28, 2001 VOLUME 8, NUMBER 48
Small Life Insurance Policies Complicate Medicaid Eligibility
Elder law attorneys often discuss characteristics common to the older individuals they deal with. Clients frequently show up early for appointments, are unflaggingly courteous and pleasant to deal with, and seem to enjoy talking about their families and travels.
One other common characteristic, perhaps arising from a Depression-era concern for such things: older clients often have several small life insurance policies, usually policies they have held for decades. Unfortunately, those policies can sometimes complicate matters when clients require nursing home care.
Franklin Miller was such a client. When the Tennessee man was admitted to St. Francis Nursing Home in Memphis in 1997, he owned four small life insurance policies. He had bought the insurance starting in 1953, and the newest policy was already 32 years old.
Mr. Millerís assets were limited, and the monthly cost of nursing home care was eating into his small estate rapidly. His wife Nona Miller filed an application for assistance from Tennesseeís Medicaid program, which subsidizes nursing home care for those who qualify financially for assistance.
Unfortunately for Mr. and Mrs. Miller, Medicaid considers the value of life insurance policies as an available resource. Upon Mr. Millerís death the four small policies would pay a total of less than $15,000, but the Medicaid agency decided that the cash surrender value of the policies prevented him from qualifying.
Medicaid eligibility rules are complicated when it comes to life insurance. If the maximum amount payable on death of the policyholder is less than $1500, the value of the policy can be ignored in calculating eligibility. If the total "face amount" of insurance exceeds that small figure, however, the cash value of life insurance must be determined. Even small life insurance policies frequently must be liquidated before nursing home residents can qualify for Medicaid.
Mrs. Miller appealed the Medicaid determination in her husbandís case. She successfully argued that there was no evidence of the cash surrender value Mr. Millerís life insurance policies, or even whether they had any cash surrender value. In the absence of that information the Medicaid eligibility worker had simply applied a rule laid out in the stateís Medicaid eligibility manual, and had estimated the policiesí value at 60% of the death benefit. That, argued Mrs. Miller, was not an acceptable way to determine her husbandís eligibility for government benefits.
The Tennessee Court of Appeals agreed. Mr. Millerís life insurance could not be counted against him, ruled the Court, especially if based on a state policy manual rather than actual evidence. Miller v. Department of Human Services, March 5, 2001.
Although the final outcome was favorable for Mr. and Mrs.
Miller, Medicaid eligibility took over three years to establish, and another
year to confirm. Mr. Miller did not live long enough to see benefits. He
died a year before the initial ruling in his favor, and two years before the
Court of Appeals confirmed that result. Meanwhile someone--Mrs. Miller,
friends and family or the nursing home itself--paid the costs of Mr.
Miller's care for the last two years of his life, waiting for a
determination of whether Mr. Miller had bought "too much" life
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