EVELEIGH, J.
The plaintiff in this administrative appeal, Mary Palomba-Bourke, appeals from the judgment of the trial court affirming the decision of the administrative hearing officer, in favor of the defendant, the Commissioner of Social Services (department).
Bourke applied to the department for Medicaid benefits in 2009 and, in 2010, the department informed Bourke that, based on its review of the combined assets of both Bourke and the plaintiff, Bourke was not currently eligible to receive Medicaid benefits. The plaintiff then sought an administrative hearing to contest the department's determination of Bourke's eligibility.
The relevant facts in the present case are undisputed, and are recounted in the decisions of both the administrative hearing officer and the Superior Court. On September 10, 1968, the plaintiff's husband at the time, Edward Palomba, created the Edward A. Palomba residual trust (trust), and, upon his death on September 5, 1976, the plaintiff was made a beneficiary of the trust. The trust was intended to permit the trustees to provide for, in their sole discretion, the education and support of Palomba's children, and for the support of the plaintiff. As of April, 2010, the principal of the trust was equal to $514,977.17. In 2000, the plaintiff married Bourke. Bourke, who is not a beneficiary of the trust, entered a long-term care facility on February 2, 2009, while the plaintiff continued to reside in the community. On August 3, 2009, Bourke applied for Medicaid benefits, and on June 9, 2010, the department conducted its analysis of the combined assets of the plaintiff and Bourke and concluded that, based on the total value of their combined assets, Bourke was not at that time eligible for Medicaid benefits. Specifically, the department concluded that, including the value of the trust, the couple's combined assets totaled $655,624.61. Pursuant to state regulation; see Dept. of Social Services, Uniform Policy Manual § 4005.10(A)(2)(a) (Uniform Policy Manual);
The plaintiff contested the department's determination and sought an administrative hearing to challenge it. Specifically, the plaintiff objected to the department's decision to count the value of the trust when determining the total value of the assets available to Bourke. The plaintiff claimed that, in including the value of the trust in Bourke's available assets, the department was following the rules created by the Medicare Catastrophic Coverage Act of 1988 (catastrophic coverage act), Pub.L. No. 100-360, § 303(c), 102 Stat. 683, 762, regarding the availability of spousal assets, and not the rules governing asset valuation that were in effect either at the time that the trust was created in 1968 or when the trust became irrevocable due to Palomba's death in 1976.
At the administrative hearing, the hearing officer rejected the plaintiff's argument. The hearing officer concluded that the plaintiff and Bourke met the definition of "[catastrophic coverage act] spouses" as defined in § 0500 of the Uniform Policy Manual,
The sole issue on appeal is whether the trial court properly affirmed the hearing officer's determination that the availability and eligibility rules of the catastrophic coverage act apply to the trust and thus, that it should be considered an asset of Bourke for purposes of his Medicaid eligibility.
"The substantial evidence rule governs judicial review of administrative fact-finding under UAPA. General Statutes § 4-183(j)(5) and (6). Substantial evidence exists if the administrative record affords a substantial basis of fact from which the fact in issue can be reasonably inferred.... This substantial evidence standard is highly deferential and permits less judicial scrutiny than a clearly erroneous or weight of the evidence standard of review.... The burden is on the [plaintiff] to demonstrate that the [agency's] factual conclusions were not supported by the weight of substantial evidence on the whole record....
"Even as to questions of law, [t]he court's ultimate duty is only to decide whether, in light of the evidence, the [agency] has acted unreasonably, arbitrarily, illegally, or in abuse of its discretion.... Conclusions of law reached by the administrative agency must stand if the court determines that they resulted from a correct application of the law to the facts found and could reasonably and logically follow from such facts.... Ordinarily, this court affords deference to the construction of a statute applied by the administrative agency empowered by law to carry out the statute's purposes.... Cases that present pure questions of law, however, invoke a broader standard of review than is ordinarily involved in deciding whether, in light of the evidence, the agency has acted unreasonably, arbitrarily, illegally or in abuse of its discretion.... Furthermore, when a state agency's determination of a question of law has not previously been subject to judicial scrutiny ... the agency is not entitled to special deference." (Citations omitted; internal quotation marks omitted.) MacDermid, Inc. v. Dept. of Environmental Protection, 257 Conn. 128, 136-37, 778 A.2d 7 (2001).
Given the nature of the plaintiff's claim, namely, that the rules in effect prior to 1988 regarding the availability of assets and the eligibility of a Medicaid applicant for medical benefits should apply to the trust in the present case, "[o]ur analysis begins with an overview of the [M]edicaid program. The program, which was established in 1965 as Title XIX of the Social Security Act and is codified at 42 U.S.C. § 1396 et seq. ([M]edicaid act), is a joint federal-state venture providing financial assistance to persons whose income and resources are inadequate to meet the costs of, among other things, medically necessary nursing facility care.... The federal government shares the costs of [M]edicaid with those states that elect to participate in the program, and, in return, the states are required to comply with requirements imposed by the [M]edicaid act and by the secretary of the Department of Health and Human Services.... Specifically, participating states are required to develop a plan, approved by the [S]ecretary of [H]ealth and [H]uman [S]ervices, containing reasonable standards ... for determining eligibility for and the extent of medical assistance to be provided....
"Connecticut has elected to participate in the [M]edicaid program and has assigned to the department the task of administering the program.... Pursuant to General Statutes §§ 17b-262 and 17b-10, the department has developed Connecticut's
"The [M]edicaid act requires that a state's [M]edicaid plan make medical assistance available to qualified individuals. 42 U.S.C. § 1396a (a)(10). The term medical assistance means payment of part or all of the cost of... care and services ... [including] nursing facility services.... 42 U.S.C. § 1396d (a); see Catanzano v. Wing, 103 F.3d 223, 229 (2d Cir.1996). Participating states are required to provide coverage to certain groups and are given the option to extend coverage to various other groups. The line between mandatory and optional coverage primarily is drawn in 42 U.S.C. § 1396a (a)(10)(A): mandatory coverage is specified in 42 U.S.C. § 1396a (a)(10)(A)(i); and optional coverage is set forth in subsection (a)(10)(A)(ii). In [M]edicaid parlance, individuals who qualify for [M]edicaid benefits pursuant to those subsections are referred to as the categorically needy because, in general, they are eligible for financial assistance under Titles IV-A (Aid to Families with Dependent Children) or XVI (Supplemental Security Income for the Aged, Blind, and Disabled) of the Social Security Act.
"Under the [M]edicaid act, states have an additional option of providing medical assistance to the medically needy — persons who ... lack the ability to pay for their medical expenses but do not qualify as categorically needy solely because their income exceeds the income eligibility requirements of the applicable categorical assistance program.... The medically needy become eligible for [M]edicaid, if the state elects to cover them, by incurring medical expenses in an amount sufficient to reduce their incomes below the income eligibility level set by the state in its [M]edicaid plan. See 42 U.S.C. § 1396a (a)(17) (in determining eligibility, state must take costs ... incurred for medical care into account); see also 42 C.F.R. § 435.301. Only when they spend down the amount by which their income exceeds that level, are [medically needy persons] in roughly the same position as [categorically needy] persons ... [because then] any further expenditures for medical expenses ... would have to come from funds required for basic necessities. Atkins v. Rivera, [477 U.S. 154, 158, 106 S.Ct. 2456, 91 L.Ed.2d 131 (1986) ]. Connecticut has chosen to cover the medically needy....
"The [M]edicaid act, furthermore, requires participating states to set reasonable standards for assessing an individual's income and resources in determining eligibility for, and the extent of, medical assistance under the program. 42 U.S.C. § 1396a (a)(17).... The resources standard set forth in Connecticut's state [M]edicaid plan for categorically needy and medically needy individuals is $1600. General Statutes §§ 17b-264 and 17b-80 (c); Uniform Policy Manual, supra, § 4005.10.... Consequently, a person who has available resources; see 42 U.S.C. § 1396a (a)(17)(B); in excess of $1600 is not eligible to receive benefits under the Connecticut [M]edicaid program even though the person's medical expenses cause his or her income to fall below the income eligibility standard." (Citations omitted; footnotes omitted; internal quotation marks omitted.) Ahern v. Thomas, 248 Conn. 708, 713-16, 733 A.2d 756 (1999).
The enactment of the catastrophic coverage act was also "intended, in part, to ease the financial burden placed on a community spouse under the prior statutory regime that required the institutionalized spouse to spend down a large
The plaintiff's specific contention on appeal is that, prior to the enactment of the catastrophic coverage act in 1988, the assets that were included in a given Medicaid applicant's eligibility determination were only "such income and resources as are, as determined in accordance with standards prescribed by the Secretary [of Health and Human Services], available to the applicant...." 42 U.S.C. § 1396a (a)(17)(B). The plaintiff's position is that, under the rules governing eligibility and availability determinations in effect before the catastrophic coverage act was enacted, the trust would not have been considered by the department when determining Bourke's eligibility for Medicaid benefits, because Bourke is not a beneficiary of the trust and, thus, it would not be considered "available" to him. Cf. Wilczynski v. Harder, 323 F.Supp. 509, 515 (D.Conn. 1971) (noting that, when determining eligibility, among other things, "[t]he state may not consider income or assets not actually available to the applicant, 42 U.S.C. § 1396a [a][17][B]"); Rowland v. Maher, 176 Conn. 57, 61-63, 404 A.2d 894 (1978) (noting that only assets actually available to applicant may be considered in determining eligibility, finding $2000 entry fee elderly patients paid to nursing home did not qualify as "available asset").
Pursuant to the provisions providing for the treatment of income included in the catastrophic coverage act, the department determines what assets and income are considered "available" to an institutionalized spouse in a very different way. Instead of focusing solely on the resources and assets that are available to the individual, the department is required to look at the income and assets available to both the institutionalized spouse and the community spouse. See 42 U.S.C. § 1396r-5 (c)(1)(B) and (2); see also Uniform Policy Manual, supra, § 4025.67.
The plaintiff contends that Connecticut courts, including this court, have previously construed the catastrophic coverage act so as not to give it retroactive effect — in other words, the plaintiff's position is that Connecticut courts have determined that the eligibility and availability methods in effect on the date that a particular trust is established or becomes irrevocable should apply. In support of her position, the plaintiff relies primarily on the Superior Court case, Hazelton v. Wilson-Coker, Superior Court, judicial district of New Britain, Docket No. CV-02-051711-S, 2003 WL 22290975 (September 19, 2003) (Bear, J.) (35 Conn. L. Rptr. 505), a case that placed great weight on two previous decisions of this court, Ahern v. Thomas, supra, 248 Conn. at 708, 733 A.2d 756, and Skindzier v. Commissioner of Social Services, 258 Conn. 642, 784 A.2d 323 (2001). The plaintiff claims that the decision in Hazelton correctly interpreted the aforementioned decisions of this court to hold that it is unlawful to apply the eligibility and availability provisions of the catastrophic coverage act to a trust established before it was signed into law. See Hazelton v. Wilson-Coker, supra, at 506-509.
The department, in response, claims that the cases cited by the plaintiff do not stand for any general rule that Connecticut law requires trusts to be treated according to the relevant Medicaid statutes in effect at the time that the trust was established or became irrevocable. Rather, the department claims, the decision of the Superior Court in Hazelton represents an incorrect, overly broad generalization of the holdings of Skindzier and Ahern, both of which: (1) dealt with different, more specialized provisions of the catastrophic coverage act; and (2) sought to determine whether to apply provisions contained in the catastrophic coverage act, or provisions included in a later law, the Omnibus Budget Reconciliation Act of 1993, Pub.L. 103-66, § 13611(e), 107 Stat. 312, 627.
This interpretation of the effective date of the provisions of 42 U.S.C. § 1396r-5 is bolstered by reference to the department's Uniform Policy Manual, which defines "[catastrophic coverage act] spouses" in its glossary of terms as "spouses who are members of a married couple one of whom becomes an institutionalized spouse on or after September 30, 1989, and the other spouse becomes a community spouse." Uniform Policy Manual, supra, § 0500. Another section of the Uniform Policy Manual provides that, in the case of "[catastrophic coverage act] spouses," the assets of the community spouse are deemed to be assets of the institutionalized spouse to the extent that they exceed the protected amount. See Id., § 4025.67(A).
We do not find persuasive the plaintiff's argument that Connecticut case law has set a precedent for applying the Medicaid
In Skindzier, this court similarly decided an issue distinct from the one we are asked to decide in the present case. In that case, the issue was whether the plaintiff was eligible for Medicaid benefits in light of the fact that her deceased husband had created two testamentary trusts of which the plaintiff was a beneficiary. Skindzier v. Commissioner of Social Services, supra, 258 Conn. at 643-44, 784 A.2d 323. These trusts were funded by property owned by the plaintiff's spouse at his death. Id., at 644, 784 A.2d 323. The primary issue in Skindzier was whether the creation of these testamentary trusts by the plaintiff's husband constituted a "disqualifying transfer of assets" pursuant to 42 U.S.C. § 1396p (c) that would have rendered the plaintiff ineligible for Medicaid benefits for a period of time. Id., at 652-53, 784 A.2d 323. This court, relying on the text of 42 U.S.C. § 1396p (d)(2)(A), found that testamentary trusts were specifically exempted from the provisions of § 1396p (c), and thus that the plaintiff was not rendered ineligible for
In Hazelton, at issue was whether the corpus of a testamentary trust created by the plaintiff's great uncle and naming her as a beneficiary should have been considered "`available'" to the plaintiff's spouse for purposes of his Medicaid eligibility. See Hazelton v. Wilson-Coker, supra, 35 Conn. L. Rptr. at 505. In that case, the trial court concluded that, because the trust at issue had been created in 1985, "[t]he [h]earing [o]fficer and the [d]epartment should have applied pre-1986 standards and rules of availability...." (Internal quotation marks omitted.) Id., at 507. The court explained that, "[a]fter Ahern, [the department] knew or should have known that [it] was required to determine and apply federal law as it existed on the date of the creation of an irrevocable inter vivos trust. After Skindzier, [the department] knew or should have known that [it] was required to determine and apply federal law as it existed on the date of the creation of a testamentary trust, e.g., the testator's date of death." Id., at 509.
We conclude that the conclusions drawn in Hazelton from this court's earlier decisions in Ahern and Skindzier are based on a misconception of the issues this court decided in those earlier cases. In neither Ahern nor Skindzier did this court make any determination as to whether the general rules regarding the treatment of income and resources of an institutionalized spouse should depend on when particular assets or resources were established. Rather, Ahern dealt specifically with the applicability of provisions related to self-settled trusts and specifically, whether the self-settled trust in that case met the definition of a "[M]edicaid qualifying trust," and was thus available to the settlor, who had applied for Medicaid benefits. (Internal quotation marks omitted.) Ahern v. Thomas, supra, 248 Conn. at 712 and n. 8, 720-28, 743, 733 A.2d 756. Skindzier dealt with the applicability of certain transfer of asset provisions that have no bearing on the present case. Skindzier v. Commissioner of Social Services, supra, 258 Conn. at 644-47, 652-54, 661-62, 784 A.2d 323. In both cases, the court decided that particular statutory provisions either did or did not apply, not on the basis of any existing statewide policy or law, but because of the effective date provision of the 1993 Medicaid amendments, which stated quite specifically that the effective date of the relevant provisions was August 11, 1993. Id., at 652-53, 784 A.2d 323; Ahern v. Thomas, supra, at 720-22, 733 A.2d 756.
In summary, the determinations that this court made in Skindzier and Ahern, regarding the applicability of specific Medicaid provisions, were not based on a recognition that, when determining the availability of a given asset or the eligibility of a given Medicaid applicant, state law or policy requires assets to be treated in accordance with the relevant Medicaid provisions that were in effect at the time that the assets were created or established. Rather, this court's conclusions regarding the applicable law in those cases resulted from the effective date provisions of the relevant Medicaid provisions at issue. See Omnibus Reconciliation Act of 1993, Pub.L. 103-66, § 13611(e), 107 Stat. 312, 627; Skindzier v. Commissioner of Social Services, supra, 258 Conn. at 652-53, 658, 784 A.2d 323, citing Ahern v. Thomas, supra, 248 Conn. at 721, 733 A.2d 756; Ahern v. Thomas, supra, at 721, 733 A.2d 756, citing Uniform Policy Manual, supra, § 4030.80(C) and (D); see also Uniform Policy Manual, supra, § 4030.80. To the extent that the decision in Hazelton is inconsistent with this opinion, Hazelton is overruled. Accordingly, we conclude that the trial court correctly concluded that the department did not act arbitrarily or abuse
The judgment is affirmed.
In this opinion the other justices concurred.
(2) ... In determining the resources of an institutionalized spouse at the time of application for benefits under this subchapter, regardless of any State laws relating to community property or the division of marital property —
(A) except as provided in subparagraph (B), all the resources held by either the institutionalized spouse, community spouse, or both, shall be considered to be available to the institutionalized spouse, and
(B) resources shall be considered to be available to an institutionalized spouse, but only to the extent that the amount of such resources exceeds the amount computed under subsection (f)(2)(A) of this section (as of the time of application for benefits)." Section 4025.67 of the department's uniform policy manual is Connecticut's implementation of this federal statute.