2008 D e c i sion s O p inion s of the U nit e d S t at e s C our t of Appe al s for the Thir d C ir c uit
11-12-2008 

# James v . R ichm an P r e c e de nt i al or N on-P r e c e de nt i al : P r e c e de nt i al D ocke t N o . 06-5092

F o llow thi s and a dd it ion al work s at : http://d i git alc ommon s .l a w . vi ll a nova . e du/thir dc ir c uit_2008

Thi s de c i sion i s br ou ght t o you for f r e e and ope n a c c e s s b y the O p inion s of the U nit e d S t at e s C our t of Appe al s for the Thir d C ir c uit at V i l l a nova U nive r sity S choo l of L a

w Di git al Reposit ory

. It h as be e n a c c ept e d for inclusion in 2008 D e c i sion s b y a n author i z e d a dmini s tr at or of V i l l a nova U nive r sity S choo l of L a

w Di git al Reposit ory

. F or mor e inform at ion, p le as e c ont a ct Be n j amin . C arl s on@l a

w . vi l l a nova . e du
. Re c omme nde d C it at ion

" J ame s v . R ichm an" (2008). 2008 D e cisio n s . P ape r 182. http://d i git alc ommon s .l a

w . vi ll anova . e du/thir dc ir c uit_2008/182P RE CE DE NT I AL UN I TED STATES CO UR T OF A PP EALS F O R T H E T H IR D C IR C U IT

_________ N o. 06- 5092

_________ *J O SE PH I N E A

. J A M E S, as t he A dm i ni s t r at or fort he Est at e of Rober tA

. J ames

v. E S T E L L E R IC H M A N , in H e r O f f icia l C a p a c ity a s S e c re tar yo f

th e C o m m o n w e a lth o f

P e n n sy lv a n ia D epart m entof Publ i c W el far e, A p p e llan t. *( A m ended Pert he C l erk' s O r derdat ed 6/ 28/ 07)

O n A p p ea l from the U n it ed S tat es D istri ct C o u rt f o r th e M id d le D istric t o f P e n n sy lv a n ia ( D
. C

. C i v. N o. 05- cv- 02647) D istric t Ju d g e : H o n . A . R ich a rd C a p u to2 A r gued on M ar ch 4, 2008

B efor e: SC I R I C A , C hi ef J udge, FI SH E R and

R O T H , C i r cui tJ udges ( O pi ni on fi l ed: N ovember12, 2008) T h o m as W
. C o rbe tt , Jr. , E sq u ir e A tto rn e yG e n e ra l H o w ard G

. H o p k irk , E sq u ir e Ca l v i n R. Ko o n s , E s q u i r e ( AR GUE D) Seni orD eputyA t t or neyG ener al Jo h n G

. K n o rr, III , E sq u ir e C hi ef D eputyA t t or neyG ener al C hi ef, A ppel l at e Li t i gat i on Sect i on 1 5 F loo r, S tr aw b erryS q u are th H arr i s bur g, PA 17102

C ouns el forA ppel l ant

M a t t h e w J
. P a r k e r , E s q u i r e ( AR GUE D) M ar s hal l , Par ker& A s s oci at es 303 A l l eghenySt r eet J er s eyShor e, PA 17740

C ouns el forA ppel l ee3 S h ir leyB erg er W h it en ac k , E sq u ir e Sc h e n c k , Pr i c e , Smi t h & Ki n g , LLP 10 W as hi ngt on St r eet M or r i s t ow n, N J 07963- 0905 S h aro n R iven so n M ark , E sq u ir e L a w O f f ic e o f S h a ro n R iv e n s o n M a rk , P . C

. 855 Sum m i tA venue J er s eyC i t y , N J 07307

C ou n sel fo r A m i cus A ppel l ee N at i onal A cade m yof El derL aw A t t or ney s and N a t i o n a l A c a d e m y o f

E l d e r L a w A t t o r n e ys N ew J er s eyC hapt er
S teph en H
. K au fm an , E sq u ir e E ri c J. P ell eti er, E sq u ir e O f f it K u rm a n , P . A

. 8 Par k C ent erC our t , Sui t e 200 O w i ngs M i l l s , M ary l and 21117

C ouns el forA m i cus A ppel l ee Fi nanci al L i fe I ns ur ance C om pany

O P I N I O N4 RO TH , C i r cui tJ udge: E s t el l e B
. R i chman, Secr et aryof the C om m onw eal t h of P en n sy lvan ia, D ep artm en t of P u b li c W elfa re (the D ep artm en t) , appea l s t he or der of t he D i s t r i ct C our t fort he M i ddl e D i s t r i ctof P e n n sy lv a n ia, e n

jo in in g the D epartm e n t f ro m d e n y in g M e d ica id b e n e f its to R o b e rt A . Ja m e s. T h e c e n tra l issu e to th e a p p e a l is w hether an annui t y , pur chas ed byJ ames’ s w i fe J os ephi ne, m ay b e tr e a ted b yth e D e p a rtm e n t as a n a v a ilab le r e so u rc e in cal cul at i ng J ames’ s el i gi bi l i t y for M edi cai d benef i t s . W e agr ee w ith th e D istric t C o u rt th a t th e D e p a rtm e n t m a yn o t so tre a t it

. W e w ill th e re f

o re a f f irm th e ju d g m e n t o f

th e D istric t C o u rt. I . BA CKGROUND A . Fac t ualBackg r ound M e d ica id a p p lica n ts are re q u ire d to e x h a u st a ll av a ilab le r es our ces i n or dert o be el i gi bl e forbenef i t s . U ndert he am en d m en ts t o M ed icaid im p lem en ted b ythe M ed icare C a ta s tr o p h ic C o v e ra g e A c t o f 1 9 8 8 (M C C A ), 4 2 U .S .C . § 1396r

- 5, a spous e l i vi ng athom e ( t he “c om m uni t ys pous e”) m ay re se rv e c e rta in in c o m e a n d a ss e ts to m e e t h is o r h e r m o n th ly needs , m aki ng t hem unavai l abl e t o t he i ns t i tut i onal i zed s pous e. T he M C C A provides t hat “no i nco m e of the com m un i t yspou se s hal l be dee m ed ava i l abl e t o t he i ns t i tut i onal i zed s pous e, ” 42 U
. S. C

. § 1396r

- 5( b) ( 1) , buts hel t er s onl ya l i m i t ed subs etof the com m un i t yspou se’ s ass e ts unde r the “co m m un i t yspou se re s o u rc e a llo w a n c e ” o r C S R A . 4 2 U .S .C . § 1 3 9 6 r- 5 (c ).5 R o b ert A

. J am es w as a reside n t of S u m m itH ea lth C are nur s i n g f

a c i l i t yi n W i l k e s - Ba r r e , Pe n n s y l v a n i a . He was admi t t ed on A ug u st 10, 2005, and di ed on M ar ch 24, 2007, w hi l e t hi s cas e w as on appea l

. J ames w as m arr i ed t o J os ephi ne A . J a m e s . O n Sept ember20, 2005, J ames fi led a R es our ce A s s es s m entw i t h t he D epart m entof Publ i c W el far e att he L uzerne C ount y A s s i s t ance O ffi ce. H e s t at ed i n the R es our ce A s s e s s m e n tt h a t , a s o f A u g u s t1 0 , 2 0 0 5 , h e a n d h i s w i f e 's avai l abl e r es our ces t ot al ed $381, 443. 00. A ft eral l ow i ng fort he C SR A and the i ns t i tut i onal i zed s pous e' s al l ow ance , J ames a nd h is w if e th e n h a d a v a ila b le re s o u rc e s to ta lin g $ 2 7 8 ,3 4 3 .0 0
. In o r d e r to re d u c e th e ir a ss e ts to th e lev e l th a t w o u ld qual i fyR ober tJ ames for M edi cai d benef i t s , on Sept ember12, 2 0 0 5 , Jo se p h in e Ja m e s h a d p u rc h a se d f o r $ 2 5 0 ,0 0 0 a sin g le p re m iu m im m e d iate irre v o c a b le a n n u ityf ro m G e n e ra l E lec tric A s s ur ance C om pany . T he annui t y w as pay abl e t o Jo s ephi ne J ames o v er an ei ghty earper i od i n m ont hl yamount s of $2, 937. 71, begi nni ng O ct ober1, 2005, and endi ng Sept ember1, 2013. T he annui t y ’ s t erm s of t he endor s ementpr ovi ded that
“ [ t]h is C o n tra c t m a yn o t b e su rre n d e re d , tran sf e rre d , co llate ra lly a ss ig n e d , o r re tu r n e d f

o r a re tu rn o f

th e p re m iu m p a id . T h is Co n t r a c t i s i r r e v o c a b l e a n d h a s n o c a s h s u r r e n d e r v a l u e . An O w nerm aynotamend t hi s C ont r act orchange anydes i gnat i on u n d e r th is C o n tra c t.” T h e p a rties a g re e th a t th e a n n u ityis actuar i al l ys ound. O n Sept ember15, 2005, R ober t J ames al s o pur chas ed a n ew au tom o b il e f

o r $2 8 , 5 5 0
. A t th is p o int, all the J am es’s6 r es our ces in ex ces s of thos e perm i t t ed byt he C SR A and the i ns t i tu t i o n al i zed s pous e' s al l ow ance had bee n s pentorconvert ed t o t h e a n n u i t y. J ames’ s Sept ember20, 2005, R es our ce A s s es s m entand appl i cat i on for M edi cai d cover age t o as s i s tw i t h t he paym entof hi s nursi n g fac i l i t ybi l l s oughtel i gi bi l i t yas of Sept ember15, 2005. O n N ovember 22, 2005, t he Luzerne C ount yA s s i s t ance O ffi c e d e t e r mi n e d t h a tRob e r tJ a me s was n o te l i g i b l e f or M e d ica id a ss ista n c e b e c a u se h e d id n o t r e c e iv e f a ir c o n s i d e r a t i o n f

o rt h e r e s o u r c e s u s e d t o p u r c h a s e t h e a n n u i t y. O n D ece m ber12, 2005, the D epart m enti s s ued a ne w not i ce t o R ober tJ ames, advi s i ng hi m that the not i ce he had pr evi ous l yr ece i ved on N ovember22, 2005, w as r es ci nded and t hathe w as “i nel i gi b le fornur s i ng hom e paym entatt hi s t i m e. E xces s r es our ces exi s tdu e to the ava i l abi l i t yof the $250, 000 a n n u ity

. Y o u m a y re a p p ly w h e n re so u rc e s a re w ith in e lig ib ili ty l i m i t s . ” I n t he D epart m ent ' s vi ew , the annui t yhad a va l ue of $185, 000 and r ep r es ent ed a r es our ce thatcombi ned w i t h ot her r e s o u r c e s o wn e d b yJ o s e p h i n e J a me s e x c e e d e d t h e CS RA

. T hes e r es our ces w er e t her efor e avai l abl e t o payfornur s i ng car e. T he D epart m entoffe r ed the dec l ar at i on of M ic hael G oodm an, C hi ef Execut i ve O ffi cerof J

. G

. W entw or t h, a fi nance company s peci al i zi ng i n t he pur chase of annui t i es , as evi dence of the val ue and mar ket abi l i t yof the annui t y , despi t e the n o n -a ss ig n m e n t lan g u a g e in th e a n n u ity ’s e n d o rse m e n t. R ober tJ ames a ppeal ed the D epart m ent ' s deci s i on t o t he O ffi ce of H ear i ngs and A ppeal s . H i s appea l i s s t i l l pendi ng.T h e b a sis o f th e S u p re m a c yC lau se c laim w a s 6 2 P a . S tat. 1 A nn. T he D epart m ent di d notcons i dert hi s s t atut or ypr ovi s i on i n enj oi ni ng t he D epart m entfr om deny i ng J ames’ s r eques tfor M edi cai d benef

i t s . T he Supr emacy C laus e i s s ue has notbeen ra is e d o n th is a p p e a l a n d w e w ill n o t c o n s id e r i t. 7 I f deni ed M edi cai d benef it s, he w oul d be l i abl e hi m s el f t o pay forhi s nur s i ng fac i l i t ycar e ata r at e of ove r$5, 000 perm ont h. B . P roce dural H i s t ory O n D ece m ber 21, 2005, R ober tJ ames fi l ed a c om pl ai nt ag ains t th e D ep artme n t i n the D istri ct C o u rt , see k ing d ec laratory and i nj unct i ve r el i ef unde r42 U
. S. C

. § 1983 and the Supr emacy C l aus e of the U

. S. C ons t i tut i on. O n M ar ch 6, 2006, J ames fi l ed 1 a r e q u e s t f

o r a t e mpo r a r y r e s t r a i n i n g o r d e r a n d a mot i on for pr el i m i nary i nj unct i on. O n M ar ch 20, t he D i s t r i ctC our tgr ant ed t he re ques t and m ot i on, enj oi ni ng t he D epart m entfr om deny i ng M e d ic a id b e n e f

its to Ja m e s u n til a f

in a l d e c isio n o n th e m e rits of the ac t i on. T he part i es t hen agr eed t o fi l e cr os s - m ot i ons for sum m aryj ud gm ent w i t h j oint st i pu l at i on s of facts and exh i bit s. T he D i s t r i ct C our t ent er ed s um m ary j udgm ent i n favor of J ames o n N o v e m b e r 2 1 , 2 0 0 6 . T h e D e p a rt m e n t a p p e a le d

. I I . DI S CU S S I ON A . Ju ri sdict i on an d M oo tness T he D i s t r i ctC our thad fe der al ques t i on j ur i s di cti o n , as t he pr i m aryi s s ue pr es ent ed w as w hethert he D epart m enthas8 m isin ter p re ted f

e d e ra l law re g a rd in g Ja m e s’s rig h t to M e d ica id b e n e f its. 2 8 U .S .C . § 1 3 3 1 ; See Li ndy v. Lynn , 501 F. 2d 1367, 1 3 6 9 ( 3 d Ci r . 1 9 7 4 )

. W e h a v e j u r i s d i c t i o n p u r s u a n t t o 2 8 U. S

. C. § 1 2 9 1
. O u r rev iew o f a de cisi o n to gran t o r d e n ys u m m ary jud g m en t i s p lena ry . S u m m aryjud g m en t is ap p rop ri ate w h ere t her e ar e no genui ne i s s ues of m at er i al fac tand, w hen vi ew i ng t he fa ct s i n t he l i ghtm os tfavor abl e t o t he non- m ovi ng par t y , t he m o v in g p a rt yis e n title d to ju d g m e n t a s a m a t t e r o f la w . See F
. R
. C

. P
. 5 6 (c); P i Lam bda P hi Fr at er ni t y, I nc. v. U ni ver s i t y of P i t t s bur gh , 2 2 9 F .3 d 4 3 5 , 4 4 1 n .1 (3 d C ir . 2 0 0 0 ). A lth o u g h Ja m e s d ied d u rin g th e p e n d e n c y o f th is a p p e a l, t he ca s e i s notm oot
. W hi l e hi s death does m oott he cont i nued im p o sitio n o f th e p e rm a n e n t in ju n c tio n a g a in st th e D e p a rtm e n t, nevert hel es s t he D i s t r i ctC our tadj udi cat ed the q u est i on of “ul t i m at e l i abi li t y ” fort he cos t s of nur s i ng car e and the D e p a rt m e n t c o n tin u e s to c o n te s t its lia b ility. See H eas l ey v . B elden & B l ake Corp. , 2 F
. 3 d 1 2 4 9 , 1 2 5 3 n . 4 (3d C ir

. 1 9 9 3 ). B . A vai l abi l i t y of

E qui t abl e R el i ef Be f o r e a d d r e s s i n g t h e s u b s t a n t i v e i s s u e s i n t h i s c a s e , we m u st f irst d e ter m in e w h e th e r a n e q u itab le r e m e d yis a v a ilab le her e. I f J ames had an adequa t e l egal r emedy , equi table rel i ef w o u ld n o t b e a p p ro p ri a te
. S ee R o e v. O per at i on R es cue , 919 F
. 2 d 8 5 7 , 8 6 7 n . 8 (3d C ir

. 1 9 9 0 ). W e r evi ew t he deci si on t o pr ovi de equi t abl e r el i ef f or a b u s e o f d i s c r e t io n . A C LU v. B l ack H

ors e Pi ke Reg'lB d. of E duc. , 84 F. 3d 1471, 1476 ( 3d C i r . 1996)

. I n or der t o obt ai n a perm a ne nti nj un c t i on , a plai nti ff m ustshow , am on g o t her things,9 t h at “ h e has no a dequat e l egal r emedy

. ” R oe , 919 F. 2d at867 n. 8. T he D i s t r i ctC our tfound thatJ ames l acke d a l egal r emedy b ec au s e th e 1 1 th A m en d m en t barred rec o v eryo f m o n etary d am ag es sh o u ld h e p rov e h e w as u n law fu ll yd en ied s u p p o rt p a ym e n ts
. T h e D ep artm en t argu es th at th e a v ail ab il ityo f m o n etary rel i ef t hroug h st at e adm i nis t rat i ve p roceedings precl ud es a fi ndi ng of i r r epar abl e harm . H ow ever , t her e i s no gener al r equi r ementt ha tp l a i nt i ffs exhaus ts t at e admi ni s t r at i ve r emedi es b e f o r e b r i n g in g a § 1 9 8 3 a c tio n . P a tsy v . B d . o f R eg e n ts , 457 U .S

. 4 9 6 , 5 1 6 (1 9 8 2 ); see al so Monr oe v. P ape , 365 U
. S. 167, 1 8 3 (1 9 6 1 ) (“ T h e f

e d e ra l re m e d yis s u p p lem e n tar yto th e sta te r emedy , and the l at t erneed notbe fi r s ts oughtand r efus ed b e f o re th e f e d e ra l o n e is in v o k e d .” ). W e con cl ud e t hat t his precept al so ho l ds t rue i n a requ est f o r i n ju n c tiv e re lie f

in a § 1 9 8 3 a c tio n . See D eSar i o v. Thom as , 139 F. 3d 80, 85- 86 ( 2d C i r . 1998)

. I f w e w er e t o d eci de ot herw i s e, w e w oul d i n eff ectbe deny i ng t he pr ece dent i al eff ect of P at s y – w e w oul d be r equi r i ng exhaus t i on before bri ngi ng t hi s t yp e o f

§ 1 9 8 3 a c t i o n . . W e mus tt h e r e f o r e d e c l i n e t he D epart m ent ’ s r eques tt hatw e i m pos e a de f act o exhaus t i on re q u ire m e n t w h e re , as h e re , a p lain tiff m a yre q u e st o n ly e q u i t a b l e r e l i e f

i n t h e f e d e r a l f o ru m. C . T r e a tm e n t o f A n n u ities u n d e r M e d ica id T he centr al i s s ue i n t hi s cas e i s w hethera non- r evoca bl e, n o n-transferrabl e ann uitym aybe tr eat ed as an avail a b le r es our ce byt he D epa rt m entfort he purpos es of ca l cul at i ngT he SSI Pr ogr ams O per ati o n s M an ual Sy s t em i s “the 2 publ i cl yavai l abl e oper at i ng i ns t ruct i ons forp roce s s i ng Soci al Se c u r i t y c l a i ms , ” a n d t h o u g h “ t h e s e a d mi n i s t r at i ve i nt erpr et at i on s are notpr oduct s of form al rul emaki ng, t hey nevert hel es s w arr antr es pect
. ” A rt z v. B arnh art , 330 F. 3d 170, 176 ( 3d C i r . 2003) ( ci ti ng W as h. D ept
. of

Soci al Ser vs . v. Kef f el er , 5 3 7 U
. S

. 3 7 1 (20 0 3 )). 10 M edi cai d el i gi bi l i t y . W e w i l l fi r s taddr es s t he tr eatm entof the annui t yi t s el f, befor e tur ni ng to the pos s i bi l i t yof tr eat i ng t he in c o m e f ro m th e a n n u ity a s a s e p a ra te re s o u rc e . In det erm i ning w hethert he an nu i t ym aybe tr e a t ed as a reso u rce , the D ep artm en t ca n n o t u se a m etho d o log y that is m o re re stric tiv e th a n th a t u se d b yth e S S I (S u p p lem e n tal S e c u rity In c o m e ) P ro g ra m . See 4 2 U .S .C

. § 1 3 9 6 a (a )( 1 0 )( C )( i) (I II ). A m ethodol ogyi s “cons i der ed t o be ‘ no m or e re s t r i ct i ve’ i f, us i ng t he me t h o d o l o g y , a d d i t i o n a l i n d i v i d u a l s ma y b e e l i g i b l e for m e d ica l assi st a n c e a n d n o in d iv id u a ls w h o a re o th e rw ise e lig ib le a re m a d e in e lig ib le f o r s u c h a s s is ta n c e .” 4 2 U .S .C . § 1396a( r ) ( 2) ( B )

. C ons equent l y , t he D epart m ent can nott r eatas avai l abl e r es our ces any as s et s t hat t he S SI r egul at i ons w oul d not t reatas avai l able r esources. W e ther efor e tur n t o t he tr eatm ent of annui t i es undert he SSI r egul at i ons . T heypr ovi de that“i f an ind ivi dual has t he r i ght , author i t yor pow er t o l i qui dat e t he prope r t y , or hi s orher s h a re o f th e p ro p e rt y , it is c o n s id e re d a [ n ] ( a v a ila b le ) r e s o u rc e .” 20 C

. F
. R
. § 416. 1201( a) ( 1)

. T he SSI Pr ogr am O per at i ons M anual Sy s t em (PO M S) gi ves t he exa m pl e of j oi nt l yow ned 211 s t ock s ubj ect t o a l egal l ybi ndi ng agr eementt hatnei t herow ner w i l l s el l w i t houtt he cons entof the other , and expl ai ns t hats uch sto c k is n o t an a ss e t u n les s th e c o -o w n e r h a s c o n se n ted to its s al e. PO M S SI 01110. 115. T he P O M S m akes i t cl eart hatt he
“ p o w e r to liq u id a te” re f e rre d to b yth e re g u latio n is n o t sim p ly t he de f act o abi l i t yt o acc om pl i s h a cha nge i n ow ner s hi p of an as s et , butm us tal s o i ncl ude the pow ert o do s o w i t houti ncurr i ng l e g a l l i a b i l i t y. Jo se p h in e Ja m e s la c k s s u c h p o w e r to c h a n g e o w n e rsh ip i n herannui t y . T he annui t y s t at es on i t s fac e thati t“maynotbe su rren d ere d , tr an sfe rred , co ll aterall yassig n ed , o r return ed fo r a r etur n of t he pr emi um pai d. ” E ven i f t he D epart m enti s corr ect t hatJ os ephi ne J ames ha s t he de f act o abi l i t yt o eff

ecta cha nge i n ow ner s hi p of t he annui t y , s he ca nnotdo s o w i t houtbr eac hi ng t he contr actand i ncurr i ng l egal l i abi l i t y . A ccor di ngl y , t he annui t ycannotbe tr eat ed as an ava i l abl e r es our ce. A l t ernat i vel y , t he D epart m entar gues t hatJ os ephi ne J a me s c o u l d c r e a t e a n e w a n n u i t y , s e l l i n g t h e r i g h tt o a n i n c o me s t r eam t hati s equal t o t he i ncome t o w hi ch she i s ent i t l ed fr om t he exi s t i ng annui t y . Such a t r ans act i on w oul d not , how ever , be a tra n sf e r o f th e e x istin g a n n u ity

. It c a n n o t th e re f o re b e u se d to su p p o rt th e tre a tm e n t o f th e e x istin g a n n u itya s a n a v a ilab le r es our ce. I ns t ead, t he D epar t m ent ’ s pos i t i on w oul d t r eatt he hypo t heti cal proceed s fr om t he c re a ti on of a n ew ann uityas a curr ent l y avai l abl e r es our ce. T her e i s no s t atut or y bas i s fors uch a theoryand, i ndeed, adopt i ng i tw oul d t end t o underm i ne the M C C A rul e that“no i ncome of t he comm uni t ys pous e s hal l be d e e m e d a v a ila b le to th e in s titu tio n a liz e d s p o u s e .” 4 2 U .S .C . § 1396r

- 5( b) ( 1)

. U nders uch a theory , t her e is n o cl earl i m i tonT he di s s entas s er t s t hatt he foc us fort he amountof the 3 J ames’ s avai l abl e re s our ces s houl d be as of A ugus t 20, 2005, t he dat e of Rober tJ ames’ s entr yi nt o t he nur s i ng hom e, r athert han 12 t he hypot het i cal t r ans ac ti on pr ocee ds t hatcoul d be tr eat ed as a ss e ts, w h e th e r ba se d o n th e sa le o f a f u tu re stre a m o f

p a ym e n ts t i ed t o a fi xed i ncome r et i r eme ntacc ount , s oci al s ecur i t y , or e v e n a re g u la r p a y c h e c k

. F in a lly , th e D e p a rtm e n t ar g u e s th a t g ra n tin g e lig ib ili ty forpeopl e i n J ames’ s s i tuat i on w oul d u n d erc utt he purpos e of M e d i c a i d , wh i c h wa s n o ti n t e n d e d a s a g e n e r a l we l f a r e p r o g r a m. W e begi n bynot i ng t hatM edi cai d i s es t abl i s hed t hr ough an ex h au sti v e set o f st atutes th at tho rou g h ly d etail w h at b en ef it s are to b e a v a ila b le a n d to w h o m th e ys h o u ld b e p ro v id e d

. See 42 U
. S. C

. § 1396 et

s eq . I n t hi s cont ext , w e do notcr eat e rul es bas ed on our ow n s ens e of t he ul t i m at e purpos e of the l aw bei ng i nt erpr et ed, butr ather se ek t o i m pl ementt he purpos e of C o n g re s s a s e x p re s s e d in th e te x t o f th e s ta tu te s it p a s s e d

. See R os enber

g v. X M V en ture s , 274 F. 3d 137, 141 ( 3d C i r . 2001) (e x p lain in g th a t th e ro le o f th e c o u rts in in terp re tin g a sta tu te is t o gi v e e f

f e c tt o Con g r e s s ’ s i n t e n t , a n d t h a ti ti s p r e s u me d t h at C o n g ress ex p resse s it s inten t thro u g h the lan g u ag e o f a statu te). A s di s cus s ed above, an i r r evoca bl e, non- al i enabl e annui t ydoes n o t fi t th e statuto ryd ef init ion o f a n av ail ab le reso u rce . In addi t ion , C ongr es s pr ovi ded a de t ai l ed s etof rul es governi ng t r ans act i ons t hat i t cons i der ed sus pi ci ous , and t he purc has e of an a n n u ityis n o t am o n g th e m . 4 2 U .S .C . § 1 3 9 6 p (c ). W e sim p ly ca n notal l ow a deni al of el i gi bi l i t yi f ther e i s no s t at u tory j us t i fi cat i on fort hatdeni al

. Such j us t i fi cat i on i s l acki ng her e. 3a s o f S e p te m b e r 1 5 , 2 0 0 5 , the e lig ib ili tyd a te s o u g h t in h is ap p li ca ti o n . B ec au se w e h av e f o u n d that Jo sep h ine J am es’s non- r evoca bl e, non- t ran sfer r abl e annui t yw oul d notbe an avai l abl e r es our ce unde rSSI r egul at i ons , and thus notan a v a i l a b l e r e s o u r c e u n d e rMe d i c a i d , R o b e r tJ a m e s b e c a me e lig ib le f o r M e d ica id c o v e ra g e a s o f S e p tem b e r 1 5 , 2 0 0 5 . H is s itu a tio n p ri o r t o th a t d a te is th e re f o re n o lo n g e r r e le v a n t. 13 I I I . CO NC L US I ON For the for egoi ng r eas ons , w e w i l l aff i r m t he j udgm ent o f th e D istric t C o u rt.14 F IS H E R , C i r cui tJudge , di s s ent i ng. T h e m a jo rityc o n c lu d e s th a t th e D e p a rtm e n t o f P u b lic W el far e ca nnott r eatt he annui t y t hat M r s . J ames purc has ed on S ep tem b er 1 2 , 2 0 0 5 , as an av ail ab le re so u rce in d eterm ining M r. J ames’ s M edi cai d el i gi bi l i t y . I r es pect ful l ydi s s ent
. I bel i eve t hati n or der t o appr ai s e t he amountof ava i l abl e r es our ces , our focus m us tbe on the da te o f M r . J ames’ s admi s s i on t o t he nur s i ng hom e. I fi nd t he ci r cumst ance s pr esen ted i n t hi s cas e t o be di s t i n g u i s h a b l e f

r o m a n i n s t a n c e whe r e a n a n n u i t ye x i s t s p r i or to th e d ate o f in sti tuti o n ali za ti o n . O n A u g u st 10 , 2 0 0 5 , M r. J ames w as admi t t ed i nt o t he Sum m i t H eal t h C ar e fa ci l i t yand, as o f th a t d a te , the Ja m e se s h a d a to tal o f $ 3 8 1 ,4 4 3 in a v a ilab le r es ource s. O n Sept ember20, M r . J ames fi l ed the R es our ce A s s es s m entform w hi ch ca ll ed fo r a l i s tof the J amese s ’ t ot al r es our ces , “s i ngl yorj oi nt l y - ow ned, ” as of t he dat e of a dm i s s i on in to th e n u rsin g h o m e . T h e $ 2 5 0 ,0 0 0 a n n u ityin c o n ten tio n d id notex iston A ugus t10. R ather , M r s . J ames pur chas ed the annui t yovera mont h l at eron Sept ember 12, s ever al day s pr i or to M r. Ja m e s f

ili n g h is a p p lica tio n f

o r M e d ica id . T h e a n n u ity pr ovi ded a ve hi cl e fort he J amese s t o r eal l ocat e thei rr es our ces a f t e rM r . J a me s b e g a n r e c e i v i n g c a r e a t t h e f a c i l i t y wh i c h , i n my o p inion , d o e s n o t cha n g e the fa ct th at as o f A u g u st 10 , M r. Jam es had e xcess re so urces for M edicai d eli gibi l i t ypu rposes. I t w o u ld b e a d if

f e re n t s c e n a ri o if

M rs . J a m e s h a d a n a lr e a d yexi s t i ng annui t yatt he dat e of hers pous e’ s i ns t i tut i onal i zat i on, t hough t hatdi d notoccuri n t hi s cas e. A ccor di ngl y , I w oul d fi nd t hatan annui t yw hi ch r epl ace s cas h e x i s t i n g a t t h e t i me o f i n s t i tu t i o n a l i z a t i o n c a n be a m ark etab le reso u rce u n d er 4 2 U
. S

. C

. § 1 3 9 6 r-5, bu t th e re co rd i s i ns uffi ci entt o m ake a nydeci s i on as t o the m arket abi l i t yof15 M r s . J ames’ s annui t y . Fi r s t , t he r ecor d i s i nadequa t e t o r es ol ve t he part i es ’ di s put e overt he i m pl i cat i ons of the ant i

- as s i gnm ent c lau se in th e a n n u ity . W h ile it a p p e a rs th a t u n d e r P e n n sy lv a n ia c o n tra c t law a n ti-as sig n m e n t c la u se s a re e n f o rc e a b le if s u f f ic ie n tly ju s tif

ie d , s ee CG U

Li f e I ns ur ance C o. of

A m er i ca v. Metr opol i tan Mor t

gage & Secur i t i es C o. , I nc. , 131 F. Supp. 2d 670, 679 ( E
. D
. Pa. 2001) , t he re cor d fai l s t o acc ountforhow any pot ent i al as s i gnm entw oul d occur

. Fi nd i ngs w oul d need t o be m a d e a s to th e rig h ts th a t th e a n ti-as sig n m e n t cla u se se e k s to p r ot ectforpr operappl i cat i on of Penns y l vani a contr actual enfo rcem ent pr i ncipl es. A ddi t i onal l y , t he r ecor d i s under devel oped r egar di ng t he D epart m ent ’ s ar gum entt hatM r s . J ames’ s annui t yi s l i qui d. T he D epart m en toffe r s t he dec l ar at i on of M r . G oodm an, an e m p lo y e e o f

J.G . W e n tw o rth , sta tin g th a t J.G . W e n tw o rth w o u ld p a y $ 1 7 0 , 0 0 0 f

o rt h e r i g h t s t o p a y m e n t s f r o m t h e a n n u i t y. H ow ever , t her e i s no i ndi cat i on i n t h e r ecor d t hatM r s . J ames coul d convertherannui t yt o cas h w i t hi n t w entyday s as r equi r ed under20 C

. F. R
. § 4 1 6
. 1 2 0 1( b)

. T he D epart m ent ’ s ar gum ent t hat t he annui t yhas m arketval ue does notequat e t o a fi ndi ng of li q u idity . A s d e m o n str ated b y2 0 C

. F
. R
. § 4 1 6
. 1 2 0 1 (c)(1), autom o b iles and l and are charact eri zed as n on l i qu i d y ett ho se exampl es carr ya ma rketval ue. Fur t her , al t hough t he d e c l a r a t i o n s t a t e s t h a t J
. G. W e n t wor t h “ wou l d r e q u i r e” t he a n n u ityo w n e r to “ re c o g n ize a f u ll sa le o f

th e ir rig h ts” a n d to ent er i nt o “a num ber of cont r actual agr eement s , ” the dec l ar at i on f a ils to a n sw e r w h e th e r th e a n n u it yiss u e r c o u ld re f u se to recogn i ze t he assi gn m en t or explai n the det ai l s of t ho se ad d it ion al co n tr ac tual ag ree m en ts th at w o u ld b e re q u ired

. In s um , I wou l d r e ma n d t o t h e Di s t r i c tCou r tf o ra d d i t i o n al f a c t f i n d i n g r e l e v a n tt o t h e a n n u i t y’ s m a r k e t a b i l i t y.