In re Bernice Landry

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Petitioner was admitted to a nursing home in September 2010. She was eighty-seven years old at the time, and had a diagnosis of dementia and Alzheimer's disease. Petitioner's adult daughter, who had the authority to act on petitioner's behalf by virtue of a power of attorney, submitted an application for long-term care Medicaid benefits in January 2011. The application sought coverage for petitioner, retroactive to October 1, 2010, pursuant to a Medicaid rule authorizing benefits for up to three months preceding the month of application. A benefits specialist with the Department for Children and Families testified that, in response to the application, she sent two separate verification requests to petitioner's daughter and an administrator at petitioner's nursing home. The Department received no response to these requests. Accordingly, in March 2011, the Department issued a Notice of Decision ("Notice") denying the application. No appeal of the denial was filed by petitioner or a person acting on her behalf within the ninety-day limit. Petitioner's daughter would submit a total of four applications, each with a request from the Department for additional information, and each time, no information was provided, and the applications were denied. With the assistance of her son, petitioner filed a fifth application for benefits in February 2012. This time, additional information verifying petitioner's financial eligibility was provided, and the application was approved by the Department in May 2012 with benefits retroactive to November 2011, which was three months prior to the date of the fifth and final application. Petitioner appealed that decision, seeking coverage retroactive to October 2010, which would have been three months prior to her first application from January 2011. An evidentiary hearing was held in July 2013 before a Department hearing officer. The Board adopted the hearing officer's findings and issued a decision reversing the Department's decision to limit retroactive benefits to November 2011. The Board concluded that, for reasons of equitable estoppel, petitioner could be awarded benefits retroactive to October 1, 2010 based on the date of the initial application. The Department sought review by the Secretary, who reversed the Board's decision. Because petitioner did not respond to the Department's multiple requests for verification, did not advise the Department of any valid reasons for failing to respond, and informed the Department's benefits specialist that the failure to respond was her responsibility, that she had "dropped the ball." Accordingly, the Secretary found no justification to invoke the doctrine of equitable estoppel, and reversed the Board's decision. Finding no reversible error, the Vermont Supreme Court affirmed the Secretary's reversal of the Board's ruling. View "In re Bernice Landry" on Justia Law