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Court finds state improperly denied Medicaid benefits

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A Delaware trial court found for a nursing home resident who applied for Medicaid and was denied for insufficient information in Green Valley SNF, LLC v. Delaware Dept. of Health and Social Services (Del. Super. Ct., No. 13A-02-002 (RBY), Dec. 31, 2013).

Pauline Bryner was admitted to Pinnacle Rehabilitation and Health Center with a diagnosis of Alzheimer’s disease. She had no family to act for her so Pinnacle on her behalf applied for Medicaid benefits and a guardianship proceeding was started. At the time, the Office of the Public Guardian was only taking emergency cases. Medicaid, through the state, requested information about property owned by Bryner. Pinnacle provided some information but the state determined the information was insufficient and denied the application.

Pinnacle filed a second application, which was also denied. This time, the application was denied due to lack of verification regarding Bryner’s resources. Medicaid sent Pinnacle a “We Need” letter with a due by date. The items the letter requested included the deed and a signed agreement to sell. Pinnacle sent tax assessment records and liens of record as evidence of the fair market value, and submitted notice of a tax sale of the property as evidence that it was for sale. The state did not consider notice of a forced sale to mean the property was on the market. The state did not receive the requested information by a deadline and denied the application again.

During this time, the state was aware that Bryner was incapacitated and still without a guardianship even though no party had the authority to obtain the requested information.

The Delaware Superior Court reversed the state’s denial of benefits because the denial was not “on the merits of all known or accessible information.”

The case can be found here.


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