Appeal from the Order of the Department of Public Welfare, in case of Appeal of: John Lozada, Case No. 15 0094 266, dated November 18, 1985.
Richard A. Breuer, for petitioner.
John Kane, Chief Counsel, with him, Jean E. Graybill, Assistant Counsel, for respondent.
Judges Colins and Palladino, and Senior Judge Kalish, sitting as a panel of three. Opinion by Judge Colins.
[ 105 Pa. Commw. Page 68]
Hamilton Bank, in its capacity as guardian of John J. Lozada, an incompetent (petitioner), appeals from a final order of the Department of Public Welfare (Department) terminating petitioner's medical assistance benefits for nursing home care on the grounds that petitioner had "funds in excess of eligibility limits." Public Assistance Eligibility Manual, § 177.83, Income Maintenance Bulletin No. 177-84-44. The Department in this case affirmed the hearing officer's denial of benefits. We affirm the Department.
[ 105 Pa. Commw. Page 69]
As the result of a motorcycle accident, petitioner cannot speak or communicate in any way, and, thus, has been adjudicated incompetent and is a resident of a nursing home. Litigation was instituted on petitioner's behalf which resulted in settlements, of which the net proceeds in favor of petitioner were approximately Two Hundred Fifteen Thousand Dollars ($215,000.00). One of the three parties partly responsible for petitioner's accident, which settled with petitioner, was the Commonwealth of Pennsylvania, Department of Transportation. The proceeds of these settlements were disbursed to petitioner's mother, as guardian.
Petitioner's mother and guardian died on June 10, 1984. At that time an accounting was done which established that only One Hundred Twelve Thousand Dollars ($112,000.00) remained in the guardian's account and it appeared that of the approximately One Hundred Three Thousand Dollars ($103,000.00) which had been expended, petitioner's mother had spent only Five Hundred Dollars ($500.00) for the benefit of her son, the incompetent petitioner. Subsequently, Hamilton Bank of Lancaster, Pennsylvania, was appointed as guardian of petitioner in September, 1984, pursuant to court intervention.
Prior to the action that generated this appeal, petitioner had received medical assistance benefits in the Medically-Needy, Disabled category through the Chester County Assistance Office (CAO), which had been unaware of petitioner's assets. In May, 1985, the nursing home in which petitioner resides informed the CAO that petitioner had substantial assets. Upon receiving this information, the CAO confirmed with Hamilton Bank that petitioner had assets in excess of One Hundred Thousand Dollars ($100,000.00). Accordingly, the CAO informed petitioner by advance notice that he was ineligible for further assistance because of excess
[ 105 Pa. Commw. Page 70]
resources. The CAO did not propose to seek repayment of the medical assistance petitioner had already received; it merely informed him that he was ineligible for any future assistance.
Petitioner appealed, and a hearing was held at which it was established that the net proceeds of all settlements in favor of petitioner were approximately Two Hundred Fifteen Thousand Dollars ($215,000.00) and that approximately ...