In re Clifford, 2012
VT 95.
The facts of this case are simple and elegant. Applicant sought long-term home health care
benefits under Vermont’s Choices-for-Care program, which Medicaid funds through
the state.
Like most Medicaid programs, Choices is income and asset
sensitive. That means an applicant must
show that she is below a certain income level and does not have valuable assets
on her books.
As with all things legal, there are exceptions to certain
income and certain assets. In particular
for this case, the rules allow an applicant to exclude the value of her home,
related outbuildings, and surrounding contiguous property.
Applicant made these exclusions as part of her application,
but she was denied when the Department of Children and Families, which
administers the program, reinserted the value of a farmhouse owned by Applicant
on adjacent property that she and her husband had previously used for rental
income. The value of this farmhouse
constituted the difference between eligibility and ineligibility for Applicant,
and she was denied access to the program.
Following this preliminary denial, the Human Services Board
reversed the Department ruling that because the house was on contiguous
property it could be included in the house exemption. The Secretary of the Department, however,
reversed the Board and reinstated the denial.
On appeal, the SCOV is faced with a single question: do the
Choices-for-Care rules require a second home located on property contiguous to
the applicant’s primary residence to be excluded as part of the primary
residence exclusion?
The answer is no. As
the SCOV notes the applicable rules allow for the exclusion of the primary residence,
related outbuildings, and the surrounding property but nothing further.
Applicant’s position rests on the fact that later in the
same rule a home is defined to include “contiguous land and any other buildings
located on the land.” Applicant argued
that this broader definition controlled and allowed her to include the
farmhouse rental unit since it sat on property contiguous to Applicant’s home.
The SCOV rejects this position by noting that the sections
that the Secretary relied upon were more specific. The section quoted by Applicant is more
general. One of the first rules of
statutory interpretation is that when general provisions and specific provisions
within the same statute appear to conflict, the specific language
controls. This is because the general
language is usually the general standard, and the specific language is the more
precise instructions.
Here the SCOV notes that it would be absurd and contrary to
Medicaid and other state regulations to allow an applicant to expand the exemption
to buildings located beyond the immediate home and related outbuildings. It would allow wealthy landowners to exempt
large holdings. More importantly, it
would run contrary to what the Legislature and the federal government have
established and intended as a relatively modest exemption. Since Legislative intent controls the reading
of a statute, the case ends once the intent is found and applied.
And with that, the SCOV affirms the Secretary. This leaves Applicant in the unenviable
position of looking to other resources for her care. Given that the value of the house was the
only difference between her and eligibility, it gives truth to the phrase house
poor.
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