Court Opinion

ID: 9797009
Source: CourtListenerOpinion
Date Created: 2023-08-31 04:10:48.963103+00
Date Added: 2024-06-11T08:51:59.478655
License: Public Domain

W. JONES, J.,
dissenting.
The majority does not find that the written language of the Department’s regulations is ambiguous. However, they do look to the Department’s and the Congress’ intent for the Medicaid system. Therefore, I respectfully dissent. The majority opinion reaches its decision based upon an inference of what the Department intended to accomplish by its rules regarding the treatment of trust. While there is some logic to the approach taken by the majority, the fact is that the plain, unequivocal language used by the department in adopting its rules specifically allows for the placement of a person’s home in a trust, thereby removing it from the countable resources at the assessment stage of the Medicaid process. If indeed the Department intended to accomplish what the majority believes was intended, it would have been a very simple matter for the department to utilize the language which it used subsequent to the Staffords’ transaction, which now clearly provides that a home transferred to a trust will nevertheless be an exempt asset not countable at the assessment stage of the Medicaid process. The fact that the department chose to amend its regulations subsequent to the Stafford transaction clearly illustrates that the interpretation by the Staffords prior to the amendment was most likely the proper interpretation of the regulations.
Analysis of a statute or regulation always begins with the literal language of the enactment. Friends of Farm to Market v. Valley County, 137 Idaho 192, 197, 46 P.3d 9, 14 (2002) (citations omitted). This Court has established that it will not look to the legislative intent of a regulation where the express written language of the regulation is unambiguous. Friends of Farm to Market, 137 *539Idaho at 197, 46 P.3d at 14 (citing Lawless v. Davis, 98 Idaho 175, 560 P.2d 497 (1977)). “Where the language is unambiguous, the clearly expressed intent of the legislative body must be given effect, and there is no occasion for a court to construe the language.” Id. If the language is clear and unambiguous, then a court may not interpret the language to include an unwritten legislative intent.
The Department erroneously interpreted its regulations by failing to include the corpus of the revocable trust (the home) in the initial resource assessment and therefore acted in a manner that was arbitrary and capricious.
The majority is correct that I.C. § 56-202(b) grants the Department the authority to promulgate rules regarding Medicaid benefits. They are also correct in finding that I.C. § 56-203(b) grants the director the authority to cooperate with the federal government in carrying out the purpose of Medicaid benefits, and that I.C. § 56-203(g) grants the Department the authority to define persons entitled to Medicaid benefits. But, they are not correct when they state that “both the federal government and the state government expect federal law to predominate.” By giving the Department the power to promulgate rules, cooperate with the federal government and define persons entitled to Medicaid benefits the legislature has granted the Department the power to create regulations in accordance with the “requirements for federal participation.” I.C. § 56-203(g). This does not some how create any unwritten intent of the federal government into the Department’s regulations. Nor, does it create a system where the Department’s rules are secondary to the federal rules. This is a clear grant of authority by the legislature for the Department to create a system of regulations that are consistent with the federal system. Without a finding that the Department’s regulations are ambiguous, this Court is re-writing the regulations to include the Department’s and Congress’ intent into unambiguous regulations and an unambiguous statute. The majority, in essence, is requiring the Staffords to comply with the unwritten intent of the Department and Congress rather then the unambiguous and plain meaning of the language of the regulation.
Additionally, the majority opinion correctly points out that the Department uses the same definition for resources for both the initial assessment date and the eligibility determination date. They also state that “[o]ne must go back and forth among the rales to determine which rule may or may not apply to either of the valuation dates.” Nowhere does the majority find the regulations and the definition of resource ambiguous, nor should they. The Department intended to use one definition for resources, which it then limits in the rules applying to the initial assessment date (Rules 736-738), which is why one must ferret through the rules to determine which definition of resource applies to which date. However, the Department did not draft the regulations in a manner that conveyed them intent or Congress’ intent. Simply put, the majority’s actions in this case would be akin to a sign stating “Park Here” and the majority finding an intent for the sign to read “Do Not Park Here.” Although, it may have been the intent, it is the Department’s error for drafting clear regulations which fail to convey their intent. Potential Medicaid applicants and recipients should be able to rely on the clear and unambiguous language of the Department’s regulations without having to dig through numerous documents containing minutes from the Congressional floor and court cases from the Third Circuit.
If the Department had intended for two definitions of “resources” they very easily could have written the regulations in that manner. The majority is correct in pointing out the use of the word “participant,” which limits the “resource” definitions to people applying or receiving Medicaid benefits. However, the majority clearly overlooks the incorporation of the definition of “resources” into the assessment date. In Rule 737, the Department states that “resources” are counted at the assessment date, and then lists out exclusions to certain exemptions. This clearly and unambiguously incorporates the definition of “resources” from the eligibility rules into the assessment rules. The use of the word “participant” also clearly indi*540cates that the Department is capable of writing regulations in a manner to exclude any definitions of “resource” within that definition from also being a resource at the initial assessment date. By using the term resources interchangeably between the initial assessment and eligibility date the Department has indicated that there is a single use of the term “resource.” Further, any and all “resources” that the Department expressly excluded at the assessment date, as opposed to the eligibility date, are written into Rule 737, entitled “Resources Excluded From Assessment Date.” It is clear that the Department intended to exclude certain “resource” rules from the assessment date, and it is clear that they listed those exclusions in Rule 737. However, one major oversight of the Department was the failure to exclude revocable trusts as a resource when the corpus consists of the family home.
The Department did not draft the statutes in a manner that makes the unequivocal express language ambiguous. Although the Medicaid system is complicated, messy and tedious, it cannot be said that any ambiguity lies in the plain language of the regulations as drafted by the Department. For instance, the entirety of Rule 278 states “[a] trust is a resource to a participant with the legal right to revoke the trust, and use the principal for his own support and maintenance. See Sections [Rules] 838 through 873 in these rules for treatment of trusts for Medicaid.” The majority uses the reference to Rules 873 through 838 as proof that the regulation “does not apply for Medicaid purposes.” I cannot follow this logic. Rule 278 exists in the Idaho Administrative Code for the agency of the Department of Health and Welfare, in the chapter entitled Rules Governing Eligibility for Aid to the Aged Blind and Disabled. The Rule itself is entitled “trusts.” I fail to see where it would be apparent that Rule 278’s resource definition “does not apply for Medicaid purposes.” One may argue that the title “Rules Governing Eligibility for Aid to the Aged Blind and Disabled” expressly states that the rules only apply for the eligibility date. However, Rule 736, which is in the same chapter, is entitled “Assessment Date and Counting FSI Resources.” Further, Rule 736 states that the Department conducts an assessment of the couple’s resources at the assessment date. I fail to see how the majority reconciles the dual use of the term “resources” by the Department to find that one definition of resources applies to the initial valuation date and another definition of resources applies to the eligibility date.
In fact, the majority incorrectly interprets the Department’s intent by finding that the definition of resources is not the same for the initial assessment date and the eligibility date. The Department recently amended Rule 737, which undoubtedly, as conceded by Petitioner, would eliminate all questions in this case, to state “[t]he resource rules used in determining eligibility for ... Medicaid are also used in determining the couple’s total combined resources for the FSI resource assessment with the following exceptions: ... an excluded home placed in trust retains its exclusion for purposes of the resource assessment.” I.D.A.P.A. 16.03.05.737. Previously, the regulation stated “Resources excluded in determining AABD cash are excluded in determining the couple’s total combined FSI resources except ...” I.D.A.P.A. 16.03.05.737 (amended 2007). Therefore, the Department intended to use the same definition for “resource” throughout the regulations. What the Department might not have intended, and later corrected, was for potential applicants to artificially inflate their resources at the assessment date, by placing exempt resources in a revocable trust. The Department’s regulation states that some excluded resources will not be excluded at the assessment date, but fails to mention that a home placed in a trust will retain its exclusion. The Department corrected this error by amending the regulation to add this language. Although, this action alone is not sufficient to show that the Department failed to effectively regulate against the Staffords’ actions initially, it does lay weight to the Staffords’ position.
Under the regulations, a trust is a resource to the person who has the legal right to revoke the trust. I.D.A.P.A. 16.03.05.278. The corpus of a revocable trust is a resource. I.D.A.P.A. 16.03.05.871.01.a. Real property is a resource, unless it qualifies for an exclu*541sion. I.D.A.P.A. 16.03.05.237. If a person is institutionalized, the value of their home (up to $750,000) is an excluded resource, when a spouse or child lives in the home. I.D.A.P.A. 16.03.05.238.02.a-b.
In the present case, the home would have been an excludable resource under the regulations. However, once the home was placed into the revocable trust, the corpus of the trust (the home) became a countable resource. The regulations clearly and unambiguously indicate that a home is an excluded resource when the non-institutionalized spouse lives in the home. However, the corpus of a revocable trust is a countable resource, regardless if the corpus of the trust is the family home. The Staffords had an ownership interest in the trust because they had a beneficiary interest in the trust and because they retained the right to revoke the trust and use the assets for their care and support. Therefore, the corpus of the trust (the home) is a countable resource. The majority and the Department should include the value of the corpus of the trust (the home) in the Staffords’ initial resource assessment.
The clear and unambiguous language of the regulations expressly states that the corpus of a revocable trust is a countable asset. Failure to include the Trust as a resource affected a substantial right of the Staffords’ because it decreased the non-institutionalized spouse’s allowable share of asséts and/or deprived Mr. Stafford of eligibility for benefits to which he was otherwise entitled. Therefore, this Court should have found the Department’s action was in error. The majority has incorrectly given weight to the Department’s intent rather than the unambiguous language of the statutes.
The Department erroneously determined that a reduction in the corpus of the Trust did not constitute a “spend-down,” and acted in a manner that is arbitrary, capricious and an abuse of discretion.
The majority does not reach the issue of whether there was a valid “spend-down,” because the majority found that the Stafford home was an excludable resource. I address this issue because I find that the corpus of the revocable trust (the home) was a countable resource to the Staffords, as defined in the Department’s regulations. A couple who is over-resourced at the assessment date (initial resource date), must “spend-down” their assets to qualify for Medicaid. That is, any amount of assets over the resource limit must be reduced. This may be accomplished by converting non-exempt assets into exempt assets.
The assessment date, or initial resource date, is the date that a person first enters continuous long-term care. I.D.A.P.A. 16.03.05.736. An assessment date determines the value of the couple’s community and separate resources. I.D.A.P.A. 16.03.05.736. An assessment may be determined at the request of either spouse regardless if an application for Medicaid has been made. I.D.A.P.A. 16.03.05.736. In order to be eligible for Medicaid, a participant must meet the eligibility requirements. I.D A.P.A. 16.03.05.700. Eligibility is determined by the current month when application for benefits is made and resources are counted as of the first of the current month. I.D.A.P.A. 16.03.05.700. The assessment date (initial resource date) is used to determine the non-institutionalized spouse’s allowable share of property (one-half of the couple’s combined resources on the assessment date up to a cap of $94,760). The eligibility date is used to determine whether the couple is eligible for Medicaid benefits based on the couple’s resources as of the first day of the month that an application is made. I.D.A.P.A. 16.03.05.700. .736, .738.
Here, the Staffords, at the initial assessment date had a countable resource in the revocable trust (the home) valued at $172,700. At the eligibility date (July 1, 2004), that countable resource had been transferred to an exempt asset, a family home, by removing the value from the corpus of the revocable trust by deeding the residence to Mrs. Stafford who lives in it. In essence, the Staffords took an asset that had a cash value, and used that cash value to acquire an exempt asset. If the trust had been a pure cash asset, the Staffords would have been able to remove the exact same cash value and purchase a home, thereby *542qualifying for Medicaid benefits. The removal of the home as a countable resource from the trust, and transferring the value of the home into an exempt resource was essentially the same thing and was a valid action by the Staffords.
The Department erred when it failed to consider the removal of the value of the home from the trust as a valid “spend-down” under the regulations. Therefore, the Department acted in a manner that is arbitrary, capricious and an abuse of discretion when it failed to follow the plain language of its own regulations. I.C. § 67-5279(3). The Department’s action affected a substantial right of the Staffords’ and should be reversed. I.C. § 67-5279(4).