Where "an institutionalized applicant for Medicaid ... transfers assets for less than fair market value during the 60โmonth โlook-back periodโ before the date of the application, the applicant may be found to be ineligible for benefits for a period of time based upon the amount of the transfer" ( Matter of Wellner v. Jablonka, 160 A.D.3d 1261, 1261โ1262, 74 N.Y.S.3d 666 [3d Dept. 2018], quoting Social Services Law ยง 366[5][e][3] ; see Social Services Law ยง 366[5][e][1][vi] ; [5]). "When such a transfer has occurred, a presumption arises that the transfer was motivated, in part if not in whole, by anticipation of a future need to qualify for medical assistance, and it is the applicant's burden to establish his or her eligibility for Medicaid by rebutting the presumption" ( Matter of Wellner v. Jablonka, 160 A.D.3d at 1262, 74 N.Y.S.3d 666 [internal quotation marks and citation omitted]; see Matter of Krajewski v. Zucker, 145 A.D.3d 1252, 1253, 43 N.Y.S.3d 215 [3d Dept. 2016] ). "[S]uch transfer will not result in such a penalty period where, as relevant here, there is a โsatisfactory showingโ that the individual โintended to dispose of the assets ... at fair market value ... [or] the assets were transferred exclusively for a purpose other than to qualify for medical assistanceโ " ( Matter of Whittier Health Servs., Inc. v. Pospesel, 133 A.D.3d 1176, 1177, 20 N.Y.S.3d 240 [3d Dept. 2015], quoting Social Services Law ยง 366[5][e][4][iii] ; seeMatter of Krajewski v. Zucker, 145 A.D.3d at 1253, 43 N.Y.S.3d 215 ).
"When such a transfer has occurred, a presumption arises that the transfer was motivated, in part if not in whole, by anticipation of a future need to qualify for medical assistance, and it is the applicantโs burden to establish his or her eligibility for Medicaid by rebutting this presumption" (RSRNC, LLC v. Wilson, 220 A.D.3d 1139, 1142, 198 N.Y.S.3d 810 [3d Dept. 2023] [internal quotation marks and citations omitted]; see Matter of Conners v. Berlin, 105 A.D.3d 1208, 1210, 964 N.Y.S.2d 680 [3d Dept. 2013]). However, such transfer will not result in a period of ineligibility where an applicant makes a satisfactory showing "that he or she intended to receive fair consideration for the transfers or that the transfers were made exclusively for purposes other than qualifying for Medicaid" (Matter of Wellner v. Jablonka, 160 A.D.3d 1261, 1262, 74 N.Y.S.3d 666 [3d Dept. 2018], citing Social Services Law ยง 366[5][e][4][i], [ii]; see Matter of Krajewski v. Zucker, 145 A.D.3d 1252, 1253, 43 N.Y.S.3d 215 [3d Dept. 2016]). Here, the record demonstrates that decedentโs daughter and son rendered certain care and covered certain shelter expenses for her before she was admitted into petitionerโs facility.
"When such a transfer has occurred, a presumption arises that the transfer was motivated, in part if not in whole, by anticipation of a future need to qualify for medical assistance, and it is the applicant's burden to establish his or her eligibility for Medicaid by rebutting this presumption" (RSRNC, LLC v Wilson, 220 A.D.3d 1139, 1142 [3d Dept 2023] [internal quotation marks and citations omitted]; see Matter of Conners v Berlin, 105 A.D.3d 1208, 1210 [3d Dept 2013]). However, such transfer will not result in a period of ineligibility where an applicant makes a satisfactory showing "that he or she intended to receive fair consideration for the transfers or that the transfers were made exclusively for purposes other than qualifying for Medicaid" (Matter of Wellner v Jablonka, 160 A.D.3d 1261, 1262 [3d Dept 2018], citing Social Services Law ยง 366 [5] [e] [4] [i], [ii]; see Matter of Krajewski v Zucker, 145 A.D.3d 1252, 1253 [3d Dept 2016]).
Specifically, petitioners argue that Triform satisfies the definition of a supervised community residence, and, as such, is an "appropriate living arrangement" ( 14 NYCRR 635โ10.3 [b][5]). "In reviewing a Medicaid eligibility determination rendered after a hearing, this Court must review the record, as a whole, to determine if the agency's decisions are supported by substantial evidence and are not affected by an error of law" ( Matter ofKrajewski v. Zucker, 145 A.D.3d 1252, 1252โ1253, 43 N.Y.S.3d 215 [2016] [internal quotation marks and citations omitted]; see Matter ofCollins v. Zucker, 144 A.D.3d 1441, 1442, 41 N.Y.S.3d 783 [2016] ; Matter of Whittier Health Servs., Inc. v. Pospesel, 133 A.D.3d 1176, 1177, 20 N.Y.S.3d 240 [2015] ). "If substantial evidence is present in the record, this Court cannot substitute its own judgment for that of the respondent[s], even if a contrary result is viable" ( Matter of Shanahan v. Justice Ctr. for the Protection of People with Special Needs, 198 A.D.3d 1157, 1158, 157 N.Y.S.3d 121 [2021] [internal quotation marks and citations omitted]).
When an institutionalized applicant for Medicaidโor the applicant's spouseโtransfers assets for less than fair market value during the 60โmonth "look-back period" before the date of the application, the applicant may be found to be ineligible for benefits for a period of time based upon the amount of the transfer ( Social Services Law ยง 366[5][e][3] ; seeMatter of Whittier Health Servs., Inc. v. Pospesel, 133 A.D.3d 1176, 1177, 20 N.Y.S.3d 240 [2015] ). When such a transfer has occurred, a presumption arises that the transfer "was motivated, in part if not in whole, by anticipation of a future need to qualify for medical assistance," and it is the applicant's burden to establish his or her eligibility for Medicaid by rebutting the presumption ( Matter of Mallery v. Shah, 93 A.D.3d 936, 937, 939 N.Y.S.2d 626 [2012] [internal quotation marks, ellipsis and citations omitted]; accord Matter of Krajewski v. Zucker, 145 A.D.3d 1252, 1253, 43 N.Y.S.3d 215 [2016] ). As pertinent here, an applicant may do so by demonstrating that he or she intended to receive fair consideration for the transfers or that the transfers were made exclusively for purposes other than qualifying for Medicaid (see Social Services Law ยง 366[5][e][4][i], [ii] ).
.38 [g][3] ); a prima facie showing does not require that the "evidence draw a causal link between the injury and the claimant's employment" (Matter of Garti v. Salvation Army, 80 A.D.3d 1101, 1102, 914 N.Y.S.2d 799 [2011] ). By comparison, in order to establish her claim for benefits, claimant bore the burden of demonstrating, "by competent medical evidence, that a causal connection existed between her injur[ies] and her employment" ( Matter of Hansen v. Saks Fifth Ave., 145 A.D.3d 1257, 1257, 42 N.Y.S.3d 678 [2016] [internal quotation marks, brackets and citation omitted]; see Matter of Tucker v. City of Plattsburgh Fire Dept., 153 A.D.3d 984, 985, 59 N.Y.S.3d 609 [2017], lv denied 30 N.Y.3d 906, 2017 WL 5616040 [2017] ). "Where ... medical proof is offered to demonstrate that causal relationship, such proof must signify a probability as to the underlying cause of the claimant's injury which is supported by a rational basis" ( Matter of Hansen v. Saks Fifth Ave., 145 A.D.3d at 1257, 43 N.Y.S.3d 215 [internal quotation marks and citations omitted]; see Matter of Granville v. Town of Hamburg, 136 A.D.3d 1254, 1255, 25 N.Y.S.3d 746 [2016] ). Claimant's medical evidence consisted solely of an August 2015 report from a physician indicating that she had a spinal injury and underwent surgery in November 2014, and recorded her subjective complaints and physical findings, while noting that her prognosis was "poor."
Specifically, petitioners argue that Triform satisfies the definition of a supervised community residence, and, as such, is an "appropriate living arrangement" (14 NYCRR 635-10.3 [b] [5]). "In reviewing a Medicaid eligibility determination rendered after a hearing, this Court must review the record, as a whole, to determine if the agency's decisions are supported by substantial evidence and are not affected by an error of law" (Matter of Krajewski v Zucker, 145 A.D.3d 1252, 1252-1253 [2016] [internal quotation marks and citations omitted]; see Matter of Collins v Zucker, 144 A.D.3d 1441, 1442 [2016]; Matter of Whittier Health Servs., Inc. v Pospesel, 133 A.D.3d 1176, 1177 [2015]). "If substantial evidence is present in the record, this Court cannot substitute its own judgment for that of the respondent[s], even if a contrary result is viable" (Matter of Shanahan v Justice Ctr. for the Protection of People with Special Needs, 198 A.D.3d 1157, 1158 [2021] [internal quotation marks and citations omitted]).