Filed December 24, 2015
MEMORANDUM OF DECISION AND ORDER ON THE PLAINTIFF'S MOTION FOR JUDGMENT ON THE PLEADINGS
DENNIS J. CURRAN, Associate Justice.
The Office of Medicaid denied James Daley's application for long-term Medicaid benefits, and his wife, Mary Daley, acting as his Personal Representative, appeals that decision.
The Office of Medicaid, known as MassHealth because it administers the Massachusetts Medicaid program (see G.L.c. 118E, § 9A) falls under the authority of the Secretary of the Executive Office of Health and Human Services. (See G.L.c. 6A, § § 16, 16B.) Mrs. Mary Daley, acting as the Personal Representative of her husband James Daley's estate, brings this action for judicial review of MassHealth's decision under G.L.c. 30A, § 14. Mrs. Daley has moved for judgment on the pleadings to vacate MassHealth's decision. A hearing has been held on that motion.
For the following reasons, Mrs. Daley's motion for judgment on the pleadings must be DENIED.
Judicial review of an agency decision is confined to the administrative record. G.L.c. 30A, § 14(4), (5). The record before MassHealth contained the following facts. Over eight years ago, on December 19, 2007, Mr. and Mrs. Daley established the " James Daley and Mary Daley Irrevocable Trust " and appointed their son James Daley and their daughter Patricia Tubaj as its trustees. (The trust's applicable provisions are discussed below.)
That same day, Mr. and Mrs. Daley conveyed their interest in their condominium located at 215 Mill Street, Unit 103 in Worcester to the Trust. They retained life estates under the property's deed and continued to live there together for about six years until health reasons required that Mr. Daley be admitted to the Millbury Health Care Center on December 20, 2013.
On February 21, 2014, Mr. Daley applied for long-term care Medicaid benefits effective January 19, 2014. On April 14, 2014, MassHealth denied Mr. Daley's application after it concluded that his assets exceeded Medicaid's $2, 000 eligibility limit. MassHealth determined he was financially ineligible for benefits because his assets included the Trust's principal, valued at $150, 943. The Trust's principal was the value of the Daleys' condominium. Mr. Daley appealed that decision to the Office of Medicaid Board of Hearings.
After a hearing, the Office of Medicaid Board of Hearings affirmed MassHealth's determination in a decision dated October 22, 2014. The Board counted the Trust's principal as an asset because (1) Mr. and Mrs. Daley's deed explicitly reserved their right to occupy and use the condominium; and (2) their Trust granted them the right to convert the Trust's principal into income.
Mr. Daley died on November 13, 2014--about seven years after the establishing the Trust. Mrs. Daley then filed a request for a rehearing, which the Board denied for failure to show good cause. On February 11, 2015, Mrs. Daley filed a complaint seeking judicial review of MassHealth's decision under G.L.c. 30A, arguing that she and her husband were essentially indigent and eligible for public benefits because their assets are held by an irrevocable trust. On October 15, 2015, Mrs. Daley filed this motion for judgment on the pleadings. MassHealth filed its opposition motion, contending that the Daleys were financially ineligible for Medicaid benefits. Mrs. Daley continues to live at the condominium.
I. Standard of Review
Under G.L.c. 30A, § 14(7), this court must uphold MassHealth's decision unless it is unsupported by substantial evidence, is arbitrary or capricious, constitutes an abuse of discretion, or is otherwise not in accordance with the law. See eVineyard Retail Sales-Mass., Inc. v. Alcoholic Bevs. Control Comm'n, 450 Mass. 825, 828, 882 N.E.2d 334 (2008). This court " must apply all rational presumptions in favor of the validity of the administrative action and not declare it void unless its provisions cannot by any reasonable construction be interpreted in harmony with the legislative mandate." Thomas v. Commissioner of the Div. of Med. Assistance, 425 Mass. 738, 746, 682 N.E.2d 874 (1997) (citation omitted). Moreover, this " court will not substitute its own judgment concerning the penalty the [agency] imposes." Kobrin v. Bd. of Registration in Med., 444 Mass. 837, 842, 832 N.E.2d 628 (2005) (citation omitted). Consequently, as a matter of law, as the party ...