A New York Appeals Court Holds That The Usual Household Expenses Incurred by a Wife Necessitate An Increased Maintenance Allowance Even Though Her Husband Is A Medicaid Recipient In A Nursing Home

A New York appeals court held that a community spouse is entitled to an increased minimum monthly maintenance needs allowance (MMMNA) because her basic monthly expenses are almost double her monthly income and therefore qualify as “exceptional circumstances” necessitating access to her husband’s income. Matter of Balzarini v. Suffolk County Dept. of Social Servs. (N.Y. App. Div., 2008 Slip Op 06704, Sept. 2, 2008).

John Balzarini entered a nursing home in March 2005, and applied for Medicaid shortly thereafter. As part of his application, Mr. Balzarini requested that his wife receive an increased MMMNA because her expenses were greater than her income. The Suffolk County Department of Social Services (DSS) approved his application, but did not increase the MMMNA, determining that Mrs. Balzarini’s expenses were “ordinary” and not “exceptional circumstances” entitling her to an increased MMMNA. Mr. Balzarini appealed.

On appeal, DSS did not dispute that Mrs. Balzarini’s monthly income of $2,445 was nearly half her monthly expenses of $4,814. Instead, DSS argued that ordinary household expenses, while legitimate, do not give rise to the exceptional circumstances necessary to increase the MMMNA. Mr. Balzarini argued that the express purpose of the Medicare Catastrophic Coverage Act was to prevent a community spouse’s everyday expenses from impoverishing them when their spouse is institutionalized.

The Supreme Court of New York, Appellate Division, overturned DSS’s decision and called for an increased MMMNA. The court found that “reasonable, ordinary expenses can be a sufficient basis upon which additional income of the institutionalized spouse may be made available to the community spouse, and that in the circumstances presented here, the DOH should have granted the petitioner’s request in part.” Furthermore, the court stated that “the statute and regulations did not intend that where housing costs exhaust the minimum monthly maintenance needs allowance, the community spouse should not be entitled to some funds with which to pay for food and other necessities of life.”