The Medical Neighborhood is an emerging concept that the U.S. Centers for Medicare & Medicaid Services has identified as one of the most promising models of reform in the care of people on Medicare. Just exactly how will this improve chronic care for this vulnerable population?
Recent Sixth Circuit U.S. Court of Appeals case involving a nursing home resident and her community spouse, appealing the district court's grant of summary judgment in favor of the director of the Ohio Department of Job and Family Services which held that the Ohio agency properly penalized institutionalized spouse based on community spouses' purchase of an annuity for himself with funds from his IRA account. The lower court held that 42 U.S.C § 1396r-5(f)(1) precluded the transfer of assets because it exceeded the community spouse resource allowance, (CSRA). However, because the transfer occurred before the agency determined eligibility for Medicaid coverage and 1396p(c)(2)(B)(i) permits an unlimited transfer of assets "to another for the sole benefit of the individual's spouse," the Court of Appeals reversed and remanded.