COURT OF APPEALS DECISION DATED AND RELEASED February 22, 1996 |
NOTICE |
A party may file with the
Supreme Court a petition to review an adverse decision by the Court of
Appeals. See § 808.10 and
Rule 809.62, Stats. |
This opinion is subject to
further editing. If published, the
official version will appear in the bound volume of the Official Reports. |
No. 95-3095-FT
STATE
OF WISCONSIN IN COURT OF
APPEALS
DISTRICT IV
PERCY PETERSON,
Petitioner-Respondent,
v.
DEPARTMENT OF HEALTH
& SOCIAL SERVICES,
Respondent-Appellant.
APPEAL from an order of
the circuit court for Iowa County:
JAMES P. FIEDLER, Judge. Affirmed.
Before Gartzke, P.J.,
Dykman and Vergeront, JJ.
PER
CURIAM. The Department of Health & Social Services appeals
from an order reversing its decision regarding the date of Percy Peterson's
medical assistance (MA) eligibility.[1] The department ruled as a matter of law that
Peterson was not eligible before his application date of August 30, 1994. The trial court held that Peterson could be
determined eligible as early as May 1, 1994, and remanded for a determination
of eligibility as of that date. We
agree with the trial court's interpretation of the applicable law, and affirm.
Peterson was institutionalized
at the Medical Care Facility of Iowa County in April 1994. Between then and August 30 he and his wife
Thora paid several thousand dollars for his care, reducing their assets from
$112,000 to $88,000. On August 30 Thora
applied for MA on his behalf. MA was
denied because the Petersons' remaining assets still exceeded the maximum
allowable amount of $72,660. See
§ 49.455(6)(b)1, Stats. It is stipulated that but for the excess
assets, Percy would have qualified for MA as of May 1 under Wis. Adm. Code § HSS
103.08(1). ("Eligibility shall
begin on the date on which all eligibility requirements were met, but no
earlier than the first day of the month 3 months prior to the month of
application.")
On review of an MA
denial, the department may grant MA eligibility despite excess assets, if all
or part of those assets are needed by the institutionalized person's spouse to
meet his or her minimum monthly maintenance needs. Sections 49.455(6) and (8), Stats. (The minimum monthly maintenance need for one
person was $1,816.50 in 1994. Section
49.455(4)(c).) At a hearing on the
matter, the Petersons produced evidence that even with the income from their
excess assets of $112,000 as of May 1, Thora could not have reached the
$1,816.50 monthly standard. They also
showed that her income potential was reduced even further after those assets
were reduced to $88,000 on August 30.
Based on the evidence of
Thora's need, the department decided that Percy was eligible for MA as of
August 30 despite the excess assets on that date. The Petersons commenced this action for § 227.52, Stats., review, however, because the
department deemed August 30 the earliest date of eligibility under the
law. They contended that the earliest
eligibility date was, instead, May 1, 1994 under Wis. Adm. Code § HSS 103.08(1). The trial court agreed and remanded the case
to the department for a determination of financial eligibility as of that
date. That order is the subject of this
appeal.
The trial court properly
determined that Percy may be deemed eligible for MA as early as May 1. The department issued its eligibility order
in January 1995, retroactive to the date of application, August 30, and based
it on the assets then existing. Having
determined that its authority under §§ 49.455(6) and (8), Stats., allowed a retroactive
determination based on then existing assets, it advances no persuasive reason
why Wis. Adm. Code § HSS
103.08(1) does not control the effective date of the retroactive
eligibility. It is the exclusive rule
on the date of an applicant's eligibility under the statutes governing MA and
the rules implementing them.
The department argues
that the purpose of MA "is not to subsidize the care of individuals who
are in a position to pay the costs of such care out of their own income or
resources at any given time." The
Petersons offered proof that as of May 1 they were not in a position to pay the
costs of Percy's care and meet Thora's minimum needs as established by
§ 49.455(4)(c), Stats. On remand, the department must therefore
reconsider the Petersons' application for MA using May 1, 1994 and not
August 30, 1994 as the earliest date of potential eligibility.
By the Court.—Order
affirmed
This opinion will not be
published. See Rule 809.23(1)(b)5, Stats.