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Agency Mistake No Basis For Retroactive Medicaid Eligibility

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JULY 10, 2000 VOLUME 8, NUMBER 2

The federal-state Medicaid program was designed to make sure poor Americans would receive necessary medical care. It now pays for about half of all nursing home costs. Tragically, the program is so complicated that it often requires expert legal assistance to ensure that benefits are received in accordance with the program’s own rules. A recent Iowa case demonstrates that it can be a mistake to rely on even Medicaid’s own staff members for interpretation of those rules.

William and Lydia Ahrendsen knew as early as 1991 that they might face nursing home placement, and they wanted to keep the family farm in the family. On advice of their attorney, they “sold” the property to their two children for two dollars; the farm was worth about $240,000 at the time. Because the “sale” was really a gift to the children, Medicaid rules made the Ahrendsen’s ineligible for Medicaid assistance for a period of months.

The period of ineligibility for such a gift is determined by dividing the value of the gift by an amount set by the state. That amount, in turn, is intended to approximate the actual monthly cost of nursing home care. In the Ahrendsen’s case, the period of ineligibility worked out to be 72 months (six years).

Both Mr. and Mrs. Ahrendsen went into the nursing home shortly after making the gift to their children. A year later, at the suggestion of the nursing home social worker, their son Glen applied for Medicaid assistance. Because the gift was just over a year old their application was denied; the Medicaid worker advised Glen Ahrendsen that they would not be eligible until August of 1997—nearly five years later.

The Medicaid worker, as it turned out, was simply wrong. Federal law provides that gifts older than three years (in most cases) are not counted in calculating Medicaid eligibility. Although there has been some dispute about what that means for people who make an early application like the Ahrendsens, Iowa’s Medicaid rules were clear: the Ahrendsens would have been eligible in February, 1994.

Glen Ahrendsen learned of the mistake in September, 1996. He immediately filed for Medicaid eligibility for his mother and father, even though his father had died two years earlier. He sought reimbursement for the nursing home payments which would have been covered during the prior two years if he had not received incorrect advice from the state’s Medicaid worker.

Federal Medicaid law limits retroactive coverage to the three months prior to filing of an application. The Iowa courts disallowed Glen Ahrendsen’s request for additional reimbursement, and the Iowa Supreme Court agreed. Because he relied on agency advice, the Ahrendsen family was simply out of luck. Ahrendsen v. Iowa Dep’t. of Human Services, July 6, 2000.

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Robert B. Fleming


Robert Fleming is a Fellow of both the American College of Trust and Estate Counsel and the National Academy of Elder Law Attorneys. He has been certified as a Specialist in Estate and Trust Law by the State Bar of Arizona‘s Board of Legal Specialization, and he is also a Certified Elder Law Attorney by the National Elder Law Foundation. Robert has a long history of involvement in local, state and national organizations. He is most proud of his instrumental involvement in the Special Needs Alliance, the premier national organization for lawyers dealing with special needs trusts and planning.

Robert has two adult children, two young grandchildren and a wife of over fifty years. He is devoted to all of them. He is also very fond of Rosalind Franklin (his office companion corgi), and his homebound cat Muninn. He just likes people, their pets and their stories.

Elizabeth N.R. Friman


Elizabeth Noble Rollings Friman is a principal and licensed fiduciary at Fleming & Curti, PLC. Elizabeth enjoys estate planning and helping families navigate trust and probate administrations. She is passionate about the fiduciary work that she performs as a trustee, personal representative, guardian, and conservator. Elizabeth works with CPAs, financial professionals, case managers, and medical providers to tailor solutions to complex family challenges. Elizabeth is often called upon to serve as a neutral party so that families can avoid protracted legal conflict. Elizabeth relies on the expertise of her team at Fleming & Curti, and as the Firm approaches its third decade, she is proud of the culture of care and consideration that the Firm embodies. Finding workable solutions to sensitive and complex family challenges is something that Elizabeth and the Fleming & Curti team do well.

Amy F. Matheson


Amy Farrell Matheson has worked as an attorney at Fleming & Curti since 2006. A member of the Southern Arizona Estate Planning Council, she is primarily responsible for estate planning and probate matters.

Amy graduated from Wellesley College with a double major in political science and English. She is an honors graduate of Suffolk University Law School and has been admitted to practice in Arizona, Massachusetts, New York, and the District of Columbia.

Prior to joining Fleming & Curti, Amy worked for American Public Television in Boston, and with the international trade group at White & Case, LLP, in Washington, D.C.

Amy’s husband, Tom, is an astronomer at NOIRLab and the Head of Time Domain Services, whose main project is ANTARES. Sadly, this does not involve actual time travel. Amy’s twin daughters are high school students; Finn, her Irish Red and White Setter, remains a puppy at heart.

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Matthew M. Mansour


Matthew is a law clerk who recently earned his law degree from the University of Arizona James E. Rogers College of Law. His undergraduate degree is in psychology from the University of California, Santa Barbara. Matthew has had a passion for advocacy in the Tucson community since his time as a law student representative in the Workers’ Rights Clinic. He also has worked in both the Pima County Attorney’s Office and the Pima County Public Defender’s Office. He enjoys playing basketball, caring for his cat, and listening to audiobooks narrated by the authors.