holding state laws that "interfere with, or are contrary to the laws of congress, made in pursuance of the constitution" are preempted
How later courts described this case
- holding state laws that "interfere with, or are contrary to the laws of congress, made in pursuance of the constitution" are preempted
Written by the judges who cited it.
The opinion
1
STATE OF MAINE SUPERIOR COURT
CIVIL ACTION
KENNEBEC, ss. DOCKET NO. AP-07-78
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" J.C""
IVAN SUZMAN,
Petitioner
v. DECISION AND ORDER
BRENDA HARVEY, COMMISSIONER
DEPARTMENT OF HEALTH AND
HUMAN SERVICES,
Respondent
Before the court is Petitioner's motion for a stay pursuant to 5 M.R.S.A. § 11004
and respondent's M.R. Civ. P. 12(b)(6) motion to dismiss Count II of the petition.
Facts:
Petitioner is a 57-year-old man with onset Parkinson's disease and receives
benefits from respondent's MaineCare program. On November 16, 2007, respondent
issued a final decision finding the hours that should be provided petitioner under the
Home & Community Based Benefits for the Physically Disabled program to be fifty-
seven. The final decision adopted the findings of a Hearing Officer made on September
28, 2007 that petitioner met the eligibility criteria for care under the MaineCare Benefits
Manual and that claimant was receiving 23 hours per week at his own expense beyond
the 80 hours provided under MaineCare. However, the final decision reversed the
determination of the Hearing Officer that these additional services were not duplicative
of MaineCare. Thus the final decision of respondent assessed petitioner's needs at 57
hours per week.
2
Petitioner thus brought an M.R. Civ. P. 80C petition for judicial review, joining to
it a Count alleging that MaineCare § 22.02-4, on which respondent relied in its decision,
violates 42 USc. § 1396(a)(17)(D). Petitioner then, on December 12, 2007, appealed to
respondent to stay its decision (not reduce hours) until this matter is judicially
reviewed. Petitioner brought an action in federal district court on December 14, 2007, in
substance re-alleging Count II of its petition in front of this court. On December 18,
2007, respondent denied petitioner's request for a stay, finding that the case failed to
meet the standards required by 5 M.R.S.A. § 11004.
Discussion:
1. Motion For a Stay
Petitioner applied to respondent for a stay. Respondent denied that stay
considering: 1) whether petitioner would suffer an irreparable injury as a result of
denial; 2) whether petitioner demonstrated a strong likelihood of success on the merits;
3) harm to adverse parties and the general public.
5 M.R.S.A. § 11004 provides:
The filing of a petition for review shall not operate as a stay of the final
agency action pending judicial review. Application for a stay of an agency
decision shall ordinarily be made first to the agency, which may issue a stay
upon a showing of irreparable injury to the petitioner, a strong likelihood of success on
the merits, and no substantial harm to adverse parties or the general public. A motion
for such relief may be made to the Superior Court, but the motion shall show that
application to the agency for relief sought is not practicable, or that application
has been made to the agency and denied, with the reasons request. In addition,
the motion shall show the reasons for the relief requested and the facts relied
upon, which facts, if subject to dispute, shall be supported by affidavits.
Reasonable notice of the motion shall be given to all parties to the agency
proceeding. The court may condition relief under this rule upon State or any
state agency or any official thereof. (emphasis added).
Irreparable Injury
3
An irreparable injury is one for which there is no adequate remedy at law.
Bangor Historic Track, Inc. v. Dep't ofAgriculture, Food & Rural Resources, 2003 ME 140, 9[
10, 837 A.2d 129, 133 (citing Bar Harbor Banking & Trust Co. v. Alexander, 411 A.2d 74, 79
(Me. 1980)). The burden lies on the petitioner. Bangor Historic Track, Inc. at 9[ 12, 837
A.2d at 133. Parkinson's disease is terminal and degenerative. Its degenerative nature
requires, petitioner argues, that he maintain the consistent care he receives and not lose
23 hours of weekly care. He argues that the loss of such care would have a serious
adverse impact on his health and the 57 hours of care would be insufficient to treat his
Parkinson's. Petitioner details this injury as inability to acquire food because lack of
grocery store trips, no care for the preparation of meals, the kitchen not being cleaned,
fewer or no timely clothing changes due to medication related sweating, and fewer
baths. Petitioner also points to the purpose of MaineCare § 22.05, in which, "Covered
Services must be required in order to maintain the member's current health status, or
prevent or delay deterioration of a member's health and/ or avoid long-term
institutional care." He argues that the purpose of the provision is to prevent irreparable
injury and thus failure to carry it out necessarily creates risk.
Respondent points out that based on petitioner's supplementing services out of
his own pocket a nurse assessor assessed his needs at 57 hours a week from MaineCare.
Respondent also argues that the harms isolated by the petitioner are purely speculative
and not concretely proven thus he does not carry his burden. Petitioner responds that
these allegations of harm come from petitioner's affidavit and are currently being
experienced. Respondent's arguments analyze the merits of petitioner's claim and not,
what seems strikingly obvious to this court, the simple notion that a Parkinson's patient
if deprived of care will suffer an irreparable injury. Accordingly, petitioner has
demonstrated an irreparable injury.
4
Hann to the respondent and the public
Petitioner argues that the veracity of harm to the respondent and the public is
greatly in question given the fact that respondent has been providing him 80 hours of
service a week for the past 9 years. Continued service until judicial resolution, he
argues, would pose a small harm compared to that suffered by the petitioner.
Respondent argues that money spent for resources provided to petitioner, which
respondent has determined to be unnecessary, necessarily trade off with the potential
resources provided to other individuals in the MaineCare system. Additionally,
respondent argues, that by providing services to someone not eligible it would not
comply with the Medicaid State Plan, and thus make it susceptible to sanctions for non
compliance.
Respondent's argument proves too much. If accepted, its argument would
destroy any opportunity an individual petitioning for judicial review of an adverse
decision by the respondent would have of obtaining a stay. 5 M.R.S.A. § 11004 clearly
recognizes the device of a stay in some instances. Potential harm to the petitioner here
outweighs harm to the generalized harm to the respondent and the general public.
Likelihood of success on the merits
Petitioner's argument is greatly predicated on its assertion that the MaineCare
regulation § 22.02-4 directly conflicts with 42 U.s.c. § 1396a(a)(17)(D). § 22.02-4 states
that an authorized plan of care must give "consideration to the member's living
arrangement, informal supports, and services provided by other public or private
funding sources ..." § 1396a(a)(17)(D) requires that state medical plans must include
"reasonable standards ...for determining ...the extent of medical assistance under the
plan which...do not take into account the financial responsibility of any individual for
5
any applicant or recipient of assistance under the plan unless such applicant or recipient
is such individual's spouse or such individual's child who is under age 21 ..." He thus
argues that federal law's language does not permit MaineCare's regulation, which takes
informal supports and funding sources into account in allocating services as
exemplified by DHHS actions here.
A "likelihood of success on the merits" is "at most, a probability; at least, a
substantial possibility." Bangor Historic Track, Inc. v. Dep't of Agriculture, 2003 ME 140, <[
9, 837 A.2d 129, 132. This court is not convinced that petitioner has reached either of
these benchmarks. The statutory section is not as simple as petitioner quotes it. 42
u.s.c. § 1396a(a) lists the mandatory requirements for a State plan for medical
assistance. 42 U.s.c. § 1396a(a)(17)(D) mandates that State plans' reasonable standards:
[D]o not take into account the financial responsibility of any individual for any
applicant or recipient of assistance under the plan unless such applicant or
recipient is such individual's spouse or such individual's child who is under 21 ...
The statutory section would thus preclude taking into account the financial
responsibility of another individual for petitioner. §§ 1396a(a)(17)(B) and (C) require
that standards:
(B) provide for taking into account only such income and resources as are, as
determined in accordance with standards prescribed by the Secretary, available
to the applicant or recipient and ...as would not be disregarded (or set aside for
future needs) in determining his eligibility for such aid, assistance, or benefits,(C)
provide for reasonable evaluation of any such income or resources.
It seems, to this court, respondent was taking into account petitioner's ability to
provide care for himself, rather than evaluating another's ability to provide resources
for him. The court sees no conflict between the federal statutory scheme and
MaineCare regulation § 22.02-4, accordingly petitioner has not proven he is likely to
succeed on the merits of his case.
6
II. Motion to Dismiss
A motion to dismiss for failure to state a claim tests the legal sufficiency of the
'"
complaint. Plimpton v. Gerrard, 668 A.2d 882, 885 (Me. 1995). When reviewing a motion
to dismiss, the material allegations of the complaint are accepted as true. Id. In ruling
on a motion to dismiss, the court should "consider the material allegations of the
complaint as admitted and review the complaint in the light most favorable to the
plaintiffs to determine whether it sets forth elements of a cause of action or alleges facts
that would entitle the plaintiffs to relief pursuant to some legal theory." Bussell v. City
of Portland, 1999 ME 103, err 1, 731 A.2d 862. Dismissal for failure to state a claim is
appropriate only where it appears beyond doubt that the plaintiff is entitled to no relief
under any set of facts which he might prove in support of his claim. Dutil v. Burns, 674
A.2d 910, 911 (Me. 1996). The legal sufficiency of a complaint is a question of law.
Sargent v. Buckley, 1997 ME 159, err 10, 697 A.2d 1272, 1275. If, on a motion to dismiss,
matters outside the pleadings are presented and considered by the court, the motion
shall be treated as one for summary judgment.
Respondent argues that Count II fails to state a basis for relief independent from
the M.R. Civ. P. 80C count. The ultimate relief sought in both instances is an order for
coverage of the full 80 hours of service based on the invalidity of § 22.02-4. The APA
certainly provides the statutory authority to declare that § 22.02-4 violates a federal
statute. See Conservation Law Foundation v. Dep't of Envt'l Protection, 2003 ME 62, errerrl9
20, 823 A.2d 551, 558.
Petitioner's response is curious, he argues that the difference between Count I
and II is that Count II involves the supremacy clause and federal preemption and is
thus different. The premise of Count I, though also inclusive of a substantial evidence
challenge, is the supremacy clause challenge based on his interpretation of §
7
1396(a)(17)(D). Petitioner also argues that Count II asks both for a declaration of
invalidity and a reversal of the determination. Petitioner's argument is unavailing.
Under Count I, the court would conclude that the rule is invalid in order to reverse the
decision under its APA/M.R. Civ. P. 80C authority (notwithstanding a substantial
evidence question), thus achieving both of these objectives. In the event there is no
substantial evidence, even if Count II were independent, it would be improper for the
court to reach the constitutional or statutory questions whether posed in Count lor
independently in Count II. Thus, Count II is not an independent claim and should be
dismissed as duplicative of Count I.
The entry is
Petitioner's motion for a stay is DENIED.
Respondent's motion to dismiss Count II of petitioner's petition is GRANTED.
Count II is DISMISSED as duplicative of Count I.
May -.£ 2008
Date Filed _----=1-=2.1-/-=-1-'--'7/'--'0::....:7_ _ Docket No. __A"-P_-_0_7_-~7_8 _
County
Action --'P'-'e"'-t"'-i~t=_i"'-on_'_'___=_F_"'o'""r____"R"_'e~v'_"i"_'e::..!w'__ _
80C
J.JABAR
Ivan Suzman vs. Brenda Harvey, Commissioner DHHS
Plaintiff's Attorney Defendant's Attorney
Ross A. Doerr, Esq. Janine A. Raquet, AAG
Disability Rights Center 6 State House Station
PO Box 2007 Augusta Maine 04333-0006
Augusta, ME 04338-2007
Date of
Entry
12/21/07 Petition For Review Of Final Agency Action, filed 12/17/07.
12/26/07 Application for Stay of Final Agency Action, filed. s/Doerr, Esq.
Proposed Order, filed.
12/27/07 Petition to Specify the course of future proceedings, filed. s/Doerr, Esq.
1/4/07 Respondent's Motion to Dismiss and Opposition to Petitioner's Motion to
Specify the Future Course of Proceedings with Incorporated Memorandum of
Law, filed. s/Raquet, AAG
1/16/08 Amended Motion to Dismiss and Opposition to Petitioner's Motion to Specify
Future Course of Proceedings, filed. s/Rpquet. Esq.
Proposed Order, filed.
1/16/08 Respondent's Opposition to Petitioner'£\ Applicf'tion for Stny. filpd.
1/17/08 Amended Motion To Specify The Future Course Of The Proceedings, With
Incorporated Memorandum Of Law, filed 1/16/08. s/Doerr, Esq.
Proposed Order, filed. (attachments)
1/24/08 Opposition to Respondent's Motion to Dismiss Count II of the Petition for
Review of Final Agency Action with Incorporated Memorandum of Law, filed.
s/Ociepka, Esq.
Certificate of service, filed. s/Doerr, Esq.
2/4/08 Affidavit of Ivan Suzman, filed. s/Suzman
2/5/08: Respondent's Reply to Petitioner's Opposition to Motion to Dismiss, filed.
s/Raquet, AAG
2/5/08 Respondent's Opposition to Petitioner's Amended Motion to Specify the
Future Course of Proceedings, filed. s/Raquet, AAG
2/11/08 Return receipt with return service made upon AAG on 12/18/07, filed.
Return receipt with return service made upon Brenda Harvey, Comm.,filed.
Amended Motion for Stay of Final Agency Action, filed. s/Doerr. Esq.
Date of
Entry Docket No.
2/14/08 Respondent's Opposition to Petitioner's Amended Motion for Stay. filed.
s/Raquet. AAG
2/20/08 Reply to Opposition to Amended Motion for Stay of Final Agency Action.
filed. s/Doerr. Esq.
Notice of smtmg tor--.!!.l. C;LtJrf
sent to attorneys of record,
3/20/08 MOTION TO CONTINUE. Jabar. J.
Motion denied. Case to be moved to 9:00 a.m. on 4/8/08
Copies to attys. of record.
4/8/08 Hearing held with the Hon. Justice Joseph Jabar. presiding.
Ross Doerr. Esq. for the Petitioner and Janine Raquet. AAG for the
Respondent.
Oral arguments made to the court. Court to take matter under advisement.
5/5/08 DECISION AND ORDER. Jabar. J.
Petitioner's motion for stay is DENIED.
Respondent's motion to dismiss Count II of petitioner's petition is
GRANTED. Count II is DISMISSED as duplicative of Count I.
Copies mailed to attys. of record.
1
STATE OF MAINE SUPERIOR COURT
CIVIL ACTION
KENNEBEC, ss. D()CKET NO. A~-2007-78
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IVANSUZMAN
Petitioner
v. DECISION AND ORDER
BRENDA HARVEY, in her official capacity
as COMNIISSIONER OF THE MAINE
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Respondent
Before the court is petitioner's M.R. Civ. P. 80C petition for judicial review of the
respondent Maine Deparbnent of Health and Human Services (DHHS)'s decision
reducing petitioner's Personal Care Attendant (PCA) weekly service hours from 80 to
57.
Factual & Procedural Background:
Petitioner, a 57-year-old man with younger onset Parkinson's disease,
receives benefits from respondent's MaineCare Home and Community Based
Benefits Program for the Physically Disabled (HCB program). Prior to June 2007,
petitioner had been receiving 80 hours per week of in-home support through
MaineCare. In addition to the 80 hours of MaineCare-reimbursed services,
petitioner was also purchasing additional services using his own resources. In
June of 2007, petitioner requested an assessment to determine whether he could
increase his MaineCare-reimbursed hours to 86.25 hours per week, the maximum
allowable under MaineCare.
2
DHHS's agent, Goold Health Systems (GHS), assessed petitioner on June
21, 2007. Laura Moody, RN, conducted the assessment, determining that
petitioner's needs totaled 57 hours. RN Moody did not include needs that were
being met by Meals on Wheels, PCA's paid for through the State of Maine Alpha
One Program, and services being provided by a live-in PCA who was bartering
her room and board in exchange for providing certain services to the petitioner. 1
In response an appeal by petitioner regarding the reduction in his PCA hours, on
November 16, 2007, respondent issued a final decision finding that petitioner should be
provided with 57 PCA hours under the HCB program. The Commissioner's final
decision adopted the Hearing Officer's findings of facf made on September 28, 2007,
that petitioner met the eligibility criteria for care under the MaineCare Benefits Manual,
and that petitioner was receiving 23 hours of additional care per week at his own
expense, beyond the 80 hours provided under MaineCare. However, the final decision
declined to accept the finding of the Hearing Officer that petitioner's 23 hours of
additional services were not duplicative of MaineCare-reimbursed hours. The final
decision assessed petitioner's needs at 57 hours per week, finding the "RN assessor
accurately noted each ADL/IADL," and "accurately documented" the "time involved
for each activity."3
1 The record, however, contains no evidence as to any finaincial impact on petitioner.
2 The Hearing Officer recommended that the Commissioner overturn the reduction in MaineCare
reimbursed hours, finding that " [e]xcept to the extent that Respondent [assessor] factored in services
provided to Claimant at his own expense," the assessment was a "reasonably reliable depiction of
Claimant's care needs at the time." The Hearing officer concluded petitioner was paying for an
additional 23 hours of services per week.
3 The Commissioner also found it appropriate to reduce petitioner's hours based upon duplicative
services petitioner acquired at his own expense. Declining to accept the Hearing Officer's Finding of Fact
# 3, the Commissioner found:
MaineCare programs do not supplant resources available through other programs,
providers, friends, etc. Nor do the rules allow for supervision/ socialization. Because of
Mr. Suzman's statements regarding the live in PCA and other part-time PCA a reduction
3
Petitioner brought an M.R. Civ. P. 80C petition for judicial review, joining with it
a Count alleging that section 22.02-4 of the MaineCare Benefits Manual, on which
respondent relied in its decision, violates 42 U.s.c. § 1396(a)(17)(D).
Standard of Review:
When the decision of an administrative agency is appealed pursuant to M.R. Civ.
P. 80C, this court reviews the agency's decision directly for abuse of discretion, errors of
law, or findings not supported by the evidence. Centamore v. Dep't of Human Servs.,
664 A.2d 369, 370 (Me. 1995). "An administrative decision will be sustained if, on the
basis of the entire record before it, the agency could have fairly and reasonably found
the facts as it did." Seider v. Bd. of Exam'rs of Psychologists, 2000 ME 206, <JI 9, 762 A.2d
551,555 (citing CWCO, Inc. v. Superintendent of Ins., 1997 ME 226, <JI 6, 703 A.2d 1258,
1261). The court will "not attempt to second-guess the agency on matters falling within
its realm of expertise" and judicial review is limited to "determining whether the
agency's conclusions are unreasonable, unjust or unlawful in light of the record."
Imagineering, Inc. v. Superintendent of Ins., 593 A.2d 1050, 1053 (Me. 1991).
"Inconsistent evidence will not render an agency decision unsupported." Seider, 2000
ME 206, <JI 9, 762 A.2d at 555. The burden of proof rests with the party seeking to
overturn the agency's decision, and that party must prove that no competent evidence
supports the Board's decision. See Bischoff v. Bd. of Trustees, 661 A.2d 167, 170 (Me.
1995).
Discussion:
in the number of IADL hours for this program was correctly determined by the assessor.
See Chapter II, Section 22.02-4 of the MaineCare Benefits Manual. In addition, at the time
of the last assessment, Mr. Suzman was being provided approximately 35 hours per
week by his live in PCA in exchange for her room and board.
4
There is substantial evidence to support the final decision of the Commissioner
that petitioner's unmet needs totaled 57 hours. RN Moody's original assessment found
that the petitioner had 57 hours of unmet needs. She took into consideration that some
of petitioner's needs were being met by Meals on Wheels, PCA's paid for through the
Alpha One Program, and through an informal barter arrangement between petitioner
and a PCA. RN Moody, however, did not merely determine how many hours were
being provided to petitioner by outside resources and then subtract that amount from
the 80 hours petitioner had been receiving through MaineCare. Instead, she made a de
novo determination of petitioner's needs, taking into consideration the other sources of
care that he was receiving to fulfill those needs, as described by petitioner. 4 Contrary to
petitioner's contentions, as discussed below, it was not improper for RN Moody to
consider these other services.
Section 22.02-4 of the MaineCare Benefits Manual states that an authorized plan
of care must "reflect the needs identified by the [CHS] assessment, giving consideration
to the member's living arrangement, informal supports, and services provided by other
public or private funding sources ...." Me. Dep't of Hum. Serv., 10 144 CMR 101, ch.
II, § 22.02-4. RN Moody's assessment of petitioner's needs-adopted as accurate and
relied upon in the Commissioner's final decision-took into consideration certain
services petitioner was receiving in addition to services provided under the HCB
program. S Accordingly, it must be determined whether consideration of these outside
services in the original assessment was proper under section 22.02-4. Recognizing that
an agency's interpretation of its own rules will not be set aside unless the rules plainly
4 RN Moody testified she would not automatically reduce hours because someone was privately paying
for them. (R. Ex. D at 56.)
5 For instance, RN Moody testified that, for example, "[i]f [petitioner] says to me the PSS who lives here at
night makes my breakfast I can't put breakfast on the IADL list for a paid PCA to do." (R. Ex. D at 25.)
5
compel a contrary result Fryeburg Health Care Ctr. v. Dep't of Human Servs., 1999 ME
122, CJI 7,734 A.2d 1141, 1143, it cannot be said that the Commissioner's reliance on the
original assessment's consideration of petitioner's alternative support was improper.
RN Moody's assessment detailed petitioner's needs and the time involved for each
ADL/IADL activity covered under MaineCare, deducting time based upon petitioner's
statements regarding alternative support. This process is consistent with section 22.02
4's directive that a plan of care must give "consideration to the member's living
arrangement, informal supports, and services provided by other public or private
funding sources."
Petitioner further argues that federal law preempts section 22.02-4. See Wis. Pub.
Intervenor v. Mortier, 501 U.S. 597, 604 (1991) (holding state laws that "interfere with, or
are contrary to the laws of congress, made in pursuance of the constitution" are
preempted). Petitioner argues that section 22.02-4 conflicts with 42 U.s.c. §
1396a(a)(17)(D), which provides that state medical plans must include:
[r]easonable standards ... for determining eligibility for and the extent of
medical assistance under the plan which ... (D) do not take into account
the financial responsibility of any individual for any applicant or recipient
of assistance under the plan unless such applicant or recipient is such
individual's spouse or such individual's child who is under 21 ....
This statutory provision would thus preclude, in determining eligibility for
medical assistance, taking into account the financial responsibility ofanother individual
for petitioner. In this instance, the original assessment, relied upon by the Commissioner
in reducing petitioner's hours, took into account petitioner's ability to provide care for
himself, rather than evaluating another individual's financial responsibility for
petitioner. Although this court agrees with petitioner that section 1396a(a)(l7)(D)
addresses not only financial eligibility, but also "the extent of medical assistance"
6
provided to a recipient, see Iensen v. Missouri Dep't of Health and Senior Servs., 186
S.W.3d 857, 862 (Mo. Ct. App. WD. 2006), this does not alter the conclusion.
In Iensen, the central issue was whether a Missouri Deparbnent of Health and
Senior Services (Deparbnent) rule conflicted with 42 U.s.C § 1396a(a)(l7)(D) by
considering the finances of an applicant's family members in determining the extent of
medical assistance that would be provided that applicant. Id. at 860. The Deparbnent
rule required that a Personal Care Assistance (PCA) services plan of care include "the
maximum number of hours of PCA to be provided based on a client's/ consumer's
unmet need." Id. at 861. "Unmet need" was defined by Deparbnent regulations as
"those routine tasks and activities of daily living as allowable by Medicaid but not
adequately met by current support systems without causing undue hardships to the
client/ consumer and/ or caregiver[.] Id. Pursuant to these regulations, following an
annual review, the applicant's PCA services were reduced because she did not
document that it would be an "undue hardship" for her parents to meet her needs. Id.
at 859. In overturning the Deparbnent's decision, the court found that the Deparbnent's
regulations essentially required the applicant to show "that her parents w[ould] lose
income (undue hardship) if they provide[d] PCA services to her." Id. at 862. Such a
regulation, the court held, was preempted because
[f]ederal Medicaid law ... states quite plainly that state plans may not,
when determining the extent of medical assistance to be provided, "take
into account the financial responsibility of any individual for any
applicant or recipient of assistance ... 42 U.S.CA. § 1396a(a)(17)(D). Ms.
Jensen's parents, while not required by law to be financially responsible
for her, have assumed that obligation by housing her. Because they do not
fall within the federal exception as the recipient's spouse or as parents of a
recipient under age twenty-one, the Deparbnent's requirement conflicts
with federal law ....
Id.
7
The court in Jensen, however, explicitly recognized that the Department's
rule specifically took into account "another's income," rather than the needs of
the applicant herself:
The Department also claims that "the unmet needs requirement does not
take another's income into account in determining eligibility -- the
requirement focuses only on the needs of the consumer and whether they
are met by the consumer's natural support system." On the contrary and
as noted above, the Department specifically requires that the caregiver's
hardship (loss of income) be shown in determining whether the recipient
has unmet needs.
Id.
Conversely, unlike the Department in Jensen, the GHS assessment relied upon
by the Commissioner focused on the needs of the petitioner and the support the
petitioner was able to provide for himself. Whereas in Jensen the Department rules
conflicted with federal law "to the extent that they consider[ed] family resources," here,
pursuant to the assessment's application of section 22.02-4, only petitioner's resources
were considered. The importance of this distinction-considering the resources of the
applicant as opposed to financial responsibility of another for the applicant-is bolstered
by the plain language of section 1396a(a)(17)(D), which prohibits the consideration of
"the financial responsibility of any individual for any applicant." Contrary to the
petitioner's contention, this court does not consider those providing petitioner with
additional services "financially responsible" for the petitioner. Petitioner was utilizing
his own resources to obtain these services. The GHS assessment considered petitioner's
ability to provide himself with care, not, like Jensen, the financial resources of others
responsible for petitioner. Therefore, the Commissioner's interpretation of the
8
regulation, as applied to petitioner through the GHS assessment, does not conflict with
42 USc. § 1396a(a)(17)(D).6
The entry is:
The petition is DENIED and the decision of the Maine Department of
Health and Human Services is AFFIRMED.
September It:, 2008
6 Because, as applied, section 22.02-4 does not conflict with federal law, this court does not address
petitioner's facial challenge. See, ~ Sabri v. United States, 541 U.s. 600, 609 (2004) (finding that because
claims of facial invalidity often rest on speculation, as a consequence, they raise the risk of "premature
interpretation of statutes on the basis of factually barebones records").
Date Fi led _------'"'1 21-/-=-1__
7<-.:/0"-'7'-----_ Docket No. ~__A_P_-_0~7-~7_8 _
County
Action _~~~P,--e=-t=i=t=i=o=ne-=F~o_r~~R=e~v~i,,-,e,,-,w-,----~~~ _
80C
J.JABAR
Ivan Suzman vs. Brenda Harvey, Commissioner DHHS
Plaintiff's Attorney Defendant's Attorney
Ross A. Doerr, Esq. Janine A. Raquet, AAG
Disability Rights Center 6 State House Station
PO Box 2007 Augusta Maine 04333-0006
Augusta, ME 04338-2007
Date of
Entry
12/21/07 Petition For Review Of Final Agency Action, filed 12/17/07.
12/26/07 Application for Stay of Final Agency Action, filed. s/Doerr, Esq.
Proposed Order, filed.
12/27/07 Petition to Specify the course of future proceedings, filed. s/Doerr, Esq.
1/4/07 Respondent's Motion to Dismiss and Opposition to Petitioner's Motion to
Specify the Future Course of Proceedings with Incorporated Memorandum of
Law, filed. s/Raquet, AAG
1/16/08 Amended Motion to Dismiss and Opposition to P~tit:loCl,.,r's Motion to Spf'cify
Future Course of Proceedings. filed. s/Rpquet. Esq.
Proposed Order, filed.
1/16/08 Respondent's Opposition to P~t:ltioner'D ApplicFtion for St~y. filpd.
1/17/08 Amended Motion To Specify The Future Course Of The Proceedings, With
Incorporated Memorandum Of Law, filed 1/16/08. s/Doerr, Esq.
Proposed Order, filed. (attachments)
1/24/08 Opposition to Respondent's Motion to Dismiss Count II of the Petition for
Review of Final Agency Action with Incorporated Memorandum of Law, filed.
s/Ociepka, Esq.
Certificate of service, filed. a/Doerr, Esq.
2/4/08 Affidavit of Ivan Suzman, filed. s/Suzman
2/5/08 . Respondent's Reply to Petitioner's Opposition to Motion to Dismiss, filed.
s/Raquet, AAG
2/5/08 Respondent's Opposition to PetitionQr's Amended Motion to Specify the
Future Course of Proceedings, filed. s/Raquet, AAG
2/11/08 Return receipt with return service made upon AAG on 12/18/07. filed.
Return receipt with return service made upon Brenda Harvey, Comm.,filed.
Amended Motion for Stay of Finnl Agency Action, flIed. n/Docrr. EGq.
Date of
Entry Docket No.
2/14/08 Respondent's Opposition to Petitioner's Amended Motion for Stay, filed.
s/Raquet, AAG
2/20/08 Reply to Opposition to Amended Motion for Stay of Final Agency Action,
filed. a/Doerr, Esq.
sent ~o aftomeyn of record.
3/20/08 MOTION TO CONTINUE, Jabar, J.
Motion denied. Case to be moved to 9:00 a.m. on 4/8/08
Copies to attys. of record.
4/8/08 Hearing held with the Hon. Justice Joseph Jabar, presiding.
Ross Doerr, Esq. for the Petitioner and Janine Raquet, AAG for the
Respondent.
Oral arguments made to the court. Court to take matter under advisement"
5/5/08 DECISION AND ORDER, Jabar, J.
Petitioner's motion for stay is DENIED.
Respondent's motion to dismiss Count II of petitioner's petition is
GRANTED. Count II is DISMISSED as duplicative of Count I.
Copies mailed to attys. of record.
Copies mailed to repositories
5/16/08 Certified Record, filed. s/Raquet, AAG
6/23/08 Petitioner's 80C Brief, filed. s/Doerr, Esq.
7/23/08 Respondent's Brief, filed. s/Raquet, Esq.
8/11/08 Petitioner's 80C Reply Brief, filed. s/Doerr, Esq.
8713708 Uncontested Motion to Extend Time to File Reply Brief, filed. a/Doerr, Esq.
Proposed Order, filed.
UNCONTESTED MOTION TO EXTEND TIME TO FILE REPLY BRIEF, Jabar, J.
PetItioner's uncontested motion for time extension for reply brief is
GRANTED.
Copies mailed to attys. of record.
9/18/08 DECISION AND ORDER, Jabar, J.
The petition is DENIED and the decision of the Maine Department of
Health and Human Services is AFFIRMED.
Copies to attys. of record and copies to repository.