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Loan to Grandson Was Not Made In Anticipation of the Need to Qualify for Medical Assistance

The Second Department determined the Department of Health’s (DOH’s) finding that the petitioner’s husband did not intend to transfer assets for valuable consideration was not supported by substantial evidence. Petitioner’s husband had loaned $200,000 to his grandson, and the grandson was making regular payments on the loan. The court explained the relevant law:

“In reviewing a Medicaid eligibility determination made after a fair hearing, the court must review the record, as a whole, to determine if the agency’s decisions are supported by substantial evidence and are not affected by an error of law” … . Substantial evidence has been defined as “such relevant proof as a reasonable mind may accept as adequate to support a conclusion or ultimate fact” … . While the level of proof is less than a preponderance of the evidence, substantial evidence does not arise from bare surmise, conjecture, speculation, or rumor …, or from the absence of evidence supporting a contrary conclusion … .

When determining Medicaid eligibility, an agency is required to “look back” for a period of 60 months immediately preceding the first date the applicant was both “institutionalized” and had applied for Medicaid benefits, to determine if any asset transfers were uncompensated or made for less than fair market value (42 USC § 1396p[c][1][A], [B]; Social Services Law § 366[5][e][1][vi]). If such a transfer was made during that period, the applicant may become ineligible for Medicaid benefits for a specified period of time (see 42 USC § 1396p[c][1][A], [E]; Social Services Law § 366[5][e][3]), unless there is a “satisfactory showing” that the applicant or the applicant’s spouse intended to dispose of the assets at fair market value or for valuable consideration, the assets were transferred exclusively for a purpose other than to qualify for medical assistance, or all assets transferred for less than fair market value have been returned to the applicant (42 USC § 1396p[c][2][C][i], [iii]; Social Services Law § 366[5][e][4][iii]). It is the petitioner’s burden to rebut the presumption that the transfer of funds was motivated, in part if not in whole, by anticipation of a future need to qualify for medical assistance … .

Applying these rules here, the DOH’s determination that the petitioner failed to make a satisfactory showing that her husband intended to transfer the assets for valuable consideration is not supported by substantial evidence. The petitioner correctly concedes that the loan was not made for fair market value since the payments due under the original note and the amended note are not actuarially sound in light of the note’s 15-year repayment term and the age of the petitioner and her husband (see 42 USC § 1396p[c][1][I]). However, the evidence adduced at the fair hearing rebutted the presumption that the transfer was motivated by anticipation of a future need to qualify for medical assistance … . In this regard, the petitioner’s husband stated that he entered into the loan agreement in order to create a source of income. The petitioner demonstrated that the loan was documented by the note and the amended note, that the petitioner’s husband received a stream of income from the loan by way of the monthly payments, and that the note provided a significantly greater rate of return than the one or two percent interest rate that the petitioner’s husband could have obtained from a bank at the time. In addition, there was evidence at the fair hearing that some of the petitioner’s assets had previously been loaned to her family members and that those loans were fully repaid. Morever, the letter from the petitioner’s physician supported her claim that she was in good health at the time of the loan, and that she only required Medicaid after she fell and broke her hip. Furthermore, the petitioner’s grandson and his wife averred that they were unable to immediately repay the entire loan because they used the loaned sum to renovate their home. Matter of Rivera v Blass, 2015 NY Slip Op 02768, 2nd Dept 4-1-15

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