Medicaid Eligibility Lost After Recipient Moves From District

JULY 15, 2002 VOLUME 10, NUMBER 2

Although many of the legal problems facing the elderly and the disabled are addressed through state laws, the underlying problems are regional, national or even universal. Though the national medical program for the elderly and disabled, Medicaid, is partially funded and broad guidelines set by the federal government, program administration is handled exclusively by states. Another area of interstate problems is guardianship law, which is almost entirely state-specific. A recent case arising, ironically enough, in the District of Columbia involves the interplay of all of those issues.

Gerald McKenzie is a 38-year-old developmentally disabled man. He was born in the District of Columbia and lived his entire life there until two years ago. During most of those years he received much of his care through the federal Medicaid program, but from providers located in D.C. and based on his eligibility in the District.

Mr. McKenzie’s aunt Sheridan Bacchus was appointed as guardian of his person in 1995, and he lived with her for the next five years. When she moved to suburban Maryland in 2000, he moved along with her. Although both of them now live at a Maryland address, Ms. Bacchus intended to keep Mr. McKenzie enrolled in the same day-care program he attended while living in the District. The District notified her, however, that Mr. McKenzie’s services were terminated immediately upon learning of his relocation.

Ms. Bacchus appealed the termination of services. She argued that Mr. McKenzie is completely unable to make a conscious decision to change his residence, and that she as guardian has the right to make that determination. Although he physically lives in Maryland, she insists, it is her intention that he remain a resident of the District.

The D.C. Court of Appeals ruled against Ms. Bacchus. The Medicaid law, said the court, requires the states and the District to provide services only to those who actually reside within their respective boundaries. Because Mr. McKenzie lives in Maryland, even though only about one mile from the District’s boundary, he will have to apply for Medicaid benefits with Maryland. McKenzie v. DC DHS, July 11, 2002.

Mr. McKenzie will probably be eligible under Maryland’s Medicaid program. He will, however, have to go through the application process again (eligibility for Medicaid in one state does not transfer to a new state when the recipient moves).

Fortunately, D.C. law expressly permits the guardianship to continue even though Mr. McKenzie now lives in Maryland. Some states require establishment of a guardianship in the new state and termination of the old proceeding. Even so, Ms. Bacchus may find it increasingly difficult to secure treatment and make decisions with an “out of state” guardianship.

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