Protecting the Community Spouse’s Financial Security in Pennsylvania Revisited

Two years ago, this column asserted, “The Pennsylvania Department of Public Welfare has finally been forced to conform to federal law regarding annuities.”  It is still not that simple.  “Protecting the Community Spouse’s Financial Security in Pennsylvania” explained that the Commonwealth’s hearing officers are now complying with federal regulations and numerous court decisions that permit a “Community Spouse” of a person in a nursing home to protect all – that’s right, ALL — of his or her assets by putting them into a special annuity.  However, the Department of Public Welfare has not revised its written policies to conform to federal Medicaid law and the Pennsylvania legislature has not repealed statutes that federal courts have held unconstitutional.

Since these illegal provisions are still in the written policy, some Medicaid workers and supervisors continue to try to enforce them.  They refuse to open Medicaid if the assets transferred into the annuity exceed the 2014 “snapshot” maximum, $117,240, or if the income from the annuity puts the Community Spouse’s income over the 2014 income limit which varies between $1,939 and $2,931, depending on shelter expenses.  Some County Assistance Offices comply with the federal requirements, but others do not.  The worker in one such case sat on an application for close to a year before denying Medicaid because income from the annuity used to protect additional assets pushed the Community Spouse over the income limit.

In a managerial conference regarding this denied case, the second-level manager agreed to request “clarification” from the DPW legal department.  Less than 24 hours later, he called and said the case would be opened.  He was told by DPW’s legal counsel that the bulletin he relied on to deny eligibility was no longer valid.

DPW is still using invalid written policies to bully applicants and scare them away from exercising their rights.  However, with assertive advocacy and willingness to take the matter to a hearing, a Community Spouse’s financial security can be protected.


John B. Payne, Attorney
Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200
©2014 John B. Payne, Attorney

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    • Thanks for your kind words, Michelle. It’s always great to hear from you, but don’t give me too much credit. My efforts are about 10% altruism and 90% enlightened self-interest (or shameless self promotion, depending on your POV). Have a nice Sunday evening.


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