Lopes v. Department of Social Services , 696 F.3d 180 ( 2012 )


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  •      No. 10-3741-cv
    Lopes v. Department of Social Services
    1
    2                                        UNITED STATES COURT OF APPEALS
    3                                            FOR THE SECOND CIRCUIT
    4
    5
    6                                                          August Term, 2011
    7
    8           Argued: September 22, 2011                                  Final Submission: December 30, 2011
    9
    10                                                   Decided: October 2, 2012
    11
    12
    13
    14                                                        Docket No. 10-3741-cv
    15
    16
    17           - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -X
    18
    19           JOHN F. LOPES, ATTORNEY-IN-FACT, AMELIA F. LOPES,
    20
    21                               Plaintiff-Appellee,
    22
    23           v.
    24
    25           DEPARTMENT OF SOCIAL SERVICES,
    26           MICHAEL P. STARKOWSKI, COMMISSIONER OF CONNECTICUT
    27           DEPARTMENT OF SOCIAL SERVICES,
    28
    29                               Defendant-Appellant.
    30
    31           ---------------------------------------X
    32
    33   Before: LEVAL, HALL and LOHIER, Circuit Judges.
    34
    35           Plaintiff-appellee John Lopes, through his wife and attorney-in-fact Amelia Lopes, filed
    36   an application for Medicaid benefits with the Connecticut Department of Social Services to
    37   cover the cost of his nursing home care. The Commissioner denied the application after
    38   determining that a payment stream Amelia Lopes was receiving from a single premium annuity
    39   was a “resource” that rendered John Lopes ineligible for Medicaid benefits. Amelia Lopes
    40   challenged this determination in the United States District Court for the District of Connecticut
    41   (Hall, J.), arguing that the payment stream was “income” that did not count against her
    42   husband’s eligibility because the annuity contract prohibited her from assigning her right to
    43   payment. The District Court granted summary judgment to Lopes. Because we conclude that
    44   the applicable regulations and the United States Department of Health and Human Services’
    1    interpretation of those regulations support Lopes’s position, we AFFIRM the judgment of the
    2    District Court.
    3
    4                                          RENE H. REIXACH, Woods Oviatt Gilman, LLC,
    5                                          Rochester, NY, for Plaintiff-Appellee.
    6
    7                                          HUGH BARBER, Assistant Attorney General (Tanya
    8                                          Feliciano DeMattia, Assistant Attorney General, on the
    9                                          brief), for GEORGE JEPSEN, Attorney General of the
    10                                          State of Connecticut, Hartford, CT, for Defendants-
    11                                          Appellants.
    12
    13
    14   LOHIER, Circuit Judge:
    15
    16           This appeal raises the issue of whether a non-assignable annuity contract that provides
    17    the spouse of an institutionalized person with monthly payments counts as an excess resource
    18    that must be spent down before the institutionalized person can receive Medicaid benefits under
    19    the Medicare Catastrophic Coverage Act of 1988 (“MCCA”). Before the United States District
    20    Court for the District of Connecticut (Hall, J.), Amelia Lopes (“Lopes”), attorney-in-fact for her
    21    husband, John Lopes, challenged the defendants’ determination that he is ineligible for Medicaid
    22    benefits because Lopes is the payee of a six-year annuity contract that provides her with fixed
    23    monthly payments of $2,340.83. Lopes contended that, because the annuity contract contains an
    24    anti-assignment provision that prohibits her from assigning her rights thereunder, the annuity
    25    payments are “income” that need not be spent down in order for her husband to receive benefits.
    26    The Commissioner of the Connecticut Department of Social Services treated the annuity as a
    27    “resource” on the ground that Lopes could potentially sell the payment stream from the annuity
    28    to a third party notwithstanding the anti-assignment provision. The District Court concluded that
    29    the Commissioner’s determination rested on more restrictive eligibility criteria than those used
    30    by the federal Supplemental Security Income Program, in violation of 42 U.S.C.
    31    § 1396a(a)(10)(C)(i), a provision of the MCCA. Accordingly, the court granted Lopes’s motion
    32    for summary judgment. We AFFIRM the judgment of the District Court.
    33
    Page 2 of 13
    1
    2                                            BACKGROUND
    3
    4          A. Statutory Framework
    5          The MCCA requires States to consider the resources of both the institutionalized spouse
    6   and the “community spouse” in determining the former’s eligibility for Medicaid benefits. 42
    7   U.S.C. § 1396r-5(c)(2)(A). The MCCA also requires States to exclude certain community
    8   spouse funds and assets from the calculation of total resources. First, it provides that “[d]uring
    9   any month in which an institutionalized spouse is in the institution . . . no income of the
    10   community spouse shall be deemed available to the institutionalized spouse.” 
    42 U.S.C. § 11
       1396r-5(b)(1). Second, it excludes specified assets, such as the couple’s home and one
    12   automobile, from counting against the eligibility of the institutionalized spouse. 
    42 U.S.C. § 13
       1382b(a). If, after these exclusions, the community spouse’s resources still exceed a pre-
    14   determined “community spouse resource allowance,” the institutionalized spouse is ineligible for
    15   Medicaid benefits until the excess resources are depleted. 42 U.S.C. §§ 1396r-5(c)(2)(B), 1396r-
    16   5(f)(2)(A). In determining eligibility for benefits under the MCCA, the States must use criteria
    17   that are “no more restrictive than the methodology which would be employed under the
    18   supplemental social security [‘SSI’] program.” 42 U.S.C. § 1396a(a)(10)(C)(i).
    19          When Lopes filed her husband’s application for Medicaid benefits, the applicable
    20   “community spouse resource allowance” was approximately $180,000.
    21          B. Factual Background
    22          Shortly before Lopes filed her husband’s application for benefits, her liquid assets
    23   exceeded the community spouse resource allowance by about $160,000. Seeking to reduce her
    24   resources to below the protected amount, Lopes purchased an immediate single premium annuity
    25   with a premium of $166,878.99 from The Hartford Life Insurance Company (“The Hartford”).
    26   The annuity contract, which was governed by Connecticut law, provided for monthly payments
    27   of $2,340.83 over a period of approximately six years. At Lopes’s election, the annuity contract
    28   contained an “Assignment Limitation Rider,” which provided:
    Page 3 of 13
    1                  This contract is not transferable. The rights, title and interest in the
    2                  contract may not be transferred; nor may such rights, title and
    3                  interest be assigned, sold, anticipated, alienated, commuted,
    4                  surrendered, cashed in or pledged as security for a loan. Any
    5                  attempt to transfer, assign, sell, anticipate, alienate, commute,
    6                  surrender, cash in or pledge this contract shall be void of any legal
    7                  effect and shall be unenforceable against [The Hartford].
    8
    9   Lopes requested a letter from The Hartford clarifying the import of the Assignment Limitation
    10   Rider. The Hartford confirmed that “neither the Annuity Contract, nor any periodic payments
    11   due thereunder can be cashed-in, sold, assigned, or otherwise transferred, pledged, or
    12   hypothecated [due to the Assignment Limitation Rider].”
    13          Lopes submitted the application for Medicaid benefits thirteen days after purchasing the
    14   annuity. Because the Department of Social Services’s Uniform Policy Manual (“UPM”) §
    15   4030.47 provides that, for purposes of determining benefit eligibility, “the right to receive
    16   income from an annuity is regarded as an available asset, whether or not the annuity is
    17   assignable,” the Commissioner sought to determine whether Lopes could sell her annuity income
    18   stream to a third party notwithstanding the Rider. Although a third party, Peachtree Financial,
    19   appears to have been willing to purchase the payment stream for approximately $99,000, Lopes
    20   maintained that the annuity was a “fixed income stream[,] . . . not an asset that she [was]
    21   required to” liquidate. In May 2010 the Commissioner told Lopes that her husband was
    22   ineligible for Medicaid benefits because she had “failed to apply for or try to get assets which
    23   may be available to [her] family.”
    24          C. Procedural History
    25          Lopes filed suit, claiming that the Commissioner’s application of UPM § 4030.47 was
    26   more restrictive than an SSI regulation providing that “[i]f the individual has the right, authority
    27   or power to liquidate the property . . . it is considered a resource,” 
    20 C.F.R. § 416.1201
    (a)(1).
    28   Lopes also relied on the SSI Program Operations Manual System (“POMS”), which clarifies that
    29   an asset is a resource only if the applicant has the “legal right, authority, or power” to liquidate
    30   it. POMS § SI 01110.115 (effective Jan. 15, 2008) (emphasis added). In response, the
    Page 4 of 13
    1   Commissioner initially argued that the Deficit Reduction Act of 2005, Pub. L. No. 109-171, 120
    
    2 Stat. 4
    , 62-64 (“DRA”), supported its denial of Lopes’s application, an argument that it abandons
    3   on appeal.
    4          The parties cross-moved for summary judgment. The District Court granted Lopes’s
    5   motion, concluding that, because Lopes would breach her contractual obligations under the anti-
    6   assignment clause if she attempted to assign her right to the payment stream, she did not have the
    7   “right, authority or power” to liquidate her interest in the annuity, as required by
    8   § 416.1201(a)(1) and the corresponding POMS provision.
    9          The Commissioner appealed, arguing, among other things, that (1) the POMS
    10   requirement of a “legal right, authority or power” to liquidate the asset is unreasonable in light of
    11   the language of § 416.1201(a)(1), which requires only the “right, authority or power” to
    12   liquidate; (2) other SSI provisions indicate that a non-assignable annuity payment stream is a
    13   countable resource; and (3) treating Lopes’s annuity as a resource would conflict with
    14   Medicaid’s policy goals of providing for those with limited means, because it would permit
    15   financially secure applicants to circumvent the Medicaid eligibility requirements by sheltering
    16   their assets in non-assignable annuities.
    17          Following oral argument, to aid our analysis, we solicited the views of the United States
    18   Department of Health and Human Services (“HHS”) regarding “(1) whether the applicable
    19   statutes and regulations . . . require an income stream from an irrevocable annuity to be
    20   considered as ‘income’ or as a ‘resource,’ and (2) the policy implications of resolving this case
    21   in favor of the plaintiff or the State.” In response, HHS, as amicus curiae, urges us to adopt
    22   Lopes’s, and the District Court’s, interpretation of the relevant SSI regulations for two main
    23   reasons: (1) the “natural reading of . . . [§] 416.1201, as clarified in POMS § SI 01110.115, is
    24   that [the Social Security Administration] will not require an applicant to renegotiate or, possibly,
    25   breach a contract in order to recover the value of a resource, such as a non-assignable annuity, in
    26   order to qualify for Medicaid”; and (2) Lopes’s retention of the annuity payment stream is not
    Page 5 of 13
    1   inconsistent with the Medicaid statute’s primary purposes, which are to provide health care for
    2   the indigent and protect community spouses from impoverishment while preventing financially
    3   secure couples from obtaining Medicaid assistance.
    4                                                DISCUSSION
    5           We review the grant of summary judgment de novo and “will uphold the judgment if the
    6   evidence, viewed in the light most favorable to the party against whom it is entered,
    7   demonstrates that there are no genuine issues of material fact and that the judgment is warranted
    8   as a matter of law.” McGullam v. Cedar Graphics, Inc., 
    609 F.3d 70
    , 75 (2d Cir. 2010)
    9   (quotation marks omitted). Because the material facts are not in dispute here, we consider only
    10   whether the annuity is non-assignable and, if so, whether it is income or a resource.1 The
    11   language of the relevant regulations, as clarified in the POMS and in HHS’s amicus brief,
    12   convinces us that the income stream from Lopes’s annuity is properly considered income, not a
    13   resource, because the annuity is non-assignable.
    14           A. SSI Regulations
    15           As noted above, the SSI regulation that differentiates between income and resources
    16   provides that a community spouse’s asset is a resource “[i]f the individual has the right, authority
    17   or power to liquidate the property, or his or her share of the property.” 
    20 C.F.R. § 18
       416.1201(a)(1). The Assignment Limitation Rider strips Lopes of both the right to assign her
    19   payments under the annuity, by providing that “[t]he rights, title and interest in the contract may
    20   not be transferred,” and the power to assign her payments, by providing that “[a]ny attempt to
    21   transfer, assign . . . [or] cash in . . . this contract shall be void of any legal effect . . . .”2 Under
    1
    The Commissioner initially argued that Lopes’s application was properly denied
    because she had failed to cooperate in pursuing potentially available assets. He conceded at oral
    argument that cooperation is relevant only if we resolve in his favor the “threshold question” of
    whether the income stream is a resource. Tr. of Oral Arg. at 34.
    2
    Although the regulation also references the “authority” to liquidate an asset, 
    20 C.F.R. § 416.1201
    (a)(1), the Commissioner does not argue that Lopes has the “authority” to assign the
    payments, as distinct from having the “right” or “power” to do so.
    Page 6 of 13
    1   Connecticut law, this language suffices to make the annuity non-assignable. See Rumbin v.
    2   Utica Mut. Ins. Co., 
    757 A.2d 526
    , 535 (Conn. 2000) (holding that a general provision
    3   prohibiting assignment eliminates a payee’s “right to assign, but not his power to do so,” and that
    4   the latter may be eliminated only through “express language to limit the power to assign or to
    5   void the assignment itself”).
    6          The Commissioner nonetheless submits that the owner of a non-assignable annuity has
    7   the effective “right, authority or power” to liquidate the asset, as long as there is a prospective
    8   purchaser for the payment stream. We cannot agree. We recognize that the SSI regulations do
    9   not specifically address the status of a “non-assignable” annuity like the one Lopes purchased.
    10   But one SSI regulation, 
    20 C.F.R. § 416.1121
    , supports the classification of the payment stream
    11   from such an annuity as income:
    12
    13                  Some types of unearned income are . . . [a]nnuities, pensions, and
    14                  other periodic payments. This unearned income is usually related
    15                  to prior work or service. It includes, for example, private
    16                  pensions, social security benefits, disability benefits, veterans
    17                  benefits, worker’s compensation, railroad retirement annuities and
    18                  unemployment insurance benefits.
    19   
    20 C.F.R. § 416.1121
    . Section 416.1121 makes clear that payments from an annuity can
    20   constitute “unearned income.” The provision also generally classifies various non-assignable
    21   income streams (social security benefits, disability benefits, and so on) as income, without regard
    22   to the existence of a prospective purchaser. These income sources are analogous to Lopes’s
    23   annuity in both their payment structure and their non-assignability.
    24          The Commissioner points to additional SSI regulations that appear to say that if an
    25   individual liquidates a resource before applying for benefits, the receipts from the liquidation are
    26   still a resource. For example, the Commissioner cites 
    20 C.F.R. § 416.1207
    (e), which provides:
    27   “If an individual sells, exchanges or replaces a resource, the receipts are not income. They are
    28   still considered to be a resource.” 
    20 C.F.R. § 416.1207
    (e); see also 
    20 C.F.R. § 416.1103
    (a)
    29   (providing that “what you receive from the sale or exchange of your own property is not income;
    30   it remains a resource”); 
    20 C.F.R. § 416.1103
    (c) (providing that “[r]eceipts from the sale,
    Page 7 of 13
    1   exchange, or replacement of a resource are not income but are resources that have changed their
    2   form,” and using as an example: “[i]f you sell your automobile, the money you receive is not
    3   income; it is another form of a resource”). In particular, the Commissioner contends that
    4   Lopes’s annuity qualifies as a resource under these regulations because Lopes converted her
    5   excess resources into a non-assignable annuity shortly before she sought benefits.
    6          We reject the argument for the following reasons. Unlike §§ 416.1201(a)(1) and
    7   416.1121, which apply more specifically to the issue in this case and guide more explicitly our
    8   consideration of whether Lopes’s annuity is a resource, the regulations upon which the
    9   Commissioner relies do not address whether the “converted” form of Lopes’s assets – the non-
    10   assignable annuity – qualifies as a resource. See United States v. Torres-Echavarria, 
    129 F.3d 11
       692, 699 n.3 (2d Cir. 1997) (“The operative principle of statutory construction is that a specific
    12   provision takes precedence over a more general provision.”). Instead, they establish only that if
    13   Lopes had converted a resource to cash, those cash proceeds would also be a resource. Nor do
    14   these regulations establish that Lopes’s annuity is a resource merely because it existed in the
    15   form of cash shortly before she applied for Medicaid. The Medicaid program categorically
    16   excludes certain assets, such as a home and one automobile, from consideration as resources. 42
    17   U.S.C. §§ 1396r-5(c)(5) & 1382b(a). How recently those assets were purchased appears not to
    18   matter in determining whether they should be excluded from the relevant pool of resources.3
    19   Accordingly, that Lopes converted cash to an annuity shortly before applying for Medicaid is
    20   irrelevant to whether the annuity, in its current form, qualifies as a resource under the applicable
    21   SSI regulations.
    22
    3
    The regulations account for the possibility that, even while receiving benefits, an
    individual may trade resources that count against Medicaid eligibility for resources that do not,
    affecting her benefits eligibility status for the following month: “If, during a month . . . an
    individual spends a resource or replaces a resource that is not excluded with one that is excluded,
    the decrease in the value of the resources is counted as of the first moment of the next month.”
    
    20 C.F.R. § 416.1207
    (c).
    Page 8 of 13
    1          B. POMS Sub-Regulation
    2          The POMS is a set of guidelines through which the Social Security Administration
    3    “further construe[s]” the statutes governing its operations. Clark v. Astrue, 
    602 F.3d 140
    , 144
    4    (2d Cir. 2010). We have held that POMS guidelines are entitled to “substantial deference, and
    5   will not be disturbed as long as they are reasonable and consistent with the statute.” Bubnis v.
    6   Apfel, 
    150 F.3d 177
    , 181 (2d Cir. 1998). But we have declined to defer to the POMS where “the
    7   plain language of the statute and its implementing regulation do not permit the construction
    8   contained within the manuals.” Oteze Fowlkes v. Adamec, 
    432 F.3d 90
    , 96 (2d Cir. 2005).
    9          As relevant here, the POMS provides that “[a]ssets of any kind are not resources if the
    10   individual does not have . . . the legal right, authority or power to liquidate them (provided they
    11   are not already in cash) . . . .” POMS § SI 01110.15 (emphasis added). This provision strongly
    12   supports the District Court’s conclusion that the payment stream from Lopes’s non-assignable
    13   annuity is income. As discussed above, notwithstanding the existence of a prospective purchaser
    14   for the payment stream, the Assignment Limitation Rider divests Lopes of the legal right and the
    15   power to direct that the payor pay the annuity benefit directly to a third party. See Rumbin, 757
    16   A.2d at 531, 535.
    17          The Commissioner asserts that the POMS guideline is not entitled to deference because §
    18   416.1201(a)(1), which limits resources to those assets that the applicant has the “right, authority
    19   or power” to liquidate, does not require that the applicant also be able to liquidate without
    20   incurring legal liability. We are not persuaded. It is reasonable to specify that liquidation must
    21   not only be physically possible, but also otherwise permitted by law, in order to qualify the asset
    22   as a resource under the MCCA. Without such a clarification, a Medicaid applicant could be
    23   required to liquidate such assets as her right to pension payments or property of which she was
    24   the trustee. Accordingly, we cannot conclude that the POMS guideline is foreclosed by “the
    25   plain language of the . . . implementing regulation.” Fowlkes, 432 F.3d at 96.
    26
    Page 9 of 13
    1          The Commissioner also argues that even if we were to defer to the POMS interpretation,
    2   the payment stream from the annuity contract qualifies as a resource because Lopes could sell it
    3   without assigning her rights by simply signing a separate contract promising to pass each
    4   payment along to a third party. Tr. of Oral Arg. at 11-13. Assuming for the moment that Lopes
    5   could do this without breaching the annuity contract, this argument proves too much. A
    6   Medicaid applicant could make a similar agreement regarding any source of income: pension
    7   checks, railroad retirement annuities, or even the applicant’s weekly income from a current job.
    8   Construing these payment streams as resources merely because the applicant could pass them on
    9   to a third party in the way the Commissioner describes conflicts with § 416.1121, which
    10   establishes that certain payment streams are considered “unearned income” and may not be
    11   counted as resources. In rejecting the Commissioner’s argument, we agree with the Third
    12   Circuit that “[u]nder [a theory permitting an annuitant to sell the income stream], there is no
    13   clear limit on the hypothetical transaction proceeds that could be treated as assets, whether based
    14   on the sale of a future stream of payments tied to a fixed income retirement account, social
    15   security, or even a regular paycheck.” James v. Richman, 
    547 F.3d 214
    , 219 (3d Cir. 2008).
    16          We conclude that POMS § SI 01110.15, which is reasonable and consistent with §
    17   416.1201(a)(1) and therefore entitled to deference, supports Lopes’s argument that the payment
    18   stream is income.
    19          C. HHS’s Views
    20          In addition to the regulations and POMS guidelines, we also have the benefit of HHS’s
    21   views in this case, which simply confirm our conclusions. The interpretive guidance of an
    22   administrative agency such as HHS “constitute[s] a body of experience and informed judgment
    23   to which courts and litigants may properly resort for guidance.” Skidmore v. Swift & Co., 323
    
    24 U.S. 134
    , 140 (1944). Even where an agency has expressed its view through a medium other
    25   than “the fruits of notice-and-comment rulemaking or formal adjudication,” United States v.
    26   Mead Corp., 
    533 U.S. 218
    , 230 (2001), the “agency’s interpretation may merit some deference
    Page 10 of 13
    1   whatever its form, given the ‘specialized experience and broader investigations and information’
    2   available to the agency, and given the value of uniformity in its administrative and judicial
    3   understandings of what a national law requires.” 
    Id. at 234
     (citation omitted) (quoting Skidmore,
    4   323 U.S. at 139); see also Christensen v. Harris Cnty., 
    529 U.S. 576
    , 587 (2000) (opinion letters
    5   from agencies entitled to Skidmore deference).
    6          For that reason, “a reasonable agency determination, when advanced in an amicus brief
    7   that is not a post hoc rationalization, may be entitled to some deference on account of the
    8   specialized experience and information available to the agency.” Conn. Office of Prot. &
    9   Advocacy for Persons with Disabilities v. Hartford Bd. of Educ., 
    464 F.3d 229
    , 239 (2d Cir.
    10   2006) (quotation marks, alteration and citation omitted); see also Serricchio v. Wachovia Sec.
    11   LLC, 
    658 F.3d 169
    , 178 (2d Cir. 2011) (considering agency’s views, expressed in an amicus
    12   brief solicited by the Court, “for persuasive value.” (citing Skidmore, 323 U.S. at 140, and N.Y.
    13   S. Rest. Ass’n v. N.Y.C. Bd. of Health, 
    556 F.3d 114
    , 130 (2d Cir. 2009))).4 Of course,
    14   regardless of the agency’s interpretation, “[t]he plain meaning of language in a regulation
    15   governs unless that meaning would lead to absurd results.” Forest Watch v. U.S. Forest Serv.,
    16   
    410 F.3d 115
    , 117 (2d Cir. 2005).
    17          In its amicus brief, HHS makes two persuasive arguments that support the District
    18   Court’s and Lopes’s interpretation of the SSI regulations. First, it interprets § 416.1121, §
    19   416.1201(a)(1), and POMS § SI 01110.15 as classifying income from non-assignable annuities
    20   as just that – income. Second, it explains that this interpretation coheres with the policy goals of
    21   Medicaid – in particular, protecting community spouses from impoverishment by
    22   permitting them to retain some of their assets, while recognizing that couples must apply a fair
    23   share of their combined resources toward the cost of care before receiving benefits.
    24
    4
    At oral argument, the Commissioner acknowledged that “the secretary [of HHS]’s
    guidance is essentially controlling.” Tr. of Oral Arg. at 15.
    Page 11 of 13
    1          HHS further notes that its interpretation of the income/resource distinction is consistent
    2   with the treatment of annuities in the DRA. The DRA provides that, so long as annuities are
    3   disclosed in Medicaid applications and name the State as the remainder beneficiary, the
    4   placement of assets in an annuity will not be considered a suspect “transfer of assets” exposing
    5   an applicant to certain penalties.5 42 U.S.C. §§ 1396a(a)(18), 1396p(c)(1)(A), 1396p(e)(1). It
    6   further provides that these disclosure requirements apply “regardless of whether the annuity is
    7   irrevocable or is treated as an asset.” 42 U.S.C. § 1396p(e)(1). That the DRA has disclosure
    8   requirements for irrevocable annuities, but does not categorically classify them as resources or
    9   designate their purchase as an impermissible transfer of assets, supports HHS’s view that
    10   Congress has not demonstrated an intent to exclude all annuity payment streams from being
    11   treated as income. See James, 
    547 F.3d at 219
     (“Congress provided a detailed set of rules
    12   governing transactions that it considered suspicious, and the purchase of an annuity is not among
    13   them.”).
    14          HHS’s position as articulated in its amicus brief accords with our reading of the relevant
    15   regulations and POMS guideline and is consistent with both Medicaid’s policy goals and the
    16   DRA. We attach some persuasive value to HHS’s views, which in any event only bolster our
    17   conclusion that Lopes’s annuity payment stream qualifies as income.
    18          We therefore hold that the payment stream from a non-assignable annuity is not a
    19   resource for purposes of determining Medicaid eligibility. In doing so, we now join those of our
    20   sister circuits that have addressed the same issue. See 
    id. at 218
     (holding that even if the
    21   community spouse “has the de facto ability to effect a change in ownership,” a non-assignable
    22   annuity “cannot be treated as an available resource”); Morris v. Okla. Dep’t of Human Servs.,
    23   
    685 F.3d 925
    , 932-34 (10th Cir. 2012) (concluding that entitlement to receive non-assignable
    5
    Under the DRA, if a couple disposes of any assets for less than fair market value during
    a specified “look-back” period, the institutionalized spouse becomes ineligible for Medicaid
    benefits for the length of time that those assets could have covered his or her medical costs. See
    42 U.S.C. § 1396p(c)(1)(A).
    Page 12 of 13
    1   annuity payments is income, and not a resource); see also Hutcherson v. Ariz. Health Care Cost
    2   Containment Sys. Admin., 
    667 F.3d 1066
    , 1069 (9th Cir. 2012) (noting that “the Medicaid
    3   statute allows the community spouse to purchase an annuity . . . allowing the spouse to convert
    4   his or her assets, which are considered in determining the institutionalized spouse’s eligibility, to
    5   income, which is not considered” (citation omitted)).
    6                                            CONCLUSION
    7          For the foregoing reasons, the judgment of the District Court is AFFIRMED.
    8
    Page 13 of 13