Benefits denied because of spouse’s financial nondisclosure

BOSTON — The Massachusetts Supreme Judicial Court has upheld the denial of long-term Medicaid benefits requested by an applicant whose spouse refused to disclose her financial resources.

“Before an institutionalized spouse may receive assistance, that spouse must disclose not only her own and the couple’s joint resources, but also those resources ostensibly available only to the community spouse,” Justice Dalila Argaez Wendlandt wrote for the SJC.

“Recognizing that in some circumstances an institutionalized spouse may not be able to determine the community spouse’s resources, Massachusetts’s Medicaid program, MassHealth, offers an additional protection for applicants; specifically, pursuant to 130 Code Mass. Regs. §517.011 (2017) (regulation), if the community spouse ‘refuses to cooperate’ or if that spouse’s ‘whereabouts [are] unknown,’ MassHealth nonetheless will provide benefits to the institutionalized spouse even if the couple’s combined resources cannot be calculated,” Wendlandt wrote.

The SJC found that the “refusal to cooperate” standard was not satisfied in the instant case.

“We conclude that MassHealth’s board of hearings (board) reasonably construed the phrase ‘refuses to cooperate’ to exclude the situation presented here, where the community spouse’s principal act of noncooperation with the institutionalized spouse was the refusal to disclose her financial resources in connection with the institutionalized spouse’s application for benefits from MassHealth. We agree with the agency’s reasonable determination that, in the context of a ‘long-term and ongoing level of cooperation’ throughout the marriage, such a refusal to disclose the community spouse’s financial resources does not fall within the type of ‘refus[al] to cooperate’ required by the regulation,” Wendlandt wrote.

The 31-page decision is Freiner v. Secretary of the Executive Office of Health and Human Services, et al.