Source: http://wi.findacase.com/research/wfrmDocViewer.aspx/xq/fac.20190731_0000797.WI.htm/qx
Timestamp: 2020-08-09 20:13:06
Document Index: 489036555

Matched Legal Cases: ['§ 49', '§ 1382', '§ 416', '§ 416', '§ 1382', '§ 49', '§ 1382', '§ 416', '§ 1382', '§ 416', '§ 416']

FindACase™ | Tarrant v. Wisconsin Department of Health Services
Tarrant v. Wisconsin Department of Health Services
Christine Tarrant, Petitioner-Respondent,
Wisconsin Department of Health Services, Respondent-Appellant.
APPEAL from an order of the circuit court for Dane County, Cir. Ct. No. 2017CV1973 RICHARD G. NIESS, Judge.
¶1 The Wisconsin Department of Health Services (Department) appeals from the circuit court's order concluding that the monthly payments Christine Tarrant received from a testamentary trust account did not constitute countable unearned income when determining her eligibility for medical assistance. Because we conclude the circuit court erred, we reverse.
¶2 As a result of her father's death, and during the time period relevant to this case, Tarrant received $4500 a month from a testamentary trust created by her father's will. In January 2017, she applied to renew government-provided medical assistance.[1] The Department treated the monthly payments as unearned income, which when combined with her other income, made her ineligible for medical assistance. As a result, her applications were denied.
¶3 Tarrant appealed the Department's decision. An administrative law judge agreed with the Department that the monthly payments constituted unearned income for purposes of determining medical assistance eligibility and that these payments made her ineligible for medical assistance. Tarrant petitioned for review by the circuit court, and the court reversed the Department's decision. The Department appeals; we now reverse the decision of the circuit court.
¶4 "When a party appeals a circuit court order reviewing a decision made by an administrative agency, we review the agency's decision, rather than that of the circuit court." Newcap, Inc. v. DHS, 2018 WI.App. 40, ¶13, 383 Wis.2d 515, 916 N.W.2d 173. Because there is no factual dispute in this case, we review de novo the application of legal authority to the facts. See Estate of Gonwa v. DHFS, 2003 WI.App. 152, ¶25, 265 Wis.2d 913, 668 N.W.2d 122.
¶5 Medical assistance is "aimed at ensuring medical care for those who cannot pay for their own care." Id., ¶19. Eligibility for such assistance "is not a default position that the Department must rebut but rather a privilege for which the applicant must prove eligibility." Id., ¶17. Thus, in this case, Tarrant bore the burden of demonstrating to the Department that she was eligible for the assistance for which she applied. We agree with the Department and the ALJ that she failed to meet that burden.
¶6 Eligibility for medical assistance is determined based upon an individual's "income and resources." Wis.Stat. § 49.47(4)(a) (2017-18)[2]; State of Georgia, Dep't of Med. Assistance v. Shalala, 8 F.3d 1565, 1566 (11th Cir. 1993) ("Applicants are needy, and therefore eligible for assistance, depending on what income and resources are available to them." (citing Schweiker v. Gray Panthers, 453 U.S. 34, 36 (1981))). "'[I]ncome' includes earned or unearned income that would be included in determining eligibility … for the aged … under 42 U.S.C. [§§] 1381 to 1385 [2016]." Sec. 49.47(4)(c). "[E]arned income means only" wages, net self-employment earnings, "remuneration received for services performed in a sheltered workshop or work activities center," and royalties. Sec. 1382a(a)(1). "[U]nearned income means all other income, including" "support and maintenance" (with certain exceptions not relevant here); "any payments received as an annuity, pension, retirement, or disability benefit"; "prizes and awards"; "payments to the individual occasioned by the death of another person" if the payments exceed last illness and burial costs; "support and alimony payments, and ... gifts … and inheritances"; "rents, dividends, interest, and royalties"; "any earnings of, and additions to, the corpus of a trust established by an individual ... of which the individual is a beneficiary"; and certain "payments to or on behalf of a member of a uniformed service for housing." Sec. 1382a(a)(2). We agree with the Department's position that the types of income identified in § 1382a(a)(2) as unearned income are not intended to be a limited list as unearned income means "all other income, including" the types specifically identified. (Emphasis added.) See also 20 C.F.R. § 416.1120 (1994) ("Unearned income is all income that is not earned income." (emphasis added)); 20 C.F.R. § 416.1121 (1994) (delineating "some types of unearned income" (emphasis added)); Rosenshein v. Florida Dep't of Children & Families, 971 So.2d 837, 839 (Fla. Dist. Ct. App. 2007) (concluding that "the federal statute is not a complete itemization of every possible type of unearned income" and that although monthly long-term care insurance payments are not specifically identified, they are nonetheless "'countable' unearned income").
¶7 Tarrant points out that 42 U.S.C. § 1382a(a)(2)(G) "expressly identifies Medicaid Qualifying Trust distributions as countable unearned income" ("any earnings of, and additions to, the corpus of a trust established by an individual … of which the individual is a beneficiary"), and she briefly asserts that the lack of similar enumeration for testamentary trust payments suggests such payments do not constitute unearned income. We disagree. Section 1382a(a)(2)(G), like Wis.Stat. § 49.454, upon which Tarrant also heavily relies, see infra ¶12, appears to address a very specific type of trust-self-settled trusts- and provides us with no indication that adoption of this provision was intended as an implication that payments from other types of trusts are not to be considered unearned income. The mildest of implications subd. (G) may have in this regard is overcome by the instruction that unearned income means "all other income" that is not earned income, see § 1382a(a)(2) and 20 C.F.R. § 416.1120, and the similar nature of the payments Tarrant received to other types of "payments" and funds considered as unearned income. For example, although not specifically discussed by the parties, if the testamentary trust payments Tarrant received do not directly satisfy the language of the enumerated "payments … occasioned by the death of another person" or "inheritances" provisions of § 1382a(a)(2)(D) and (E) respectively, the payments at least bear much similarity to those types of payments. We see no reason why Tarrant's testamentary trust payments, occasioned by her father's passing, should not similarly be treated as unearned income.
¶8 "Income," earned or unearned, "is anything you receive in cash or in kind that you can use to meet your needs for food and shelter." 20 C.F.R. § 416.1102 (1994). In addition to other authorizations, the trust in this case authorized the trustees to pay Tarrant "reasonable sums" for her "comfort and well-being" and stated that "[t]his provision shall be construed liberally." Thus, Tarrant's trust payments appear to be funds available for her unrestricted use for her comfort and well-being, and we see no error with the Department treating these payments as unearned income for purposes of determining her eligibility for medical assistance. See State ex rel. DHS v. Trust Co. of Okla., 890 P.2d 1342, 1347 & n.15, 1349 (Okla. 1995) (noting "[f]ederal regulations defining income for SSI provide that income is anything received in cash or in kind that can be used to meet needs for food, clothing and shelter" and concluding that disbursements from a trust "may be income for medical [assistance] eligibility purposes … if they are utilized to meet" such needs (citing 20 C.F.R. §§ 416.1102, 416.1103 (1994))).
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&para;9 Wisconsin Stat. &sect; 49.45(34) and Wisconsin case law lead us to look to the state Medicaid Eligibility Handbook for additional guidance in determining whether the Department appropriately included Tarrant&#39;s monthly trust payments in determining her eligibility for medical assistance.[3] Section 49.45(34) directs that the Department prepare the handbook and that it be used for administration of the medical assistance program. Further, our supreme court has recognized that the handbook "is consistent with the federal and state legislation regarding medical assistance," Tannler v. DHSS, 211 Wis.2d 179, 187-88 & n.10, 564 N.W.2d 735 (1997), and has expressed that "because the … Handbook is designed ...