Island County determined that such a claim was 

permissible under state and federal law. The appellate court 

reversed and remanded, with one justice dissenting. 358 Ill. 

App. 3d 225. We granted the Department=s petition for leave to 

appeal. 177 Ill. 2d R. 315. For the reasons that follow, we now 

affirm the judgment of the appellate court. 

The relevant facts are not in dispute. Beverly and Julius 

Tutinas were married for more than 48 years. They resided 

together in Moline in a home to which they held joint title. The 

couple also held joint title to an automobile. They had no 

children. 

In 1994, Julius= declining health required that he be cared 

for in a nursing home. On July 7 of that year, the Department of 

Public Aid approved Julius for medical assistance pursuant to 

Title XIX of the Social Security Act, commonly known as the 

Medicaid Act (42 U.S.C. '1396 et seq. (2000)). 

Julius began receiving Medicaid payments in August of 

1994. Those payments continued until he died in 1997 at the 

age of 66. The payments totaled $61,154.48. 

No probate estate was created for Julius following his 

death. Because Julius and his wife, Beverly, held the marital 

home and their automobile in joint title, full ownership of the 

home and car passed to Beverly when Julius died. Beverly 

lived on for several more years, eventually passing away in 

May of 2001. Unlike Julius, Beverly neither applied for nor 

received Medicaid payments. 

 

 1Since this action commenced, the name of the Department of Public Aid 

has changed. Effective July 1, 2005, it became known as the Department of 

Healthcare and Family Services. 
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Beverly left a will when she died naming her sisters, Shirley 

A. Nelson and Betty J. Hines, as coexecutors. Beverly=s will 

was admitted to probate by the circuit court of Rock Island 

County on May 25, 2001, and letters of office were issued to 

Betty Hines as independent executor (see 755 ILCS 5/28B2 

(West 2002)). 

Beverly=s estate consisted of only two items, her home and 

the automobile she had once held in joint title with Julius. Both 

items were liquidated during the administration of her estate. 

The home was sold for $69,641.89, the car for $2000. 

In July of 2001, the Department of Public Aid filed a claim 

against the estate to recover the $61,154.48 in Medicaid 

payments it had made on behalf of Julius between 1994 and 

1997. Betty Hines, acting in her capacity as executor, filed a 

notice that the claim was being disallowed. The Department of 

Public Aid challenged the rejection of its claim on the grounds 

that it was contrary to the applicable provisions of the Probate 

Act of 1975 (755 ILCS 5/1B1 et seq. (West 2002)). Faced with 

that challenge, Hines, as executor, petitioned the circuit court 

pursuant to section 28B5 of the Probate Act (755 ILCS 5/28B5 

(West 2002)) for instructions regarding the claim. 

Following briefing and a hearing, the circuit court entered a 

detailed order, recounting the pertinent facts of the case and 

reviewing the governing law. In the circuit court=s view, section 

5B13 of the Public Aid Code (305 ILCS 5/5B13 (West 2002)) 

and 89 Ill. Adm. Code '102.200, an administrative regulation 

based on that statute, permitted the Department to seek 

reimbursement from Beverly=s estate for the Medicaid 

payments it had made on Julius= behalf. The circuit court 

further concluded that the aforementioned provisions of Illinois 

law do not conflict with and are not preempted by 42 U.S.C. 

'1396p(b), the section of the Medicaid Act pertaining to 

adjustment or recovery of Medicaid payments. 

Hines appealed. After determining that it had jurisdiction to 

hear the appeal pursuant to Supreme Court Rule 304(b)(1) 

(155 Ill. 2d R. 304(b)(1)),2

 the appellate court concluded that 42 

 

 2Rule 304(b)(1) authorizes appeals from A[a] judgment or order entered 

in the administration of an estate, guardianship, or similar proceeding which 
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U.S.C '1396p(b) does not permit the Department to seek 

recovery from the estate of a Medicaid recipient=s surviving 

spouse under the facts present here and that the provisions of 

Illinois law invoked by the Department in this proceeding 

exceed the authority granted by the Medicaid Act. It therefore 

held that the Department=s claim against Beverly=s estate must 

be dismissed. Accordingly, it reversed the judgment of the 

circuit court and remanded for further proceedings. 358 Ill. App. 

3d at 233. One justice dissented. 

 

finally determines a right or status of a party. 155 Ill. 2d R. 304(b)(1). 

Committee comments to this rule indicate that orders allowing or 

disallowing a claim fall within its provisions. See In re Estate of Stepp, 271 

Ill. App. 3d 817, 819 (1995). Reasoning that the circuit court=s order had the 

effect of allowing the Department=s claim, the appellate court determined it 

possessed jurisdiction under this rule to review that order on the merits. We 

agree. 

The Department petitioned for leave to appeal. 177 Ill. 2d R. 

315. That petition was allowed, and the matter is now before us 

for a decision on the merits. As indicated at the outset of this 

opinion, the sole question before us is whether the 

Department=s claim against Beverly=s estate was permissible 

under the Medicaid Act and the state statutes and regulations 

implemented pursuant to that Act. This issue presents a 

question of law, which we review de novo. Bowman v. 

American River Transportation Co., 217 Ill. 2d 75, 80 (2005). 

In undertaking our review, we begin with a brief discussion 

of the purposes and operation of the Medicaid Act. The Act, 

which originated in the 1960s, created a cooperative program 

under which the federal government reimburses state 

governments for a portion of the costs of providing medical 

assistance to low income groups. Gillmore v. Illinois 
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Department of Human Services, 218 Ill. 2d 302, 304-05 (2006). 

States are not required to participate in the Medicaid program. 

Once they elect to do so, however, they must design their own 

plans and set reasonable standards for eligibility and 

assistance. See 42 U.S.C. '1396(a)(17) (2000). Such plans 

and standards must comport with the Medicaid Act and the 

regulations promulgated thereunder by the United States 

Department of Health and Human Services. See Cohen v. 

Quern, 608 F. Supp. 1324, 1326 (N.D. Ill. 1984); Smith v. 

Miller, 665 F.2d 172, 175 (7th Cir. 1981). 

The Act provides that participating states must designate an 

agency to administer their Medicaid plans. See 42 U.S.C. 

'1396(a)(5) (2000); 42 C.F.R. '431.10(a) (2003). The agency 

designated by Illinois to administer its Medicaid plan is the 

Department of Public Aid. See 305 ILCS 5/2B12(3) (West 

2002); American Society of Consultant Pharmacists v. Garner, 

180 F. Supp. 2d 953, 958 (N.D. Ill. 2001). 

Under the Act, two types of low income groups are eligible 

for medical assistance: the categorically needy and the 

medically needy. Categorically needy persons are those who 

are automatically eligible to receive cash grants under one of 

the general welfare programsBthe Aid to Families with 

Dependent Children program (AFDC) (42 U.S.C. '601 et seq.

(2000)) or the Supplemental Security Income for the Aged, 

Blind, or Disabled program (SSI) (42 U.S.C. '1381 et seq.

(2000)). See 305 ILCS 5/5B2(1) (West 2002); 42 C.F.R. 

'435.100 et seq. (2003). The medically needy are persons who 

are ineligible to receive cash grants under AFDC or SSI 

because their resources exceed the eligibility threshold for 

those programs, but who still lack the ability to pay for medical 

assistance. See 305 ILCS 5/5B2(2) (West 2002); 42 C.F.R. 

'435.300 et seq. (2003). People who fall into the second 

category are called MANG (Medical Assistance-No Grant) 

recipients. See 89 Ill. Adm. Code '120.10(a) (Conway-Greene 

CD-ROM March 2002). Gillmore v. Illinois Department of 

Human Services, 218 Ill. 2d at 304-05. Julius was a MANG 

recipient. 

To qualify for Medicaid as a MANG recipient, a person must 

have low income and low assets, and the person must Aspend 
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down@ any resources over the statutory and regulatory limits. 

See 89 Ill. Adm. Code '120.10(d) (amended at 24 Ill. Reg. 

7361, eff. May 1, 2000). ASpend down@ requirements pose an 

obvious hardship to the spouses of medical assistance 

recipients, who face the prospect of being left with virtually 

nothing to live on once the couple=s income and resources are 

reduced to the level necessary to qualify for Medicaid. To 

ameliorate that hardship, Congress enacted the Medicare 

Catastrophic Coverage Act of 1988 (MCCA) (Pub. L. No. 

100B360), which includes provisions to protect, financially, the 

spouse who was not receiving medical assistance. These 

provisions, commonly called the spousal impoverishment 

provisions, allow the spouse to retain a certain level of 

resources and income and protect those amounts from use as 

payment for an institutionalized spouse=s nursing home care. 

See 42 U.S.C. '1396rB5 (2000); Cleary v. Waldman, 167 F.3d 

801, 805 (3d Cir. 1999). 

The Medicaid Act affords an additional element of financial 

protection to the families of Medicaid recipients by limiting the 

circumstances in which a state may seek reimbursement for 

the payments it made on the recipient=s behalf. The Act, as 

amended by the Omnibus Budget Reconciliation Act of 1993 

(OBRA) (Pub. L. No. 103B66, '13612(a)), expressly provides 

that A[n]o adjustment or recovery of any medical assistance 

correctly paid on behalf of an individual under the State plan 

may be made,@ except in three specified circumstances. 42 

U.S.C. '1396p(b) (2000). Only one of those exceptions is 

relevant here. It is set forth in subsection (1)(B) of the statute, 

which provides: 

AIn the case of an individual who was 55 years of 

age or older when the individual received such medical 

assistance, the State shall seek adjustment or recovery 

from the individual=s estate ***.@ 42 U.S.C. 

'1396p(b)(1)(B) (2000). 

The statute further provides that any adjustment or recovery 

under the foregoing paragraph may only be made after the 

death of the Medicaid recipient=s surviving spouse, if he or she 

has one. 42 U.S.C. '1396p(b)(2) (West 2000). 
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 Congress has determined that for the purposes of 42 

U.S.C. '1396(b), the definition of a deceased recipient=s 

estate shall include all real and personal property and 

other assets included within the individual=s estate as 

defined by the particular state=s probate law. 42 U.S.C. 

'1396p(b)(4)(A) (2000). Where the deceased recipient 

received or is entitled to receive benefits under Aa longterm insurance policy in connection with which assets or 

resources in the manner described in clause (ii) [of 

subsection (b)(1)(C) of the statute], the definition of the 

deceased recipient=s estate shall also include: 

Aany other real and personal property and other 

assets in which the individual had any legal title or 

interest at the time of death (to the extent of such 

interest), including such assets conveyed to a survivor, 

heir, or assign of the deceased individual through joint 

tenancy, tenancy in common, survivorship, life estate, 

living trust, or other arrangement.@ 42 U.S.C. 

'1396p(b)(4)(B) (2000). 

In addition, the Act provides that a state may, at its option, 

adopt this second, more expansive definition of estate to all 

cases, not just those involving long-term care insurance 

policies. 42 U.S.C. '1396p(b)(4)(B) (2000). 

Under the foregoing provisions, the Department clearly had 

a right to seek reimbursement from Julius= estate, as defined 

by Illinois law, following Beverly=s death. That, however, is not 

what it is attempting to do. Through this action, it seeks 

reimbursement from the estate of Beverly, his surviving 

spouse, even though she, herself, received no Medicaid 

payments. 

Nothing in the Medicaid Act authorizes such recourse. As 

we have just indicated, the Act provides three and only three 

exceptions for when the state may seek reimbursement for 

costs correctly expended on behalf of a Medicaid recipient. All 

are specifically directed to the estate of the recipient. No 

provision is made for collection from the estate of the 

recipient=s spouse. 

Where, as here, the language of a statute is clear and 

unambiguous, the court must enforce it as written. It may not 
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annex new provisions or substitute different ones, or read into 

the statute exceptions, limitations, or conditions which the 

legislature did not express. People ex rel. Department of 

Professional Regulation v. Manos, 202 Ill. 2d 563, 568 (2002), 

quoting Bronson v. Washington National Insurance Co., 59 Ill. 

App. 2d 253, 261-62 (1965). Moreover, as the appellate court 

correctly observed, it is a basic principle of statutory 

construction that A >the enumeration of exceptions in a statute 

is construed as an exclusion of all other exceptions.= @ 358 Ill. 

App. 3d at 232, quoting People ex rel. Sherman v. Cryns, 203 

Ill. 2d 264, 286 (2003). In cases such as this, where a statute 

specifies exceptions to a general rule, no exceptions other than 

those designated will be recognized. In re Estate of Tilliski, 390 

Ill. 273, 283, 61 N.E.2d 24 (1945). The appellate court was 

therefore correct to conclude that the Medicaid Act cannot be 

construed as permitting the state to look to the estate of a 

spouse of a recipient of medical assistance for reimbursement 

of costs correctly paid on the recipient=s behalf. 

Section 5B13 of the Illinois Public Aid Code (305 ILCS 

5/5B13 (West 2004)) does give the Department a claim against 

the estate of a person or Athe estate of the person=s spouse@

for amounts expended for the person for the type of nursing 

home care received by Julius. The right to collection conferred 

by this statute, however, is expressly limited. Under the 

statute=s terms, the Department may assert its claim for 

reimbursement only to the Aextent permitted under the federal 

Social Security Act.@ 305 ILCS 5/5B13 (West 2004). Such a 

limitation is required by the primacy of federal law. Although a 

state possesses wide discretion in administering its Medicaid 

programs, that discretion is qualified by its mandate to adhere 

to federal statutes and corresponding federal regulations. See 

Smith v. Miller, 665 F.2d at 178. As we have just explained, 

federal law does not authorize a state to seek reimbursement 

of Medicaid payments from the estate of a recipient=s spouse. If 

section 5B13 of the Public Aid Code were read to authorize 

collection from the estate of a recipient=s spouse, it would 

therefore exceed what is permitted by the Social Security Act 

and could not serve as the predicate for the Department=s 

claim against Beverly=s estate. See In re Estate of Budney, 197 
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Wis. 2d 948, 950, 541 N.W.2d 245, 246 (App. 1995); In re 

Estate of Craig, 82 N.Y.2d 388, 394, 624 N.E.2d 1003, 1006, 

604 N.Y.S.2d 908, 911 (1993). The same is true for 89 Ill. Adm. 

Code '102.200, the administrative regulation based on that 

statute invoked by the circuit court in support of its decision. 

While the Medicaid Act does not authorize the Department 

to proceed against Beverly=s estate, that does not end our 

inquiry. As we have just discussed, the Act bestows on Illinois 

the option of defining the estate of a Medicaid recipient such as 

Julius more expansively than under this state=s normal probate 

law. 42 U.S.C. '1396p(b)(4)(B) (2000). Under the Act, assets 

conveyed to a spouse the way the house and automobile were 

conveyed to Beverly could have been defined by the Illinois 

General Assembly to remain part of the Medicaid recipient=s 

estate for purposes of recovering Medicaid payments. 

Reported decisions indicate that some other states have 

elected to take this approach. See In re Laughead, 696 N.W.2d 

312 (Iowa 2005) (under Iowa Code section 249A.5(2)(c), the 

estate of a medical assistance recipient includes any real 

property, personal property or other asset in which the recipient 

had any interest at the time of the recipient=s death, to the 

extent of such interests, including but not limited to interests in 

jointly held property); Estate of DeMartino v. Division of 

Medical Assistance & Health Services, 373 N.J. Super. 210, 

861 A.2d 138 (2004) (N.J. Stat. Ann. '30:4DB7.2 (West 1997) 

defines deceased Medicaid recipient=s estate to include Aassets 

conveyed to a survivor, heir or assign of the recipient through 

joint tenancy, tenancy in common, survivorship, life estate, 

living trust or other arrangement@); State of Nevada 

Department of Human Resources v. Ullmer, 120 Nev. 108, 

___, 87 P.3d 1045, 1050 (2004) (statutes broaden the 

definition of Aestate@ to include Aassets conveyed to a survivor, 

heir or assign of the [deceased] [Medicaid] recipient through 

joint tenancy, tenancy in common, survivorship, life estate, 

living trust or other arrangement@); In re Estate of Jobe, 590 

N.W.2d 162, 164 (Minn. App. 1999) (Minnesota statute 

expressly allows claims for recovery of medical assistance 

costs rendered for predeceased spouse up to value of assets 

that Awere marital property or jointly owned property *** during 
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the marriage); In re Estate of Knudson, 132 Idaho 213, 216, 

970 P.2d 6, 9 (1998) (Medicaid recipient=s estate defined by 

Idaho statute to include community property of surviving 

spouseBMedicaid Act preempts recovery from surviving 

spouse=s estate except to the extent of such community 

property). 

For a brief period, the General Assembly took that 

approach as well. It exercised the option conferred on states by 

42 U.S.C. '1396p(b)(4)(B) and, in 1995, amended section 

5B13 of the Public Aid Code (305 ILCS 5/5B13 (West 2004)) to 

make the more expansive definition of estate applicable in all 

proceedings to recover amounts correctly paid on behalf of 

Medicaid recipients in Illinois. After only a year, however, the 

legislature changed its position. In 1996, it enacted new 

legislation which expressly limited the more expansive 

definition of estate to the only situation where the Medicaid Act 

requires it to be used, namely, where the deceased recipient 

Ahas received (or [was] entitled to receive) benefits under a 

long-term care insurance policy.@ See 305 ILCS Ann. 5/5B13, 

Historical & Statutory Notes, at 189 (Smith-Hurd 2001). That 

limitation was in effect when both Julius and Beverly died, and 

it remains in effect today. 

The existence of this statutory limitation distinguishes our 

case from In re Estate of Schwab, 1998 N.D. 226, 586 N.W.2d 

847, a decision cited by the Department in support of its 

position. The North Dakota statutes at issue in Schwab did not 

define a recipient=s estate as Illinois has, and the matter was 

left to the court to delineate. It is therefore of no use in 

resolving this case. Our legislature has spoken clearly on the 

matter, and we are bound to follow the law as written. 

Because no long-term care insurance policy was involved 

here, Julius= estate consists only of that property that would be 

regarded as part of his estate under the Probate Act of 1975 

(755 ILCS 5/1B1 et seq. (West 2004)). 305 ILCS 5/5B13 (West 

2004). Under Illinois probate law, property held in joint tenancy 

is never part of the estate of the joint owner who dies first. 

Upon the death of one joint tenant, title to the property 

automatically vests in the surviving joint tenant. See In re 

Estate of Alpert, 95 Ill. 2d 377, 381 (1983). Accordingly, the 
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house and automobile at issue in this case cannot be deemed 

part of Julius= estate for purposes of the Department=s action 

for reimbursement of the Medicaid payments made on his 

behalf. The proceeds from the sale of that property are 

therefore not subject to the Department=s claim under section 

5B13 of the Public Aid Code (305 ILCS 5/5B13 (West 2004)). 

For the foregoing reasons, the Department=s claim for 

reimbursement should not have been permitted by the circuit 

court. The appellate court=s judgment reversing the circuit 

court=s order and remanding the cause to the circuit court for 

further proceedings is therefore affirmed. 

Affirmed.

JUSTICE KILBRIDE took no part in the consideration or 

decision of this case.