Valliere v. Comm'r of Soc. Servs.

328 Conn. 294

178 A.3d 346

Paul VALLIERE, et al.

v.COMMISSIONER OF SOCIAL SERVICES

SC 19701

Supreme Court of Connecticut.

Argued September 12, 2017

Officially released February 1, 2018^*

Jennifer L. Callahan, assistant attorney general, with whom, on the brief, were George Jepsen, attorney general, and Hugh Barber, assistant attorney general, for the appellant (defendant).

Carmine Perri, with whom, on the brief, was Bruce A. Fontanella, for the appellees (plaintiffs).

Daniel J. Klau filed a brief for the Office of the Probate Court Administrator as amicus curiae.

Rogers, C.J., and Eveleigh, McDonald, Robinson, Vertefeuille and Espinosa, Js.^**

ROBINSON, J.

In this appeal, we consider the relationship between General Statutes § 45a–655 (b) and (d)¹ in determining whether a spousal support order previously rendered by the Probate Court is binding on the defendant, the Commissioner of Social Services (commissioner), when calculating the allowance that may be diverted to the support of the community spouse of a Medicaid eligible institutionalized person pursuant to 42 U.S.C. § 1396r–5, a provision originally enacted as part of the Medicare Catastrophic Coverage Act of 1988 (catastrophic coverage act), Pub. L. No. 100–360, § 303 (a) (1) (B), 102 Stat. 683, 754. The commissioner appeals² from the judgment of the trial court sustaining the administrative appeal brought by the plaintiffs, Paul Valliere (Paul) and Ellen Shea, the conservatrix and executrix of the estate of Paul's late wife, Marjorie Valliere (Marjorie), from the commissioner's decision to set a community spouse allowance for Paul in the amount of $0 with respect to the Medicaid benefit that paid for Marjorie's long-term residential care. On appeal, the commissioner contends that, because § 45a–655 (b) and (d) must be construed in light of the federal single state agency requirement that is implemented by General Statutes § 17b–261b,³ the trial court improperly concluded that the community spouse allowance was controlled by a spousal support order rendered by the Probate Court prior to the application for, and award of, Medicaid benefits. We disagree and, accordingly, affirm the judgment of the trial court.

The record reveals the following undisputed facts and relevant procedural history. On November 18, 2012, Marjorie was admitted to MidState Medical Center (MidState). On November 24, 2012, MidState discharged Marjorie to the Meriden Center, a skilled nursing facility, where she resided until her death on October 17, 2013. Paul continued to reside in their family home in Meriden. On March 18, 2013, the Probate Court appointed Shea, Marjorie's daughter, as conservatrix of Marjorie's estate.⁴

On March 21, 2013, Shea filed an application in the Probate Court seeking an order of spousal support for Paul pursuant to § 45a–655, contending that, in order to continue to reside in the community and pay the cost of his own "support, maintenance and medical treatment,"⁵ Paul needed to "own, use and exercise control over all or some of the [nonincome] producing assets, the income producing assets, [Marjorie's] total net income and [his own] total net income, all retroactive to March 18, 2013," the date that the Probate Court appointed Shea as conservatrix. The application further represented that Marjorie was "not receiving public assistance, state administered general assistance, or Medicaid, and [she] has not applied for or is receiving such medical assistance, but [she] reserves, and does not waive, her right to prepare, file and prosecute in the future [an] application, claiming [Medicaid] benefits." (Emphasis in original.) Shea provided notice of the application to the commissioner and to the Department of Administrative Services.

Following a hearing, on June 25, 2013, the Probate Court issued a decree, pursuant to §§ 45a–655 (a) and (b), and 17b–261b, which made findings in accordance with the representations in the application, namely, that, "[i]n order to continue to reside in the community and pay the cost of [his own] support, maintenance and medical treatment," Paul "now requires, and in the future will continue to require, to own, to use, and to exercise control over all or some of the [nonincome] producing assets, of the income producing assets, of [Marjorie's] total net income and [his own] total net income." In addition to directing Shea to transfer Marjorie's assets to Paul, the Probate Court ordered Shea, inter alia, to pay Marjorie's total net monthly income of $1,170.33 to Paul as spousal support, "which amount ... is known, identified, and defined as ... the community spouse allowance in [ 42 U.S.C. § 1396r–5 (d) (5) ]⁶ and in [Dept. of Social Services, Uniform Policy Manual § 5035.30 (B) (1) (b) ]."⁷ (Footnote added.) The Probate Court directed that this payment be made retroactive to November 18, 2012, the date Marjorie was admitted to MidState. The Probate Court provided notice of the hearing and a copy of the decree to the commissioner.

On July 15, 2013, an application was filed with the Department of Social Services (department) seeking Medicaid assistance for Marjorie. The department granted that application but, in doing so, declined to follow the community spouse allowance set in the Probate Court's decree. Instead, the department determined that Marjorie had an applied income obligation that required her to pay $898.45 monthly toward her care from April, 2013, through her death in October, 2013, and that no community spouse allowance was available pursuant to department policy.⁸

On February 13, 2014, Shea requested an administrative fair hearing for the purpose of challenging the department's refusal to accept the community spouse allowance set by the Probate Court. After a hearing, the commissioner, acting through a hearing officer, issued a decision on October 10, 2014, upholding the denial of the requested community spouse allowance and the determination of Marjorie's applied income obligation. The hearing officer concluded that, under § 17b–261b, the department is the "sole agency" tasked with determining eligibility for Medicaid benefits under state and federal law, and the Probate Court lacked the authority to set the community spouse allowance for Medicaid purposes. Specifically, the hearing officer concluded that, once an individual applies for Medicaid under § 45a–655 (d), only the department may set the community spouse allowance. Rejecting the plaintiffs' reliance on 42 U.S.C. § 1396r–5 (d) (5), the federal Medicaid statute addressing preexisting court orders, the hearing officer criticized the plaintiffs for what he described as "obvious" forum shopping, observing that it was "clear from a review of the Probate Court decree and the sequence of events that ... the Probate Court [was being used] to make a Medicaid eligibility determination, which the law does not permit." The hearing officer subsequently denied a timely request for reconsideration.

On December 8, 2014, the plaintiffs filed an administrative appeal pursuant to General Statutes § 4–183 challenging the commissioner's decision. In its comprehensive memorandum of decision, the trial court observed that this case concerned the interplay between the federal and state statutes implementing the catastrophic coverage act. Emphasizing that no party had challenged the Probate Court's determination with respect whether the support ordered was " 'proper under the circumstances of the case,' " the trial court concluded that, consistent with 42 U.S.C. § 1396r–5 (d) (5), § 45a–655 (b) authorized the Probate Court to set the community spouse allowance at the time that it did because Marjorie had not yet applied for or received Medicaid benefits. The trial court further determined that the restriction in § 45a–655 (d) applies only when "an institutionalized conserved person 'has applied for or is receiving [Medicaid benefits].' " The trial court determined that these subsections of § 45a–655"thus harmonized the standards the Probate Court must utilize in the approval of a [community spouse allowance] with the Medicaid scheme. If no prior court order has entered then the department is free, indeed required, to apply the standard enunciated by [ 42 U.S.C. § 1396r–5(d)(2) through (4) ].⁹ Where a prior court order regarding a [community spouse allowance] has entered, however, the department is obliged to adopt that amount pursuant to [ 42 U.S.C.] § 1396r–5 (d) (5)."¹⁰ (Footnote added.) Accordingly, the trial court rendered judgment sustaining the plaintiffs' administrative appeal from the department's community spouse allowance calculation "that would have resulted in [no] community spouse allowance and $898.45 in applied income rather than [the] prior Probate Court ... calculation [that] would have resulted in a [community spouse allowance] of $1170.33 and no applied income." This appeal followed.

On appeal, the commissioner argues that 42 U.S.C. § 1396r–5 (d) (2) and (3) sets a uniform national standard for the calculation of community spouse allowances, subject to an exception in 42 U.S.C. § 1396r–5 (d) (5) for court-ordered support, and for "exceptional circumstances resulting in significant financial duress" under 42 U.S.C. § 1396r–5 (e) (2), which provides a fair hearing procedure for spouses dissatisfied with their allowances.¹¹ The commissioner then contends that § 17b–261b implements the federal "single state agency" requirement of 42 U.S.C. § 1396a (a) (5), which renders the department the "sole agency to determine eligibility" for Medicaid and, therefore, restricts the Probate Court's authority to approve community spousal support to an "order [that] is consistent with state and federal law." The commissioner further contends that the Probate Court exceeded its authority under § 46b–655 (b) because only the department may determine the Medicaid community spouse allowance. As such, the commissioner then argues that the Probate Court exceeded its limited authority under § 45a–655 (...