Wednesday, December 5, 2012

House Poor

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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