Gustafson v. North Dakota Department of Human Services

Summary

The Supreme Court of North Dakota reviewed the denial of Medicaid eligibility to John L. Gustafson based on the treatment of his wife's annuity as an available asset and potentially disqualifying transfer. The court held that the Department of Human Services failed to determine and disclose the wife's reasonable life expectancy as required by statute and agency policy. It reversed the district court's judgment and remanded for the Department to assess life expectancy and reevaluate Medicaid eligibility.

Holdings

1. When the Department rejects the life-expectancy estimate supplied by a Medicaid applicant and the applicant's physician, the burden shifts to the Department to establish the purchaser's reasonable life expectancy under N.D.C.C. § 50-24.1-02.8(2)(d).
2. The Department's order was not in accordance with law because the Department failed to determine and disclose the wife's reasonable life expectancy before deciding the annuity was not actuarially sound.

Questions Presented

1. Whether the Department properly determined that the annuity was not actuarially sound for Medicaid eligibility purposes.
2. Whether the Department properly treated the annuity as an available asset or a disqualifying transfer.
3. Whether the Department was required to determine and disclose the purchaser's reasonable life expectancy after rejecting the life-expectancy estimate supplied by the applicant and the applicant's physician.

Disposition

reversed_and_remanded