The opinion
STATE OF MAINE SUPERIOR COURT f
CUMBERLAND, ss. CIVIL ACTION /
DOCKET NO. AP-01-074
MARITA BONVILLE )
Petiti jad
wa Na ) ORDER AND DECISION
" mot Tt ¢ 6 DONALD L. GARBRECHT
DEPT. OF HUMAN SERNUCESO'S gueqund LO BRARY
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Pending before the Court is the Petitioner’s, Marita Bonville (“Petitioner”), Rule
80C Petition for Appeal from the Department of Human Services’ (“DHS”) decision to
terminate her Medicaid benefits. For the following reasons the Court denies Petitioner’s
Appeal. ‘
BACKGROUND
In 1991 Petitioner stopped receiving Supplemental Security Income, but was
eligible for Medicaid under a provision of the Maine Medical Eligibility Manual
(“MMEM”). The provision allows DHS to disregard the Social Security benefits of
disabled widows, not receiving Medicare, when calculating income.
In December of 1999 Petitioner began receiving Medicare. DHS explained that it
would now include her Social Security benefits when calculating her income. As a result
her income level worked to terminate her Medicaid eligibility effective September 30,
2000. DHS informed Petitioner that she would need to meet a $2,676.00 deductible
during the subsequent six months to receive any further Medicaid benefits.
Petitioner requested a hearing and DHS sent her a Fair Hearing Report. The
report described the particulars of the hearing, cited sections of law on which DHS based
its decision, and explained the calculation of the deductible.
On November 5, 2001, the Hearing Officer affirmed DHS’s decision, stating that
Hearing Officer had no authority to waive any portion of the deductible.
DISCUSSION
Due Process
The Fourteenth Amendment of the United States Constitution and Article One of
the Maine Constitution guarantees that no person shall be deprived of “life, liberty or
property without due process of law.” U.S. Const. amend. XIV; Me. Const. art.1, §6-A.
The United States Supreme Court has identified what process is due where life, liberty or
property interests are at stake. A court must consider 1) what private interests are at
stake; 2) the risk of erroneous deprivation of rights due to the current procedure and the
probable value of additional procedures; and 3) the governments interest including the
administrative burden providing the additional procedures place on the government.
Matthews v. Eldrigdge, 424 U.S. 319 (1976). Due Process is a flexible concept and the
necessary procedures vary from situation to situation. Hopkins v. Department of Human
Services, 2002 ME 129, 918; 802 A.2d 999 (internal citations omitted).
The first step in determining whether a plaintiff has a due process claim is to
identify a specific liberty or property interest the government action allegedly affects.
Wayfield v. Town of Tisbury, 935 F. Supp. 880, 882 (citing Board of Regents v. Roth,
408 U.S. 564, 569 (1972). Parties agree Petitioner’s benefits constitute a property
interest and that DHS correctly determined that Petitioner failed to meet the criteria for
Medicaid benefits. Therefore since terminating the benefits qualifies as government
action affecting a property interest, the next step is to evaluate what procedures the State
owed the Petitioner, whether the State afforded the Petitioner those procedures, and if
additional procedures are necessary. Id.; see also Matthews, 424 U.S. 319 (1976).
Arguments
Petitioner contends DHS prejudiced her hearing by not giving her notice of the
grounds upon which they were terminating her Medicaid benefits. Further, Petitioner
contends DHS cited only general sections of law in the Fair Hearing Report, not specific
sections as 42 C.F.R. § 431.210 requires, and DHS failed to include those sections in
their termination letter. As a result the notice was ambiguous, vague and unclear leading
to an arbitrary decision that violated Petitioner’s due process rights.
Petitioner argues if DHS provided a detailed worksheet with relevant formulas,
income information, calculations and other relevant information she could have properly
prepared for the hearing. She alleges DHS’s inadequate procedures create a high risk of
erroneous deprivation and the additional procedures place an insignificant burden on the
government. The risk of deprivation and the nature of the interest outweigh any
governmental burden.
The State counters that DHS properly terminated Petitioner’s benefits because her
income exceeded the federal and state guidelines. Further, DHS provided Petitioner with
notice of her hearing, during which Petitioner had the opportunity to cross-examine and
demonstrate eligibility. Greely v. Commissioner, Department of Human Services, 748
A.2d 472 (Me. 2000). Moreover, if the Court granted her another hearing, the outcome
would be the same.
Federal Rules
42 C.F.R. §431.206(b) requires a Medicaid agency to inform the recipient in
writing of (1) the right to a hearing, (2) how to obtain a hearing, and (3) the right to
represent yourself or obtain counsel, before taking action to suspend, terminate or reduce
services. Hopkins, 2002 ME 129, 49 (citing 42 C.F.R. §431.206(b)). The notice must
contain: (a) a statement of what action the state intends to take; (b) the reasons for the
intended action; (c) the specific regulations that support the action; (d) an explanation of
the individual’s right to request a hearing; and (e) an explanation of the circumstances
under which they continue Medicaid if the individual requests a hearing. Id.
State Rules
If the recipient requests a hearing, DHS must provide a Fair Hearing Report
detailing the reasons for the agency action. If income is an issue, the Eligibility
Specialist must describe how the agency calculated net income. Hopkins, 2002 ME 129,
q10 (citing Maine Medicaid Eligibility Manual App. A.) The purpose of a hearing “ts to
review whether the agency acted in accord with defined policy and procedural
requirements in carrying out is actions.” Maine Department of Human Services reg. 10
144 332; Me. Medicaid Eligibility Manual (MMEM), App. A). The hearing officer
reviews whether the agency followed proper procedures. Id. The “Eligibility Specialist”
determines whether the recipient received proper notice. Id. The notice “must cite the
manual section on which the decision to deny or reduce benefits is based.” Hopkins,
2002 ME 129, { 10.
Notice
Courts may vacate an agency’s action if it results in “procedural unfairness.”
Hopkins, 2002 ME 129, §12 (quoting Maine v. Shalala, 81 F.Supp.2d 91, 95 (D.Me.
1999). Petitioner argues the Fair Hearing Report cited only general and not specific
sections. The court in Hopkins, which dealt with the same situation and applied the same
statutory formula, stated a defective notice did not prejudice Medicaid recipients when
they knew the reason the state terminated their benefits was their increased income.
Hopkins, 2000 ME 129, §15. The Petitioner has the burden of showing that DHS’s
notice prejudiced her in order to prevail. Id at {13. Petitioner fails to offer any evidence
that DHS would have decided her case differently, had the Fair Hearing Report cited
specific sections. The numbers clearly support DHS’s decision and absent a showing of
prejudice, this omission does not violate Petitioner’s Due Process. Id at 15.
Additional Procedures
Petitioner also claims a worksheet describing all relevant formulas and other
information would have allowed her to prepare for the hearing. However, the Fair
Hearing Report laid out the statutory formula for calculating benefits. Along with the
termination letter, the Fair Hearing Report provided sufficient information to enable
Petitioner to understand the reasons for the intended termination of her benefits in order
to prepare for the hearing. Moreover, the Petitioner does not contest the calculation of
her income on which DHS based its determination. No additional preparation could have
changed the outcome, Petitioner’s income was too high and DHS needed to put her on the
deductible plan. Id at 6.
““Good Cause” Provision
The court in Hopkins stated that as a condition of eligibility, the agency must
require applicants and recipients to take all necessary steps to obtain any annuities,
pensions, retirement, and disability benefits to which they are entitled, unless they can
ro
show good cause for not doing so. Hopkins, 2000 ME 129, 916 (citing 42 C.F.R.
§435.608(a)). State law does not include a “good cause” provision. Under state rules,
individuals must take all appropriate steps to obtain benefits to which they are entitled.
This includes applying for the benefit and providing the other benefit source with
necessary information to determine eligibility for the benefit. Hopkins, 2000 ME 129,
{16 (citing MMEM, §1270).
Petitioner argues for the first time in Plaintiff's Reply Brief that DHS did not
inform her of the “good cause” exception (available only in the Federal rule). Petitioner
shows that had she been aware of the “good cause” provision she could have presented
evidence at the hearing showing a reduction in her other benefits for “good cause” would
keep her eligible for Medicaid benefits. Pursuant to M.R.Civ.P. 7(e) however, she should
have raised this argument in her Appeal not in her Reply Brief. Maine Rules of Civil
Procedure require that a reply be “strictly confined to replying to new matter raised in the
opposing memorandum.” M.R.Civ.P. 7(e). Further, the rules require the Petitioner to file
a reply seven days after the opposing memorandum and Petitioner filed her reply eight
days after DHS’s opposing memorandum. Without commenting on the validity of the
Petitioner’s argument, she did not raise the issue in a timely manner.
The Petitioner has failed to show that DHS’s notice, while not in strict compliance
with procedure, contributed to an erroneous deprivation of her Medicaid benefits.
THE DOCKET ENTRY IS:
Rule 80(c) Petition for Appeal is denied.
The clerk is ordered to incorporate this decision into the docket by ref é
—A-£
mere Court
DATED: September /{ , 2002
Date Filed _ 12-05-01 Cumberland Docket No. AP-01-074
County
Action RULE 80C APPEAL
MARITA BONVILLE VS. MAINE DEPARTMENT OF HUMAN SERVICES
Plaintiff? Defendant’s Attorney
s Attorney Elizabeth L. Bancroft, Stu.
w/d FHERESA-FORD.--STUDENE ATPORNEY Atty
Cumberland Legal Aid Clinic
246 Deering Avenue
Portland, ME 04102
(207) 780-4370
Date of
Entry
Marina Thibeau, AAG
6 STATE HOUSE STATION
AUGUSTA, .ME 04333
Robert M. Laskey, AAG
6 State House Station
- Augusta, ME 04333-0006
(207) 626-8800