COSTA TINGOS died in 2020, but four years later lawyers are still arguing about whether MassHealth, the state’s Medicaid program, improperly denied him coverage for a stay in the Sancta Maria Nursing Facility in Cambridge.
In arguments before the Supreme Judicial Court on Wednesday, MassHealth said it acted correctly because Tingos failed to disclose all of his assets, particularly the assets of his wife of 50 years. The state agency needed that information because it typically attempts to recoup the cost of some of the care it provides from the estate of clients who pass away in nursing homes.
But Tingos’s estate and the Massachusetts Chapter of the National Academy of Elder Law Attorneys say that he couldn’t disclose his wife Mary’s assets because he had little or no knowledge of them. The couple’s relationship was tumultuous with the husband’s gambling addiction and his partial paralysis leading to a decision to keep most of their finances separate for over 15 years.
After five years of back and forth on the issue, including three formal hearings, MassHealth denied Tingos coverage, even after he passed away in 2020. The state agency said Tingos’s wife was not “genuinely uncooperative,” pointing to the fact that Tingos, until he needed nursing home care, lived in a home paid for by his wife. His wife also held power of attorney over his affairs while he was in the nursing home and the couple filed joint tax returns.
The SJC justices questioned whether MassHealth’s more specific regulations on spousal asset disclosure and cooperation were in accordance with Medicaid’s broader federal rules. Medicaid is a joint state-federal medical insurance program, with broad federal rules and more specific rules that vary state by state.
Tingos’s estate argued that his lack of a relationship with his wife – “the community spouse,” as MassHealth calls her — should not be a wall blocking his healthcare coverage. Several of the justices seemed to agree.
“What the state agency has done is undermine the federal program that Congress had in mind,” said SJC Associate Justice Dalila Argaez Wendlandt. “MassHealth as a state agency is adding an element that is absent in the federal statute.”
Justice Scott Kafker appeared to agree with Wendlandt. “Your community spouse here is not cooperating. In plain language, she’s refusing to turn over the goods,” said Kafker.
In Massachusetts, MassHealth requires applicants to disclose all assets of their community spouse unless the person refuses to cooperate or cannot be found. In Tingos’s case, the question was whether his spouse was actually refusing to cooperate.
MassHealth argues its policy is more inclusive than other state Medicaid programs. “A lot of states actually have narrower exceptions and a lot of them do use refusal to cooperate,” said Assistant Attorney General Cassandra Bolonos, representing the Executive Office of Health and Human Services.
The Delaware version of Medicaid is more specific about requiring that a couple must be separated for a year preceding the need for a nursing home or a similar type of long-term care facility. Connecticut allows the reassignment of support rights if the patient in institutionalized care cannot locate the other spouse, according to Bolonos.
Tingos’s wife, Mary, very clearly did not want to be associated with her husband later in life, but she chose to maintain some ties because of her strong religious background and their shared children. In an affidavit provided to the court, she said the couple did not communicate frequently as they aged.
“It is indisputable in this case that Mrs. Tingos did not cooperate by providing financial information. MassHealth is merely making a public policy statement and preaching a sermon to Mrs. Tingos,” said Jamie Knudsen, an attorney appearing on behalf of Tingos’s estate.
Maya Shavit is a reporter with the Boston University State House Reporting program.