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Medicaid applications review policy doesn't violate federal law

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An administrative law judge’s refusal to consider evidence of conditions that aren’t disclosed on a Medicaid disability application doesn’t violate federal law and the Due Process Clause, a majority on the Indiana Court of Appeals ruled today.

The judges disagreed in Anne Walterman Murphy, et al. v. William Curtis, et al.  No. 49A04-0909-CV-503, about whether the trial court was correct in granting summary judgment for a class of Medicaid applicants who were denied benefits. The applicants had originally applied for benefits citing one condition and were denied. They then reapplied based on other conditions and at their hearing before an administrative law judge, tried to present evidence on the conditions in the denied applications.

Judges Paul Mathias and Cale Bradford reversed summary judgment in favor of the class and ordered summary judgment entered for the state. They didn’t find the Family and Social Services Administration’s interpretation of the applicable statutes and regulations to be unreasonable, violative of any of the cited statutes or regulations, or constitute denial of due process.

The majority noted that the de novo hearing by the ALJ provided for under Indiana Code Section 12-15-28-4 doesn’t allow for the applicant or county office to introduce additional evidence at the hearing that is unrelated to the conditions in the application being reviewed.

“Furthermore, simply because due process and the applicable regulations require a de novo hearing does not mean that the scope of the hearing must be expanded to include every possible condition that the applicant claims could result in benefits,” wrote Judge Mathias. “A de novo hearing does not require the consideration of materials unrelated to the issue appealed. Otherwise, the need for an initial application and review by the (Medicaid Medical Review Team) would be essentially superfluous.”

Judge Patricia Riley dissented because she believes the current policy used by the ALJ excluding any evidence not alleged in the original application, but that which could establish the applicant is entitled to benefits, violates the basic notions of due process and also an ALJ’s duty in inquire.

“…I conclude that the ALJ’s duty of inquiry is not suspended when the applicant fails to list a particular disability in his or her application or raises it for the first time during the administrative hearing; rather, an ALJ is obligated to investigate the disabling effects of each possible impairment suggested by the record and which may be relevant in order to reach an informative conclusion as to whether the applicant is eligible to receive assistance,” she wrote. “Today’s majority decision falls well short of this goal.”
 

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  1. Linda, I sure hope you are not seeking a law license, for such eighteenth century sentiments could result in your denial in some jurisdictions minting attorneys for our tolerant and inclusive profession.

  2. Mazel Tov to the newlyweds. And to those bakers, photographers, printers, clerks, judges and others who will lose careers and social standing for not saluting the New World (Dis)Order, we can all direct our Two Minutes of Hate as Big Brother asks of us. Progress! Onward!

  3. My daughter was taken from my home at the end of June/2014. I said I would sign the safety plan but my husband would not. My husband said he would leave the house so my daughter could stay with me but the case worker said no her mind is made up she is taking my daughter. My daughter went to a friends and then the friend filed a restraining order which she was told by dcs if she did not then they would take my daughter away from her. The restraining order was not in effect until we were to go to court. Eventually it was dropped but for 2 months DCS refused to allow me to have any contact and was using the restraining order as the reason but it was not in effect. This was Dcs violating my rights. Please help me I don't have the money for an attorney. Can anyone take this case Pro Bono?

  4. If justice is not found in a court room, it's time to clean house!!! Even judges are accountable to a higher Judge!!!

  5. The small claims system, based on my recent and current usage of it, is not exactly a shining example of justice prevailing. The system appears slow and clunky and people involved seem uninterested in actually serving justice within a reasonable time frame. Any improvement in accountability and performance would gain a vote from me. Speaking of voting, what do the people know about judges and justice from the bench perspective. I think they have a tendency to "vote" for judges based on party affiliation or name coolness factor (like Stoner, for example!). I don't know what to do in my current situation other than grin and bear it, but my case is an example of things working neither smoothly, effectively nor expeditiously. After this experience I'd pay more to have the higher courts hear the case -- if I had the money. Oh the conundrum.

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