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COA: Expenses apply under penalty period

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The Indiana Court of Appeals ruled in favor of a woman who wanted her out-of-pocket payments to a nursing facility allowed as a spend-down expense, finding the Indiana Family and Social Services Administration's denial of her request would penalize her twice.

In Bernice M. Reedy, by her next best friend Mentoria Headdy v. Indiana Family and Social Services Administration, No. 53A01-0806-CV-294, the Court of Appeals had to determine if Reedy's out-of-pocket nursing facility payments could be an allowable spend-down, or out-of-pocket expense, while she was serving out a transfer penalty period. Reedy entered a nursing home in 2005 and applied for Medicaid in 2006. For one year, her coverage wouldn't include payments for nursing facility services because she had improperly transferred money to become eligible for Medicaid; Reedy would have to pay for her care out-of-pocket during that time. Reedy also received medical assistance under Medicaid but was required to spend-down more than $3,000 a month before Medicaid would cover her other health-related services such as prescriptions.

The FSSA rejected Reedy's request to have her out-of-pocket nursing facility expenses applied toward her monthly spend-down, which was affirmed by an administrative law judge at a hearing.

The FSSA believed Reedy couldn't apply her out-of-pocket expenses while on a transfer penalty period, but there is no statute, administrative code provision, or case that addresses this issue, wrote Judge Michael Barnes. The appellate court's review of the administrative law judge's decision shows no statutory interpretation.

The Court of Appeals examined 405 Ind. Admin. Code 2-3-10(f), which defines which incurred medical expenses submitted to the county office will be credited toward the spend-down; nursing facility services and rehabilitative services are included on the list.

While under the transfer penalty, the spend-down only applies toward Medicaid's coverage of Reedy's non-nursing facility expenses, so the court "fails to see how applying the nursing facility expenses to Reedy's spend-down 'cancels out' the transfer penalty as the FSSA suggests," Judge Barnes wrote.

"Similarly, under the FSSA's approach, being subject to a transfer penalty subjects an individual to an additional punitive measure by effectively raising the spend-down to the amount of the calculated spend-down plus the individual's nursing facility expenses. The State points to no support for this double punishment, and without such we will not impose the extra burden on Reedy," he wrote.

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  1. CCHP's real accomplishment is the 2015 law signed by Gov Pence that basically outlaws any annexation that is forced where a 65% majority of landowners in the affected area disagree. Regardless of whether HP wins or loses, the citizens of Indiana will not have another fiasco like this. The law Gov Pence signed is a direct result of this malgovernance.

  2. I gave tempparry guardship to a friend of my granddaughter in 2012. I went to prison. I had custody. My daughter went to prison to. We are out. My daughter gave me custody but can get her back. She was not order to give me custody . but now we want granddaughter back from friend. She's 14 now. What rights do we have

  3. This sure is not what most who value good governance consider the Rule of Law to entail: "In a letter dated March 2, which Brizzi forwarded to IBJ, the commission dismissed the grievance “on grounds that there is not reasonable cause to believe that you are guilty of misconduct.”" Yet two month later reasonable cause does exist? (Or is the commission forging ahead, the need for reasonable belief be damned? -- A seeming violation of the Rules of Profession Ethics on the part of the commission) Could the rule of law theory cause one to believe that an explanation is in order? Could it be that Hoosier attorneys live under Imperial Law (which is also a t-word that rhymes with infamy) in which the Platonic guardians can do no wrong and never owe the plebeian class any explanation for their powerful actions. (Might makes it right?) Could this be a case of politics directing the commission, as celebrated IU Mauer Professor (the late) Patrick Baude warned was happening 20 years ago in his controversial (whisteblowing) ethics lecture on a quite similar topic: http://www.repository.law.indiana.edu/cgi/viewcontent.cgi?article=1498&context=ilj

  4. I have a case presently pending cert review before the SCOTUS that reveals just how Indiana regulates the bar. I have been denied licensure for life for holding the wrong views and questioning the grand inquisitors as to their duties as to state and federal constitutional due process. True story: https://www.scribd.com/doc/299040839/2016Petitionforcert-to-SCOTUS Shorter, Amici brief serving to frame issue as misuse of govt licensure: https://www.scribd.com/doc/312841269/Thomas-More-Society-Amicus-Brown-v-Ind-Bd-of-Law-Examiners

  5. Here's an idea...how about we MORE heavily regulate the law schools to reduce the surplus of graduates, driving starting salaries up for those new grads, so that we can all pay our insane amount of student loans off in a reasonable amount of time and then be able to afford to do pro bono & low-fee work? I've got friends in other industries, radiology for example, and their schools accept a very limited number of students so there will never be a glut of new grads and everyone's pay stays high. For example, my radiologist friend's school accepted just six new students per year.

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