## Facts

- Robert Poindexter, Mirl Whitaker, Maurice Hardy, Virginia McCulley, and Roger Meredith were “community spouses,” meaning each lived in the community while his or her spouse was institutionalized in a nursing home.
- Each institutionalized spouse qualified for and received Medicaid benefits that paid for nursing-home care.
- After Medicaid began paying for that care, Illinois sought to recover the nursing-home costs from the community spouses by using Illinois spousal-support laws, asserting that financially able spouses can be required to support an institutionalized spouse.
- The community spouses filed suit against Illinois seeking declaratory and injunctive relief, arguing that the federal Medicare Catastrophic Coverage Act of 1988 (MCCA), including 42 U.S.C. § 1396r-5 (the Medicaid spousal-impoverishment provisions), displaced Illinois’s use of state support law to obtain reimbursement from community spouses.
- Illinois responded that the MCCA’s spousal-impoverishment provisions regulate how income and resources are treated when determining Medicaid eligibility and post-eligibility allocation, but do not restrict a state from enforcing separate, generally applicable spousal-support obligations after benefits have been paid.
- The trial court agreed with the community spouses and ruled that federal law preempted Illinois’s recovery efforts, but the appellate court reversed; the community spouses appealed to the Illinois Supreme Court.

## Issues

1. Whether the MCCA’s Medicaid spousal-impoverishment provisions (42 U.S.C. § 1396r-5) preempt Illinois from using state spousal-support laws to seek reimbursement from community spouses for Medicaid-funded nursing-home care provided to institutionalized spouses.

## Decision

- The Illinois Supreme Court affirmed the appellate court.
- The court held that the MCCA does not preempt Illinois spousal-support laws used to pursue reimbursement from financially able community spouses after Medicaid has paid nursing-home costs.
- As a result, Illinois was not barred by federal law from proceeding with state-law efforts to obtain support or reimbursement from the community spouses.

## Legal Principles

- Federal preemption requires a showing of congressional intent to displace state law through express language, occupation of the field, or a direct conflict that makes compliance with both laws impossible or frustrates the federal statute’s operation.
- Domestic relations and family support obligations are traditionally governed by state law, and courts do not treat those areas as displaced by federal statute without clear direction from Congress.
- The MCCA spousal-impoverishment provisions address Medicaid eligibility and the treatment of spousal income and resources in determining eligibility and allowances; they do not, by their terms, eliminate or replace state-law duties of spousal support.
- A state’s use of general spousal-support law to seek payment from a financially able community spouse can coexist with the federal eligibility framework because the federal statute sets rules for benefit qualification and allowances, while state law supplies an independent basis for support and potential reimbursement.
- In the absence of explicit federal restrictions on post-payment recoupment from community spouses through support obligations, and without a demonstrated statutory conflict, state support enforcement is not displaced.

## Conclusion

Poindexter v. Illinois holds that the MCCA’s spousal-impoverishment provisions protect community spouses in the Medicaid eligibility and allowance process, but they do not bar Illinois from using its spousal-support laws to seek reimbursement or support from a financially able community spouse for Medicaid-funded nursing-home care provided to an institutionalized spouse.


Poindexter v. Illinois, 890 N.E.2d 410 (2008)