Kathryn Wild VS State of Louisiana, Department of Health & Hospitals

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STATE OF LOUISIANA COURT OF APPEAL FIRST CIRCUIT NO 2008 CA 1056 KATHRYN WILD VERSUS STATE OF LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS Judgment On Rendered December 23 2008 Appeal from the 19th Judicial District Court In and for the Parish of East Baton Rouge State of Louisiana Trial Court No 528 215 Honorable Janice Clark Peter J Losavio Jr Judge Presiding Attorneys for Plaintiff Appellee Kathryn Wild Kent S DeJean Christopher W Nielson Baton Rouge LA Attorney for Defendant Appellant State of Louisiana Department of Health and Hospitals Neal R Elliott Jr Baton Rouge LA FORE CARTER C J WHIPPLE AND DOWNING JJ CARTER C J Defendant the Louisiana appeals the district LDHH denial of Medicaid benefits reasons that follow we Health Department of court reversal of LDHH s and administrative s Wild plaintiff Kathryn Campbell to Hospitals For the affirm FACTS AND PROCEDURAL HISTORY In nursing August 2003 Kathryn Campbell Wild entered the Heritage in home Alzheimer Baton community home located Louisiana 703 at Wild created 29 a revocable living an in Denham interdiction community home Also in 2003 inter vivos remained in their Springs Wild to Mr Wild Mrs his as Mr 2003 which had trust September previously provided for in an amended and modified trust instrument dated August 2003 wherein Mrs Wild had donated all of her interest in the listed in the principal revocable couple s of Mr Wild trust upon Mr Wild three of the 2003 September 20 on separate property Wild Jr of progression of the to Drive Maple Allegedly fearing the necessity donated all of her interest in the been due Her husband Willie E disease s Louisiana Rouge Manor Mr Wild died s trust provided that death the s couple Mr Wild original living s included the Denham Mr Wild trust Springs home the sole beneficiary would become irrevocable became ill and was The and that At that diagnosed or point In October with cancer November 3 2003 The schedule of assets incorporated document included other assets that considered the was The corpus children would become the beneficiaries unexpectedly on Wild trust to Mr assets community home in its are not in the Willie E relevant to this ineligibility 2 Wild appeal determination Jr living since LDHH trust only The next year Wild Meadors for application on acting routine Mrs as Wild Term Care Long Louisiana Medicaid June 2 2004 Program authorized s resources 36 month look back transfer was by Wild eligibility s As vendor benefits for a a LDHH instituted After status a gathering a Mrs Wild for less than fair market value within a s to qualifY rejected LDHH presumed that for Medicaid benefits Mrs Mrs Wild penalty living LDHH Consequently done with the intent Medicaid benefits an trust amounted to period upon that determination representative made behalf of Mrs Wild information LDHH determined that Mr Wild transfer of daughter Mary Kathryn s LTC vendor payment benefits under the on of Mrs investigation Mrs Wild Wild was application s rendered certain number of months based the Based for LTC ineligible for LTC on the value of the transferred home Wild Mrs timely filed An administrative ALJ who hearing planning There 2 LDHH court pursuant actually two hearings for the an to Mrs Wild s Bureau of Appeals Administrative Law denial of Mrs Wild Mrs Wild s Judge request for s rebuttal claim after he had established the timely filed the a petition for trust judicial provisions of the Louisiana s appeal rebuttal claim because LDHH had notified the Bureau of Appeals of Mrs Wild denying s process was complicated in this case held before the AU After the first hearing the AU ordered LDHH to reconsider Mrs Wild the merits s Mrs Wild purposes procedural background were held before unexpectedly shortly review in the district The appeal with LDHH eligibility essentially rejecting that Mr Wild died 2 was eventually affirmed LTC Medicaid for estate an s appeal request for Medicaid 2005 3 The subsequent eligibility was prematurely AU decision made on April on 1 I 3 Administrative Procedure Act LSA RS 49 950 held on February 25 2008 after which the district oral argument On 21 April reversing the ALJ decision rebutted the successfully to transfer of a this the district The district presumption that resources done with the intent was 2008 court scheduled further signed a ruled that Mrs court Mr Wild s was Wild had trust living judgment amounted It is from for LTC Medicaid benefits qualifY to judgment that LDHH appeals ruling upholding LDHH Mrs Wild transferred it regardless to s ineligibility the was trust the home was alienated required to by that LDHH an LDHH maintains that a Mr once Eligibility as a resource presumption that it Mrs a home Manual and the facts in this was Wild to a community spouse because case living in the home is transfer of property for less than fair market value Wild further argues that even that the transfer was done for avoid the inevitable and health from Alzheimer the Wild when he for Medicaid qualifYing s determination is in direct contradiction with the s interest in considered the ALJ reversing be counted of whether Mrs Wild could rebut the Louisiana Medicaid donating erred in determination permanently transferred for purposes other than counters court ineligible for LTC Medicaid benefits because was community residence 3 court hearing by her for less than fair market value and that it LDHH argues that the district not A et seq s if it did constitute estate transfer the facts show planning purposes embarrassing disease a Mrs Mrs Wild wanted to interdiction due to her Mrs Wild also maintains that declining at the time confusing procedural path requiring two hearings before the AU resulted in the filing of two separate petitions for judicial review in the Nineteenth Judicial District Court In Re Kathryn Wild Docket No 528 215 Division D and In Re Kathryn The Wild Docket No 528 215 and re 532 087 Section allotted to Division 8 D The suits on July 4 were 18 2006 consolidated under suit number that Mr Wild created the revocable corpus of the trust there Wild based upon the Mr Wild s death claims that Mr amount to an was no simple not was Wild living and trust indication that Mrs Wild would outlive Mr fact that she anticipated at sick and he was was Since not the time of the transfer Mrs Wild establishment of the revocable s home into the placed the alienation of the property for purposes of living did trust not qualifYing for LTC Medicaid benefits STANDARD OF REVIEW The Louisiana Administrative Procedure Act 49 964G the governs judicial review of a APA at final decision in LSA RS an agency adjudication providing that G The the case affirm the decision of the agency for further proceedings The court may court may or remand reverse or modifY the decision if substantial rights of the appellant have been prejudiced because conclusions or decisions the administrative inferences are 1 In violation of constitutional 2 In 3 findings or statutory provisions of the statutory authority of the agency Made upon unlawful procedure excess by other error oflaw 5 Arbitrary or capricious or characterized by abuse of discretion or clearly unwarranted exercise of discretion or 6 Not supported and sustainable by a preponderance of the In the evidence as determined by the reviewing court 4 Affected application of this rule the court shall make its own determination and conclusions of fact by a preponderance of evidence based upon its own evaluation of the record reviewed application of the rule where the agency has the opportunity to judge the credibility of witnesses by first hand observation of demeanor due on the witness stand and the reviewing court does not regard shall be given to the agency s determination of credibility issues in its Anyone reverse Dept entirety upon judicial review In the of the six bases listed in the statute is sufficient to an agency determination of Health and Doc s Hospitals 07 0480 5 Clinic La APMC App v 1 Cir modifY State ex 11 2 07 or reI 984 So 2d 711 AP A further without a specifies jury When functions writ denied 07 2302 718 that reviewing as an by appeal to the review of the district to appeal no the factual legal findings v Cir 9 20 06 So 2d 174 App Maraist conduct its 26 5 04 provided This v dispute as findings or deference is owed appeal and Doc 879 So 2d 815 Court to factual s Clinic 984 So 2d Hospitals 05 1904 817 4 2d So 673 we Dept 675 appellate may be analyzed under either LSA RS recognize review is on application context See 02 2677 La court will an s holding Hospitals finding standard of review Carpenter 944 2d So 49 964G 5 of law to facts in 00 2001 Multi Care La or administrative agency App 49 964G 6 I 49 964G 6 Inc v s review our Credibility determinations of evidence this court of Health and s 948 Consequently this that the 1997 amendment to LSA R S court 1 App in LSA RS 49 964G courts with the function of fact the 719 126 07 La specifically considered as factual questions under LSA RS While La at review of the record in accordance with the becomes somewhat intertwined Louisiana by the Alton Ochsner Medical Foundation evaluation of the evidence and 4 On LSA RS 49 965 608 writ denied 06 2804 because when the issue 6 may seek legal conclusions of the district court just no Dept of Health independent own court a of of court Once aggrieved party an by the Louisiana Supreme 944 So 2d 604 1 Cir standards State or at 718 court court judgment s the district Clinic 984 So 2d appropriate appellate conclusions of the Carpenter s the district court by court deference is owed Doc court court LSA RS 49 964F administrative final decision an appellate the record to The by the review shall be conducted and shall be confined final judgment is rendered review judicial 974 So 2d 665 La 2 15 08 State Cir 119 01 empowered are but of 804 district in the administrative context this does not affect district court decisions in the administrative over at 608 2 n 6 the application of the facts to the law analysis under LSA R S 49 964G 5 Because the basic underlying at district facts court was required to purposes of qualifYing 39 368 739 writ denied 05 1103 96 0196 La App La 3 21 97 are not a in corpus is for Medicaid benefits Hospitals standard of review of facts a dispute in this App 05 17 6 La an This requires 2 Cir 3 2 05 904 70 1 2d So legal determination by LDHH in resource for interpretation an State v Dept 2d So 735 895 We addressed the Sanders 691 So 2d 90 where statutory law and case Thus an LDHH Pilley v 684 So 2d 460 463 writ denied 97 0352 1 Cir 11 8 96 question of whether the we stated comprising the t rust can be considered as a resource for determining Medicaid eligibility clearly requires an interpretation The the case to available question oflaw Smith La to 944 So 2d at 609 Carpenter trust of statutory law and therefore it is of Health and legal conclusion subject a interpret and apply the statutory law question is whether the The issue is or not the assets application of the of law to the facts of this is incorrect in its assertion that its prior resolution of this question constitutes a finding of fact which must be afforded great deference upon review Appellate review of lower district question s of court was legally court was correct decision to simply review of whether the If the correct or legally incorrect law is in its determination that discontinue Medicaid benefits and public policy its reversal appropriate of LDHH was LDHH contrary to s law decision would be s Citations omitted Accordingly to the facts we to must examine the pertinent statutory law and determine if the district court ineligibility determination was legally correct in this s reversal apply that law of LDHH s case LAW AND ANALYSIS The Medicaid state Program authorizes federal financial participation in medical assistance plans that provide funds 7 to persons whose income and resources App Ouzts 2 Cir 880 So 2d 918 determination that are S 1396a 17 A program 42 U S C resources and income available Behalf of La Hargrove 13 6 97 Sanders 684 So 2d state the S 1396a Dept Eligibility calculated La the App for LTC v State 2 Cir 3 3 04 et seq The to only reasonable C Hargrove on 96 1072 Hospitals La Medicaid assistance if are La Income s Id Smith is fulfilled Dept 895 resource So 2d based available of Health and to Property held in the 740 at on need applicant Hospitals 38 If resources limit the MEM to including benefits specifically resources are 220 greater than applicant is ineligible trust mayor may not be is part of the federal Social Security Act 42 U S c S portion of Title 42 of the United States Code dealing with Program applicable Eligibility Manual determinations 867 So 2d 879 882 for LTC Medicaid benefits 1396 B a 31 32 writ denied 97 1072 eligibility by evaluating income and The Medicaid consider must where the individual resides vendor payments Supplemental Security 5 eligibility of the assistance provide of Health and nursing facilities in Louisiana Estate of Messina 17 for at 464 forth standards for Medicaid for LTC a and La participate in the standards objectives applicant LDHH created the Louisiana Medicaid set Hospitals 38 634 States that An individual is entitled by the Sanders 684 So 2d seq These standards 692 So 2d 30 695 So 2d 983 the criteria established to State La 1 Cir 3 27 97 App a 42 D S C v 920 consistent with the method of evaluation et institute reasonable to required 1396 S of necessary medical cost of Health and Secretary La Dept 7 29 04 are program v pay for the to 42 D S C and services treatment care at 464 insufficient are certain transfers of assets is found in Section 1396p 8 considered So 2d a eligibility for purposes of Medicaid resource Smith 895 MEM sets at 740 Section I of the Louisiana Medicaid forth the eligibility types of resources factors anytime during application establishment of trusts Medicaid benefits are was made as 6 LDHH after the 36 month or Transfers of the sale period before include the resources purchase trade exchange presumed to be for the purpose of or the reduce opportunity resources providing evidence that the transfer to rebut the in order was to qualifYing for However in all MEM 1 1671 and MEM 1 1673 to consider all must MEM 1 1671 Transfers of resources for less than applicants shall be offered transfer filed well as giving away of property fair market value was Manual and Section 1 1634 governs be considered Pursuant to MEM 1 1671 transfers that occurred the Medicaid to Eligibility presumption that qualifY solely for cases for Medicaid some a by other purpose MEM 1 1673 and MEM 1 1674 Home property is not considered if the home and the spouse lives in the home Wild argues and was applicant MEM 1 1673 agree that the home property we living in a nursing home while is Accordingly was Mr Wild lived in the his separate property Mrs Wild maintains that this the transfer of assets penalty provisions according 1674 and MEM 1 1720 community of transfer for 6 Effective a trust February is considered to be the date the 8 2006 the look back trusts was extended to 60 months 42 use to was an to MEM 1 Furthermore MEM 1 1720 home her spouse exception to 1673 MEM 1 provides that the date trust was established period for all cases involving 1396p c J B i MEM 1 1720 9 Mrs excluded since she Likewise when Mrs Wild transferred her interest in the home as away from living revocable However LDHH used the date the approximately eight transfer LDHH months after the under the became Wild trust trust were the citing MEM 1 couple at to be made reversal of the ALJ s necessity was of Medicaid established for Mr estate death Mr and he had the s to decline Mrs Wild daughter Mrs Mr Wild to having Mrs process which according to the s they perceived to s beneficiary of the Meadors disease be time his She also testified that for her Mr and Mrs Wild trusts as were an extremely embarrassing 10 to Mr Wild because of to care daughter the transfers and prior testified before the incompetent through Wild declared Wilds Wild facts but contains trust at any continue always done According to their daughter the sole resources to resulting from Alzheimer fully expected was revoke the ALJ that Mrs Wild transferred all of her rapid Mrs prevent the purposes to supporting these Mr Wild ability and Mrs Wild planning we Wild rather than the purpose of qualifYing for interdicting Mrs evidence of any other intent trust Mrs LDHH application for LTC Medicaid benefits s The record contains evidence living by finding that s successfully rebutted the presumption by showing that trust a and the beneficiaries his death thorough review of the record and relevant MEM sections a Mrs Wild avoid the date of as 1666 and MEM 1 1720 properly rejected her established that LDHH considered resource in the district court living was public records children rather than Mrs Wild the home s no error Wild recorded in the position is that when Mr Wild transferred the home into transferred a After no was instrument that became irrevocable trust find s trust were he had trying to interdiction Therefore simply estate planning tools which benefitted Mr Wild to access the assets necessary to care by making it easier for Mr Wild The record supports the fact that Mr Wild time the trust Wild had would established in no reason ever Wild died instrument requires was anticipate to Wild was applied recorded of the trust as in determining the not intent to Almost trust a ignored permanently is considered focused making the clear on the Wild not was established at resource the LDHH for as required by Wild 7 he 1720 time when Mr Wild no evidence of any eligibility purposes prior his death thus to at the transfer as ofthe date the trust MEM 1 1720 it is clear that the transfer did similar situation in her involving a there is transfer of was the care care or was Mrs Wild house to Mr kept the house in his possession for his Looking a a representative acknowledged ineligible for LTC Medicaid benefits because Compare determination meeting the needs of Mr and testimony before the ALJ that the transfer of the of Mrs Wild be the date the to requirement of MEM I anticipate his death there is available long as trust the date of recordation alienate the property for Medicaid Remarkably allowed as months after Mr eligibility Mr Wild could have revoked the trust at any time was an that Mrs Wild date of transfer sick and did the home the Mr and Mrs or eight at the mandate of MEM 1 1720 which incorrectly Because the revocable trust was to the date of transfer when In effect LDHH and the ALJ good health for LTC Medicaid benefits and the Contrary established LDHH in that Mr Wild would die that the date of transfer for trust was was September 2003 therefore be in necessitous circumstances Mrs 7 for Mrs Wild established not make Mrs no ownership evidence that of an annuity for LTC between spouses that was found to not affect the donor spouse eligibility Medicaid benefits Pacente v Jindal 99 0601 La App 4 Cir 12 29 99 751 So 2d s 343 347 II the transfer was made with the intent to qualify for LTC Medicaid benefits We therefore find that the record supports the district court Mrs Wild rebutted the court did not err in presumption Accordingly reversing the ALl s we decision s conclusion that conclude the district to uphold LDHH s ineligibility determination CONCLUSION For all of the above outlined district court judgment the amount of Health and reasons we affirm the April which reversed the administrative decision 2 861 32 are assessed Hospitals AFFIRMED 12 21 2008 Costs in against the Louisiana Department of STATE OF LOUISIANA COURT OF APPEAL FIRST CIRCUIT NO 2008 CA 1056 KATHRYN WILD VERSUS STATE OF LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS f3 tQ Downing J and concurs assigns I agree with the result and address a Martinville L L c 6 10 05 why in an v appellate the 41 42 court must Procedure Act give deference La RS 49 964 The Louisiana 1 as 1997 to a trial explained court court s 1 Cir App La factual findings the Louisiana Administrative to follows legislature effective June 12 4 p 05 0457 predecessors this and its administrative review pursuant an n to In St applicable standard of review Louisiana Tax Com 917 So 2d 38 I write generally agree with the analysis regarding misstatement reasons to enacted Acts 1997 No amend G 6 to 128 S make paragraph weighs the evidence and makes its own conclusions of fact by preponderance of the evidence defer to the trial court s factual we Accordingly the trial court a fact finder who where the standard of review it with the function of fact finding to determinations and use a manifest error legislature has empowered while giving due deference the agency s credibility Citations omitted determinations La RS 49 964 G 6 See also Lirette 10 6 06 v City of Baton Rouge 945 So 2d 40 44 writ 05 1929 denied 06 2659 5 p La La App 1 Cir 948 So 2d l8 07 129 Even determinations in reversing determination majority the so majority concurs with the trial Specifically it concluded that the district the I ALl s fully and with the decision agree to therefore uphold court LDHH s s did factual not err ineligibility with the result reached analysis except insofar as stated here I court by the

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