Alford v. Miss. Div. of Medicaid
| Docket Number: | 2008-CA-01984-SCT | |
| Supreme Court: | Opinion Link Opinion Date: 03-25-2010 Opinion Author: Lamar, J. Holding: Affirmed |
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| Additional Case Information: |
Topic: Application for medicaid - Community spouse resource allowance - Minimum monthly maintenance needs - 42 U.S. Code Section 1396r-5 - Moot appeal - Public interest exception - Jurisdiction - Mississippi Code Section 43-13-116 - Exhaustion of administrative remedies Judge(s) Concurring: Waller, C.J., Carlson, P.J., Dickinson, Randolph, Kitchens and Pierce, JJ. Non Participating Judge(s): Chandler, J. Concurs in Result Only: Graves, P.J., without separate written opinion. Procedural History: Bench Trial Nature of the Case: CIVIL - STATE BOARDS AND AGENCIES |
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| Trial Court: |
Date of Trial Judgment: 12-02-2008 Appealed from: MADISON COUNTY CHANCERY COURT Judge: Cynthia Brewer Disposition: The chancery court found that it had jurisdiction to grant separate maintenance via a QDRO. It further held that it had no authority to grant relief under 42 U.S. Code Section 1396r-5 prior to the Alfords exhausting their administrative remedies. Case Number: 2008-993-B |
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| Party Name: | Attorney Name: | Brief(s) Available: | ||
| Appellant: | Jo Carol Alford, Individually, and as Executrix of the Estate of Arthur Randall Alford, Deceased |
RONALD C. MORTON, A. ELIZABETH WHITAKER |
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| Appellee: | Mississippi Division of Medicaid | OFFICE OF THE ATTORNEY GENERAL: WILLIAM H. MOUNGER, CHARLES P. QUARTERMAN | ||
Synopsis provided by:  If you are interested in subscribing to the weekly synopses of all Mississippi Supreme Court and Court of Appeals hand downs please contact Tammy Upton in the MLI Press office. |
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| Topic: | Application for medicaid - Community spouse resource allowance - Minimum monthly maintenance needs - 42 U.S. Code Section 1396r-5 - Moot appeal - Public interest exception - Jurisdiction - Mississippi Code Section 43-13-116 - Exhaustion of administrative remedies |
| Summary of the Facts: | Prior to filing an application for Medicaid, Jo Carol Alford filed a petition in chancery court to increase the community spouse resource allowance and the minimum monthly maintenance needs allowance under 42 U.S. Code Section 1396r-5, because her husband, Arthur Alford, suffered from multiple sclerosis, and the maximum MMMNA and CSRA allowed by the Mississippi Division of Medicaid were insufficient to prevent her impoverishment once her husband entered a nursing home and applied for Medicaid. In its answer, the Division alleged that no application had been filed on behalf of Mr. Alford for Medicaid eligibility, and that the Alfords had failed to exhaust administrative remedies. The chancery court found that it had jurisdiction to grant separate maintenance via a qualified domestic relations order. It further held that it had no authority to grant relief under 42 U.S. Code Section 1396r-5 prior to the Alfords exhausting their administrative remedies. Mrs. Alford timely filed her notice of appeal. During the pendency of the appeal, Mr. Alford passed away. Mrs. Alford filed a motion to substitute Arthur Alford, individually, with the executrix of his estate, Jo Carol Alford. The motion was granted. |
| Summary of Opinion Analysis: | Issue 1: Moot appeal The Division argues that the action is now moot. Mrs. Alford concedes the controversy is now moot, but argues the Court should apply the “public interest” exception and decide the merits of this action. There is an exception to the general rule as respects moot cases, when the question concerns a matter of such nature that it would be distinctly detrimental to the public interest that there should be a failure by the dismissal to declare and enforce a rule for future conduct. This case presents such a matter of public interest. Medicaid impacts many Mississippians, and therefore it is prudent to declare a rule for future conduct regarding the jurisdiction of the courts to increase the MMMNA and CSRA. Issue 2: Jurisdiction In computing resources for purposes of eligibility, 42 U.S.C. § 1396r-5(c)(1)(A)(I) requires the state agency to assess the couple’s total value of the resources. The community spouse is allowed to retain a community spousal resource allowance (CSRA), which is excluded from the eligibility calculation and is subject to a statutory cap. An enhanced CSRA will reduce the resources the statute deems available for the payment of medical expenses; accordingly, the institutionalized spouse will become eligible for Medicaid sooner. Once the institutionalized spouse becomes eligible, the agency must determine the amount of income that is to be applied monthly to payment for the costs of care in the institution. In determining the amount of income that is to be applied for the cost of care, the statute allows various protected amounts to be deducted from the institutionalized spouse’s income, one being the community spouse monthly income allowance (CSMIA). The CSMIA is calculated based upon the minimum monthly maintenance needs allowance (MMMNA). The MMMNA is established by each state based upon the official poverty line and an excess-shelter allowance; however, it is subject to a statutory cap. Mrs. Alford argues that the unambiguous language of the MCCA provides our state courts with authority to increase the CSRA and the MMMNA. Mrs. Alford points to 42 U.S. Code Section 1396r-5(d)(5) and 42 U.S. Code Section 1396r-5(f)(3) in support of her argument. 42 U.S. Code Section 1396r-5(e) specifically provides a mechanism for administrative review and revision of the CSMIA, MMMNA, and CSRA. Furthermore, Mississippi Code Section 43-13-116 sets forth the administrative-hearing process and provides that an aggrieved claimant is entitled to seek judicial review in a court of proper jurisdiction. Where a remedy before an administrative agency is provided, relief must be sought by exhausting this remedy before the courts will act. Mrs. Alford argues that the Division’s own rules limit its authority to grant the requested relief, and as such, an administrative appeal is futile and a waste of resources. However, the agency’s rule does not specifically address the agency’s ability to raise the MMMNA (the needs allowance) above the federal maximum. Furthermore, the relevant inquiry concerns the provisions of 42 U.S. Code Section 1396r-5, which the Division is bound to follow. Thus, the plain language of the MCCA does not confer jurisdiction upon our state courts to increase the MMMNA and CSRA prior to an exhaustion of administrative remedies. |
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