may not be cited except as provided by
Minn. Stat. § 480A.08, subd. 3 (1996).
STATE OF MINNESOTA
IN COURT OF APPEALS
In Re: Appeal of Decision of the
Commissioner of Human Services in the
Appeal of Charlotte L'Allier for Medical Assistance.
Filed March 11, 1997
Reversed and Remanded
Ramsey County District Court
File No. C2966019
Jeffrey W. Schmidt, Stuart E. Schmitz & Associates, 1225 Capital Centre, 386 North Wabasha, St. Paul, MN 55102 (for Appellant)
Susan Gaertner, Ramsey County Attorney, Kristi Swanson Wendorff, Assistant County Attorney, Suite 560, 50 West Kellogg Boulevard, St. Paul, MN 55102 (for Respondent Ramsey County Community Human Services)
Hubert H. Humphrey III, Attorney General, Mark W. Traynor, Assistant Attorney General, 900 NCL Tower, 445 Minnesota Street, St. Paul, MN 55101 (for Respondent Minnesota Department of Human Services)
Considered and decided by Toussaint, Chief Judge, Lansing, Judge, and Huspeni, Judge.
The district court affirmed the Commissioner's decision denying Charlotte L'Allier medical assistance. Because the calculation resulting in the denial relies on an incorrect definition of L'Allier's first continuous period of institutionalization, we reverse.
After exhausting $250,000 of her personal assets for health care, L'Allier applied for medical assistance benefits in December 1995. Ramsey County Community Human Services calculated her eligibility based on a "first continuous period of institutionalization" occurring after September 30, 1989. According to that calculation, which included both L'Allier's and her husband's assets, she was ineligible.
L'Allier filed an administrative appeal, and, after a hearing, the appeals referee recommended reversing the denial of medical assistance. The Commissioner of the Minnesota Department of Human Services rejected the referee's recommendation because L'Allier entered Marian Center's board and care unit but not the nursing unit before September 30, 1989. The Commissioner ruled that
[t]he Marian Center Boarding Care unit is not a medical institution as that term is defined, and admission thereto cannot qualify as institutionalization.
L'Allier appealed, and the district court affirmed the Commissioner's denial of benefits. L'Allier now appeals the district court decision.
The procedure for determining medical assistance eligibility changed with the enactment of the Medicare Catastrophic Coverage Act of 1988 § 303, Pub. L. 100-360, 102 Stat. 683. Prior to the enactment, states could consider only income and resources available to the institutionalized spouse when determining the extent of medical assistance. Dullard, 529 N.W.2d at 442. After the Act, states could consider the total value of both spouses' resources to the extent either spouse had an ownership interest. The Act allowed application of the former criteria if the institutionalized spouse began the "first continuous period of institutionalization" before September 30, 1989. 42 U.S.C. § 1396r-5(c)(1)(A) (1994); Dullard, 529 N.W.2d at 443 n.4.
L'Allier argues that her first continuous period of institutionalization began on September 1, 1989, when she entered the boarding care facility and that her eligibility should therefore be considered under the pre-MCCA criteria. We agree.
The Department of Human Services interpreted the Act's reference to "continuous period of institutionalization" to mean residence in a "medical institution" as defined in federal regulations. See 42 CFR § 435.1009 (1995). But we are not convinced that Congress intended to incorporate a particular definition with its reference to institutionalization. Rather, we believe the Act's reference to institutionalization may be understood relying on the term's ordinary meaning. See Will v. Michigan Dep't of State Police, 491 U.S. 58, 64, 109 S. Ct. 2304, 2308 (1989) (courts must follow ordinary usage of terms, unless Congress gives them specified or technical meaning).
The ordinary meaning of institutionalization is consistent with the federal regulations definition of institution contained in 42 CFR § 435.1009:
Institution means an establishment that furnishes (in single or multiple facilities) food, shelter, and some treatment or services to four or more persons unrelated to the proprietor.
L'Allier was institutionalized, within the ordinary meaning of that term, when she entered the Marian Center's boarding care unit on September 1, 1989.
L'Allier was unable to receive proper care at her home and sought a nursing care facility on the advice of her personal physician. Because Marian Center did not have a nursing unit bed available, she was cared for in the boarding unit beginning September 1, 1989. She has remained in continuous care in that facility since that time. On the specific facts before us, we conclude that the district court too narrowly defined institutionalization for purposes of determining L'Allier's eligibility for medical assistance.
Reversed and remanded.