ILNews

Judges send Medicaid case back for review

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The Indiana Court of Appeals remanded a Medicaid benefits denial to the Administrative Law Judge because her decision lacked findings of fact making the case mostly unreviewable by the appellate court.

Alesa Pack applied for Medicaid in 2008. Prior to her application, she had been in two car accidents, diagnosed with panic disorder and schizophrenia, and had many surgeries and treatments for her injuries from the accidents. Pack mentioned physical and psychological ailments as her reason for applying. The review team, ALJ, and Family and Social Services Administration denied benefits; the trial court ruled against Pack.

While her appeal was pending, Pack obtained Medicaid benefits, but this issue isn’t moot because the application for benefits at issue covers medical costs from a two-year period during which her newly awarded benefits don’t provide coverage, noted Judge L. Mark Bailey.

In reviewing the ALJ’s decision, the appellate court found no error in her decision regarding Pack’s physical condition. The ALJ found basic facts contrary to Pack’s assertions and concluded through a proper application of the regulations that she wasn’t substantially impaired from walking or light office work. But the ALJ barely touched upon Pack’s psychiatric conditions. The ALJ didn’t apply the functional limitation factors set forth in the state’s Medicaid regulations and her use of the record on Pack’s psychiatric conditions was selective, wrote Judge Bailey in Alesa Pack v. Indiana Family and Social Services Administration, No. 89A05-1004-PL-240.

“We are mindful here of our duty not to reweigh evidence, a function properly assigned to the ALJ,” he wrote. “Yet the ALJ’s findings here leave us without confidence that she weighed Packs’ psychiatric evidence or applied relevant law to that evidence in reaching a decision.”

The judges sent the case back to the ALJ because the decision was issued “without observance of procedure required by law.” The court also addressed the purposes, function, and proper form of findings of fact and conclusions of law in an administrative context because of the number of administrative orders issued each year.

“Yet we are at times confronted with orders that are defective because the agency’s decision lacks support in the record, that do not adequately articulate a basis for the agency’s decision, that recite the contents of evidence presented to an agency without making proper findings of basic fact, or that simply fail to adequately or rationally apply law to found facts,” Judge Bailey wrote. “Failing to follow proper procedures and form for agency orders may reflect an underlying failure to observe due process of law, whether or not due process was actually had by any or all affected parties and whether or not the agency’s ultimate decision is correct.”

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  1. It appears the police and prosecutors are allowed to change the rules halfway through the game to suit themselves. I am surprised that the congress has not yet eliminated the right to a trial in cases involving any type of forensic evidence. That would suit their foolish law and order police state views. I say we eliminate the statute of limitations for crimes committed by members of congress and other government employees. Of course they would never do that. They are all corrupt cowards!!!

  2. Poor Judge Brown probably thought that by slavishly serving the godz of the age her violations of 18th century concepts like due process and the rule of law would be overlooked. Mayhaps she was merely a Judge ahead of her time?

  3. in a lawyer discipline case Judge Brown, now removed, was presiding over a hearing about a lawyer accused of the supposedly heinous ethical violation of saying the words "Illegal immigrant." (IN re Barker) http://www.in.gov/judiciary/files/order-discipline-2013-55S00-1008-DI-429.pdf .... I wonder if when we compare the egregious violations of due process by Judge Brown, to her chiding of another lawyer for politically incorrectness, if there are any conclusions to be drawn about what kind of person, what kind of judge, what kind of apparatchik, is busy implementing the agenda of political correctness and making off-limits legit advocacy about an adverse party in a suit whose illegal alien status is relevant? I am just asking the question, the reader can make own conclsuion. Oh wait-- did I use the wrong adjective-- let me rephrase that, um undocumented alien?

  4. of course the bigger questions of whether or not the people want to pay for ANY bussing is off limits, due to the Supreme Court protecting the people from DEMOCRACY. Several decades hence from desegregation and bussing plans and we STILL need to be taking all this taxpayer money to combat mostly-imagined "discrimination" in the most obviously failed social program of the postwar period.

  5. You can put your photos anywhere you like... When someone steals it they know it doesn't belong to them. And, a man getting a divorce is automatically not a nice guy...? That's ridiculous. Since when is need of money a conflict of interest? That would mean that no one should have a job unless they are already financially solvent without a job... A photographer is also under no obligation to use a watermark (again, people know when a photo doesn't belong to them) or provide contact information. Hey, he didn't make it easy for me to pay him so I'll just take it! Well heck, might as well walk out of the grocery store with a cart full of food because the lines are too long and you don't find that convenient. "Only in Indiana." Oh, now you're passing judgement on an entire state... What state do you live in? I need to characterize everyone in your state as ignorant and opinionated. And the final bit of ignorance; assuming a photo anyone would want is lucky and then how much does your camera have to cost to make it a good photo, in your obviously relevant opinion?

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