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Estate of Robertson v. Tsai

Superior Court of Massachusetts, Worcester

December 30, 2015

Estate of Christina M. Robertson
Daniel Tsai, Assistant Secretary for MassHealth et al No. 132973

          Filed Date January 16, 2016


          Honorable Shannon Frison, J.

         This case arises out of the Office of Medicaid's denial of Christina M. Robertson's application for long-term Medicaid benefits.[1] The Office of Medicaid, also known as MassHealth for the Massachusetts Medicaid program it administers, 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. Ms. Robertson's estate brings this action for judicial review of MassHealth's decision under G.L.c. 30A, § 14. Both parties now move for judgment on the pleadings. A hearing has been held on those motions.

         For the following reasons, the plaintiff's Motion for Judgment on the Pleadings is DENIED . The defendant's Motion for Judgment on the Pleadings is ALLOWED .


          Judicial review of an agency decision is confined to the administrative record. M.G.L.c. 30A, § 14(4)(5). The record before MassHealth contained the following facts. Thomas and Christina M. Robertson were the grantors and beneficiaries of the Robertson Family Trust, an irrevocable trust in which they were entitled to income-only distributions. As a married couple, the Robertsons established the trust on May 23, 1990. They named two of their children, William Dale Robertson and Jeanne McKeen, as trustees. Christina and Thomas funded the trust with titles to their house in Casco, Maine, their mobile home in Sturbridge, Massachusetts, their boat, a bank account, and several life insurance policies. Those assets were valued at $580, 793.

         The trust directs the trustees to pay Christina and Thomas all of the net income--that is, dividends and investment interest--generated by the trust. Section 3.02 governs the payment of the trust principal to Christina and Thomas Robertson. It provides:

The trustees shall have discretion to pay the Grantors or on their behalf so much of the principal of the Trust as is necessary to provide for their health, including payment for nursing home care and home health care, for a period of time ending thirty months after the most recent date that the Trustees received Trust property from the Grantors. After that date, the Trustees shall have no discretion to invade principal on behalf of the Grantors.

Section 5.02 empowers the trustees to terminate the trust should the existence of the trust jeopardize Thomas or Christina Robertson's receipt of government benefits. It provides:

[I]f, in the judgment of the Trustees, the primary beneficiaries require any service or benefit for which they would qualify for assistance under any federal, state, or local governmental program but for the existence, size, or terms of this Trust, and if the costs of such service or benefit are such that they would, if borne by the Trust, risk substantial depletion of the Trust, the Trustees may, in their sole discretion, terminate the Trust and distribute the Trust corpus to the beneficiaries named in Article 4.01 as though the Grantors were deceased.

         And under Section 10.2, Christina and Thomas Robertson retained the right to live in the homes held by the trust and situated in Maine and Massachusetts.

         Christina M. Robertson applied for long-term care benefits in August 2010 when she was moved to a nursing home. MassHealth denied her application because it opined that her countable assets exceeded the program limit of $2, 000. Ms. Robertson appealed that denial to the Board of Hearings of the Office of Medicaid. After hearing, the Board denied her appeal. The hearing officer concluded that the trust principle was countable and exceeded the $2, 000 program limit. He also concluded that the trust was a Medicaid Qualifying Trust so the entire principal was considered available and countable. Further, the hearing officer decided that, pursuant to section 3.02 of the trust, the principal was countable for a period of thirty months (until September 2011) due to Ms. Robertson's transfer of $14, 000 into the trust via a check dated March 19, 2009.

         Ms. Robertson then sought review of the Board of Hearings decision in the Superior Court via M.G.L.c. 30A, § 14. Ms. Robertson asked the court to vacate the Board's decision. MassHealth asked the court to remand the matter back to the Board. MassHealth contended that, although the Board had ruled in its favor, the Board's decision was marred by several procedural and substantive deficiencies that required correction. Specifically, MassHealth argued that the hearing officer afforded Ms. Robertson, but not MassHealth, the opportunity to respond to memoranda submitted before the hearing and evidence introduced at the hearing; stated incorrectly that MassHealth failed to introduce certain evidence and then made an incorrect factual finding based on that error; and failed to fully address the argument that the entire trust had always been countable, regardless of the status of the $14, 000 check. After a hearing in Superior Court, the Court (Tucker, J.) remanded the matter back to the Board of Hearings for further proceedings. The Court found it " unusual" for MassHealth to request a remand in a matter in which it was the prevailing party, but found that " the Agency was improperly denied the opportunity to respond to evidence that Robertson was permitted to submit following the conclusion of the hearing." Ms. Robertson moved for reconsideration, and Justice Tucker denied that motion.

         Upon remand, the hearing officer again issued a decision denying Ms. Robertson's appeal on July 2, 2013. This time, a different hearing officer decided that trust was a Medicaid Qualifying Trust; that the principal was available to Ms. Robertson because section 3.02 must be disregarded as the trustees had discretion to disburse funds to Ms. Robertson; and that Ms. Robertson continued to have access to the funds in the trust because she need only deposit one cent in the trust to make the entire principal available to her. ...

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