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. I have dealt with more than a few I-465 moat-protected government attorneys and even judges who just cannot seem to wrap their heads around the core of this 800 year old document. I guess monarchial privileges and powers corrupt still ..... from an academic website on this fantastic "treaty" between the King and the people ... "Enduring Principles of Liberty Magna Carta was written by a group of 13th-century barons to protect their rights and property against a tyrannical king. There are two principles expressed in Magna Carta that resonate to this day: "No freeman shall be taken, imprisoned, disseised, outlawed, banished, or in any way destroyed, nor will We proceed against or prosecute him, except by the lawful judgment of his peers or by the law of the land." "To no one will We sell, to no one will We deny or delay, right or justice." Inspiration for Americans During the American Revolution, Magna Carta served to inspire and justify action in liberty’s defense. The colonists believed they were entitled to the same rights as Englishmen, rights guaranteed in Magna Carta. They embedded those rights into the laws of their states and later into the Constitution and Bill of Rights. The Fifth Amendment to the Constitution ("no person shall . . . be deprived of life, liberty, or property, without due process of law.") is a direct descendent of Magna Carta's guarantee of proceedings according to the "law of the land." http://www.archives.gov/exhibits/featured_documents/magna_carta/

  2. I'm not sure what's more depressing: the fact that people would pay $35,000 per year to attend an unaccredited law school, or the fact that the same people "are hanging in there and willing to follow the dean’s lead in going forward" after the same school fails to gain accreditation, rendering their $70,000 and counting education worthless. Maybe it's a good thing these people can't sit for the bar.

  3. Such is not uncommon on law school startups. Students and faculty should tap Bruce Green, city attorney of Lufkin, Texas. He led a group of studnets and faculty and sued the ABA as a law student. He knows the ropes, has advised other law school startups. Very astute and principled attorney of unpopular clients, at least in his past, before Lufkin tapped him to run their show.

  4. Not that having the appellate records on Odyssey won't be welcome or useful, but I would rather they first bring in the stray counties that aren't yet connected on the trial court level.

  5. Aristotle said 350 bc: "The most hated sort, and with the greatest reason, is usury, which makes a gain out of money itself, and not from the natural object of it. For money was intended to be used in exchange, but not to increase at interest. And this term interest, which means the birth of money from money, is applied to the breeding of money because the offspring resembles the parent. Wherefore of an modes of getting wealth this is the most unnatural.

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