A New York appellate court recently upheld a decision regarding Medicaid eligibility that affects nursing home care for Hildegarde Cvetkovic. The court ruled on October 9, 2026, that Cvetkovic's application for an undue hardship waiver was not properly submitted, which means she will not receive full Medicaid coverage for her nursing home care. This ruling is significant as it clarifies the requirements for Medicaid applicants seeking waivers for transfer penalties.
The case, officially titled Matter of Cvetkovic v. New York State Dept. of Health, was filed under docket number 665 TP 26-00285. It involved Cvetkovic, who sought a waiver after the Oneida County Department of Social Services (DSS) imposed a transfer penalty on her Medicaid application. The court's decision has important implications for individuals navigating the Medicaid system, particularly those in need of nursing home services.
Cvetkovic, along with the Oneida Center for Rehabilitation and Nursing, initiated the legal proceedings against the New York State Department of Health after DSS determined that her waiver request was not valid. The dispute arose from a finding that Cvetkovic had made an uncompensated transfer of assets during the look-back period, which affected her eligibility for Medicaid benefits. The case was transferred to the Appellate Division of the Supreme Court in the Fourth Judicial Department after a fair hearing was held.
The court's ruling confirmed the DSS's decision that the effective date for Cvetkovic's undue hardship waiver would be October 1, 2022, which was three months prior to her application for the waiver. The court stated, "the undue hardship waiver period could extend no more than three months prior to the month in which the application for an undue hardship waiver was made." This means that Cvetkovic's coverage would not retroactively apply to the beginning of her nursing home stay, which is a crucial point for those seeking financial assistance for long-term care.
Judges Montour, Ogden, Greenwood, Nowak, and Skinner were involved in the decision, which emphasized the importance of following the proper procedures when applying for Medicaid benefits. The court found that Cvetkovic's son, who acted as her power of attorney, did not request the undue hardship waiver at the time of the initial application. Instead, he indicated that there were no transfers that would affect her eligibility.
The court ruled that DSS was not required to evaluate undue hardship unless a request was made by the applicant. This ruling reinforces the idea that applicants must take the initiative in their Medicaid applications, particularly when it comes to waivers related to transfer penalties. The court highlighted that the governing statute and rules require applicants to demonstrate their eligibility for such waivers.
Furthermore, the court addressed claims that Cvetkovic's due process rights were violated when DSS determined her eligibility for Medicaid without providing a notice of her right to present evidence against the presumption that the transfer was made to qualify for Medicaid. The court concluded that any failure to provide this notice did not warrant annulment of the DSS decision, as Cvetkovic was informed of her rights and did not present any evidence to rebut the presumption.
The ruling sets a precedent for future Medicaid cases, particularly those involving transfer penalties and undue hardship waivers. It clarifies that applicants must be proactive in their requests and that agencies are not obligated to consider waivers unless explicitly requested. This decision could impact many individuals in similar situations, as it emphasizes the importance of adhering to the application process.
Going forward, this ruling may influence how Medicaid applicants approach their applications, especially regarding the timing and submission of undue hardship waiver requests. It serves as a reminder that understanding the rules and requirements of Medicaid is crucial for those seeking assistance with nursing home care.
As for what’s next, it is unclear if Cvetkovic will appeal the decision. The court's ruling is final unless further legal action is taken. There may also be related cases pending that could further clarify Medicaid eligibility and waiver processes in New York.