Opinion ID: 1048529
Heading Depth: 3
Heading Rank: 1

Heading: Medicaid Provisions

Text: By passing the Medicare Catastrophic Coverage Act of 1988 (MCCA), Congress sought to protect community spouses from “pauperization” while also preventing financially secure couples from unnecessarily obtaining Medicaid assistance. Morris, 685 F.3d at 929 (citing H.R. Rep. No. 100-105, pt. 2, at 65 (1987)); see also Lopes v. Dep’t of Soc. Servs., 696 F.3d 180, 188 (2d Cir. 2012). Congress directed that a couple’s combined resources are counted in determining Medicaid eligibility for an institutionalized spouse, 42 U.S.C. § 1396r-5(c)(2)(A), but the income of the community spouse is not included, id. § 1396r-5(b)(1). See Morris, 685 F.3d at 930. Further, “a couple may convert joint resources—which may affect Medicaid eligibility—into income for the community spouse—which does not impact eligibility—by purchasing certain types of [income generating investments].” Id. at 928; see also Lopes, 696 F.3d at 188 (holding nontransferable annuity for community spouse was not countable resource); James v. Richman, 547 F.3d 214, 218-19 (3d Cir. 2008) (same). The MCCA directs that in determining Medicaid eligibility, state agencies must use criteria that are “‘no more restrictive’ than the eligibility requirements under the Supplemental Security Income (SSI) Act.” Houghton, 382 F.3d at 1170 -4- (quoting 42 U.S.C. § 1396a(r)(2)(A)); see also Lopes, 696 F.3d at 182-83 (noting the same directive in 42 U.S.C. § 1396a(a)(10)(C)(i)); James, 547 F.3d at 218 (same). Thus, the SSI regulation that defines what constitutes a resource, 20 C.F.R. § 416.1201, properly guides the analysis here. See Lopes, 696 F.3d at 183; James, 547 F.3d at 218; see also Morris, 685 F.3d at 930, 932-33. Under that regulation, “[i]f the individual has the right, authority or power to liquidate the property . . . , it is considered a resource,” but if not, “the property will not be considered a resource.” 20 C.F.R. § 416.1201(a)(1). Property is “liquid” and thus a “resource” if it “can be converted to cash within 20 days.” Id. § 416.1201(b). In addition to its regulations, the Social Security Administration (SSA) has issued a Program Operations Manual System (POMS) “through which [it] further construes the statutes governing its operations.” Lopes, 696 F.3d at 186 (internal quotation marks omitted; alteration incorporated). Consistent with 20 C.F.R. § 416.1201, the relevant POMS provision states that “assets of any kind are not resources if the individual does not have . . . the legal right, authority, or power to liquidate them.” POMS § SI 01110.15 (effective April 18, 2011).1 1 POMS “are not products of formal rulemaking” entitled to Chevron deference, but “they nevertheless warrant respect” under the broader Skidmore framework. Wash. State Dep’t of Soc. & Health Servs. v. Guardianship Estate of Keffeler, 537 U.S. 371, 385-86 (2003) (citing Skidmore v. Swift & Co., 323 U.S. 134, 139-40 (1944)); see United States v. Mead Corp., 533 U.S. 218, 226-27, 234-35 (2001) (discussing Skidmore and Chevron, U.S.A., Inc. v. Natural Res. Def. Council, Inc., 467 U.S. 837 (1984)); see also James, 547 F.3d at 218 n.2. And as interpretations of the SSA’s own regulations, POMS are “controlling unless plainly erroneous or (continued) -5-