The opinion
IN THE COMMONWEALTH COURT OF PENNSYLVANIA
Jose Ramirez, :
Petitioner :
:
v. : No. 60 C.D. 2020
: ARGUED: December 9, 2020
Department of Human Services, :
Respondent :
BEFORE: HONORABLE MARY HANNAH LEAVITT, President Judge1
HONORABLE RENÉE COHN JUBELIRER, Judge
HONORABLE P. KEVIN BROBSON, Judge
HONORABLE PATRICIA A. McCULLOUGH, Judge
HONORABLE ANNE E. COVEY, Judge
HONORABLE CHRISTINE FIZZANO CANNON, Judge
HONORABLE ELLEN CEISLER, Judge
OPINION NOT REPORTED
MEMORANDUM OPINION
BY JUDGE CEISLER FILED: January 22, 2021
Petitioner Jose Ramirez petitions for review of Respondent Department of
Human Services’ December 26, 2019 ruling, which affirmed the Department’s
denial of Ramirez’s application for coverage of his long-term medical care via
Pennsylvania’s General Assistance (GA) program, due to the fact that he is an
undocumented immigrant. Though we conclude that the Department’s ruling was
legally erroneous, we affirm on alternate grounds.
I. Facts and Procedural History
On February 18, 2019, Ramirez, an undocumented immigrant in his late 40s,
was admitted to the Garden Spring Nursing Home in Willow Grove, Pennsylvania.
Certified Record (C.R.) at 29. At that point, Ramirez was suffering from the
1
This case was assigned to the opinion writer before Judge Brobson succeeded Judge
Leavitt as President Judge.
following conditions: anoxic brain damage; quadriplegia; persistent vegetative state;
and contracture of extremities. Id. It is not clear from the record when exactly
Ramirez arrived in the United States, how he came to reside at Garden Spring, or
how he was injured. Id.
On February 22, 2019, Ramirez, through Garden Spring,2 filed an application
with the Department, via which Ramirez sought coverage for his long-term medical
care under Pennsylvania’s Medical Assistance (MA) Program. Id. at 9, 12.3
On August 12, 2019, the Department’s Montgomery County Assistance
Office denied this application, on the basis that Ramirez’s condition did not qualify
for emergency medical assistance, because
the information that [the Department] received [did] not
show that [Ramirez had] a medical condition manifesting
itself by acute symptoms of sufficient severity (including
severe pain) such that the absence of immediate medical
attention could reasonably be expected to result in placing
[Ramirez’s] health in serious jeopardy, serious
2
Ramirez was, and is, in a vegetative state and, thus, cannot play an active role in this
matter, despite the fact that he is obviously its subject.
3
The . . . MA[] Program is authorized by Sections 441.1-453 of the
[Human Services] Code, Act of June 13, 1967, P.L. 31, [as
amended,] added by Act of July 31, 1968, P.L. 904, . . . 62 P.S. §§
441.1-453. Those who are categorically needy or medically needy
under the standards of financial eligibility established by [the
Department] are eligible for MA. See [Sections 441.1 and 442.1 of
the Human Services Code,] 62 P.S. §§ 441.1, 442.1[,] and 55 Pa.
Code §§ 141.81, 171.81. The MA program is funded jointly by the
state and the federal government. Federal funding is contingent upon
adherence to the requirements of the federal Medicaid statute, Title
XIX of the Social Security Act, 42 U.S.C. §§ 1396-1396(p) and its
accompanying regulations. Adherence is normally evaluated by
submission of a plan to the Secretary of the Health and Human
Services Department . . . , who then approves or disapproves the
plan.
Martin v. Dep’t of Pub. Welfare, 514 A.2d 204, 206 n.1 (Pa. Cmwlth. 1986).
2
impairment to bodily functions, or serious dysfunction of
a bodily organ or part.
C.R. at 12.
Ramirez administratively appealed this denial to the Department’s Bureau of
Hearings and Appeals on August 14, 2019. The Bureau’s Administrative Law Judge
Susan E. Logan held an appeal hearing via telephone on November 19, 2019. During
this hearing, the Department explained that it had determined that Ramirez was an
undocumented immigrant and, thus, Ramirez could be eligible for MA benefits only
if he had an emergency medical condition (EMC). Hr’g Tr., 11/19/19, at 13-16. The
Department determined that Ramirez did not suffer from an EMC, because Ramirez
had a permanent medical issue, rather than an acute one; therefore, he was ineligible
for MA benefits. Id. at 16-17. Ramirez’s attorney did not challenge the Department’s
conclusion that Ramirez had not been afflicted by an EMC. Id. at 20. Instead, he
clarified that Ramirez was seeking GA medical benefits, which he claimed are
funded exclusively by the Commonwealth and do not require proof that the applicant
suffers from an EMC. Id. at 20-24. The Department’s attorney then stated that
Ramirez was ineligible for such coverage, because he is an undocumented
immigrant. Id. at 24-25. ALJ Logan asked Ramirez’s attorney if his client was indeed
undocumented, whereupon Ramirez’s attorney admitted he had no evidence to the
contrary. Id. at 25.
On December 17, 2019, ALJ Logan denied Ramirez’s administrative appeal.
After summarizing the parties’ respective positions, ALJ Logan quoted at length
from a number of Department regulations,4 the Department’s Operations
Memorandum 09-06-03, and sections of the Department’s Medical Assistance
4
Specifically, 55 Pa. Code §§ 141.61, 141.81, 149.23, and 150.1-.11. See C.R. at 31-34.
3
Eligibility Handbook,5 which collectively address eligibility relating to citizenship,
alienage, and residency for the GA and MA programs. C.R. at 30-40. In addition,
ALJ Logan quoted 8 U.S.C. § 1641(b), a federal statute that defines “qualified alien”
as “an alien who is lawfully admitted for permanent residence under the Immigration
and Nationality Act [8 U.S.C. §§ 1101-05a, 1151-60, 1181-89, 1201-04, 1221-31,
1252-60, 1281-88, 1301-06, 1321-30, 1351-63a]” as well as Spring Creek
Management, L.P. v. Department of Public Welfare, 45 A.3d 474 (Pa. Cmwlth.
2012), which addresses what constitutes an EMC. C.R. at 35. ALJ Logan concluded
that,
[b]ased on the regulations, Departmental policy, exhibits
and testimony provided, . . . the Department correctly
denied [Ramirez’s] application for MA because he . . . is
an undocumented non-citizen, does not qualify for GA
[medical benefits] because of this status, and does not have
an EMC that meets the criteria for this to be authorized.
Id. at 41.
Ramirez then administratively appealed ALJ Logan’s decision, but the
Department’s Chief Administrative Law Judge Tracy L. Henry affirmed the decision
in full on December 26, 2019. Id. at 26. This petition for review followed on January
25, 2020.6
5
Specifically, Sections 305.4, 305.42, 322.1, 322.3, 322.33, and 322.34 of the Handbook.
See C.R. at 35-40.
6
Prior to filing his petition for review, Ramirez administratively petitioned for
reconsideration of Chief ALJ Henry’s determination on January 10, 2020. C.R. at 43-56. On
January 21, 2020, the Department’s Secretary Teresa D. Miller granted reconsideration, but
Secretary Miller ultimately affirmed Chief ALJ Henry’s determination on February 26, 2020. Id.
at 58, 60. Secretary Miller’s ruling, however, is not before us in this matter.
4
II. Discussion
Ramirez presents a number of arguments for our consideration,7 which we
summarize as follows.
First, the Department’s regulations governing eligibility for GA benefits only
require proof of citizenship when these benefits take the form of Aid to Families
with Dependent Children (AFDC). Since Ramirez was not seeking AFDC benefits,
he did not need to show that he was a citizen of the United States in order to establish
that he was eligible for coverage of his long-term care at Garden Spring via GA
medical benefits. Ramirez’s Br. at 11-14.
Second, the Department improperly relied upon the aforementioned
Operations Memorandum and sections of the Handbook. Neither of these things
constitute properly promulgated administrative regulations, as they were not subject
to notice or the comment and review process, and, thus, they cannot serve as a basis
for denying Ramirez access to GA medical benefits. Id. at 15-16.
Third, MA benefits and GA medical benefits are two distinct categories
subject to different eligibility requirements. The Department erroneously conflated
the requirements governing MA benefits, which include that the applicant be a
citizen of the United States, a refugee, or a certain type of lawfully admitted
immigrant, with those governing GA medical benefits, which do not include this
type of requirement. Id. at 17-21.
Finally, Ramirez is eligible for GA medical benefits under the Department’s
regulations for coverage of his long-term care. He has a permanent disability which
7
“Our scope of review is limited to determining whether constitutional rights were
violated, whether the adjudication is in accordance with law or whether necessary findings of fact
are supported by substantial evidence. Section 704 of the Administrative Agency Law, 2 Pa. C.S.
§ 704.” Gilroy v. Dep’t of Pub. Welfare, 946 A.2d 194, 196 n.3 (Pa. Cmwlth. 2008).
5
renders him unable to financially provide for himself, and the Department’s
regulations specifically authorize GA medical benefits in such a situation. The
Department erred in concluding otherwise. Id. at 22-25.
We agree with Ramirez that the Department failed to articulate a legally valid
basis for denying his application. Indeed, the administrative regulations, case law,
and statutes discussed by ALJ Logan in her December 17, 2019 decision do not, in
themselves, establish that undocumented immigrants are ineligible for GA medical
benefits. Furthermore, the other documents cited in this decision, i.e., the Handbook
and the Operations Memorandum, were not subject to notice, public comment, or
review, and therefore do not carry the force of law. See Nw. Youth Servs., Inc. v.
Dep’t of Pub. Welfare, 66 A.3d 301 (Pa. 2013). As such, none of these cited materials
stand as an impediment to granting Ramirez such benefits.
Even so, this does not mean that Ramirez is entitled to receive them. Despite
the Department’s erroneous reasoning, it remains that “we may affirm an agency’s
decision ‘on other grounds where grounds for affirmance exist.’” Turner v.
Unemployment Comp. Bd. of Rev., 899 A.2d 381, 385 (Pa. Cmwlth. 2006) (quoting
Kutnyak v. Dep’t of Corr., 748 A.2d 1275, 1279 n. 9 (Pa. Cmwlth. 2000)). In this
situation, another law, 8 U.S.C. § 1621, bars Ramirez from receiving GA medical
benefits. This statute reads as follows:
(a) In general
Notwithstanding any other provision of law and except as
provided in subsections (b) and (d), an alien who is not--
(1) a qualified alien (as defined in section 1641 of
this title),
(2) a nonimmigrant under the Immigration and
Nationality Act, or
6
(3) an alien who is paroled into the United States
under section 212(d)(5) of such Act for less than one
year,
is not eligible for any State or local public benefit (as
defined in subsection (c)).
(b) Exceptions
Subsection (a) shall not apply with respect to the following
State or local public benefits:
(1) Assistance for health care items and services that
are necessary for the treatment of an emergency
medical condition (as defined in section
1396b(v)(3) of Title 42) of the alien involved and
are not related to an organ transplant procedure.
(2) Short-term, non-cash, in-kind emergency
disaster relief.
(3) Public health assistance for immunizations with
respect to immunizable diseases and for testing and
treatment of symptoms of communicable diseases
whether or not such symptoms are caused by a
communicable disease.
(4) Programs, services, or assistance (such as soup
kitchens, crisis counseling and intervention, and
short-term shelter) specified by the Attorney
General, in the Attorney General’s sole and
unreviewable discretion after consultation with
appropriate Federal agencies and departments,
which (A) deliver in-kind services at the community
level, including through public or private nonprofit
agencies; (B) do not condition the provision of
assistance, the amount of assistance provided, or the
cost of assistance provided on the individual
recipient's income or resources; and (C) are
necessary for the protection of life or safety.
(c) “State or local public benefit” defined
(1) Except as provided in paragraphs (2) and (3), for
purposes of this subchapter the term “State or local
public benefit” means--
(A) any grant, contract, loan, professional
license, or commercial license provided by an
7
agency of a State or local government or by
appropriated funds of a State or local
government; and
(B) any retirement, welfare, health, disability,
public or assisted housing, postsecondary
education, food assistance, unemployment
benefit, or any other similar benefit for which
payments or assistance are provided to an
individual, household, or family eligibility
unit by an agency of a State or local
government or by appropriated funds of a
State or local government.
(2) Such term shall not apply--
(A) to any contract, professional license, or
commercial license for a nonimmigrant
whose visa for entry is related to such
employment in the United States, or to a
citizen of a freely associated state, if section
141 of the applicable compact of free
association approved in Public Law 99-239
or 99-658 (or a successor provision) is in
effect;
(B) with respect to benefits for an alien who
as a work authorized nonimmigrant or as an
alien lawfully admitted for permanent
residence under the Immigration and
Nationality Act qualified for such benefits
and for whom the United States under
reciprocal treaty agreements is required to
pay benefits, as determined by the Secretary
of State, after consultation with the Attorney
General; or
(C) to the issuance of a professional license
to, or the renewal of a professional license by,
a foreign national not physically present in
the United States.
(3) Such term does not include any Federal public
benefit under section 1611(c) of this title.
(d) State authority to provide for eligibility of illegal aliens
for State and local public benefits
8
A State may provide that an alien who is not lawfully
present in the United States is eligible for any State or local
public benefit for which such alien would otherwise be
ineligible under subsection (a) only through the enactment
of a State law after August 22, 1996, which affirmatively
provides for such eligibility.
8 U.S.C. § 1621. The GA benefits Ramirez seeks fall within this statute’s definition
of “public benefits,” Ramirez does not fall within any of the categories of people
generally allowed to get such benefits, and none of the exceptions to this statutory
prohibition apply to Ramirez’s situation.
Furthermore, our General Assembly has not only failed to pass a law allowing
undocumented immigrants to receive public benefits, as allowed under 8 U.S.C. §
1621(d), but has enacted a statute of its own that effectively excludes Ramirez from
receiving the benefits he seeks. Per Section 432 of the Human Services Code,
[e]xcept as hereinafter otherwise provided, and subject to
the rules, regulations, and standards established by the
department, both as to eligibility for assistance and as to
its nature and extent, needy persons of the classes defined
in clauses (1), (2), and (3) shall be eligible for [GA]:
....
(3) Other persons who are citizens of the United States, or
lawfully admitted aliens who are eligible for general
assistance.
62 P.S. § 432. This restriction applies to all forms of GA. Id. § 403(a) (“The
[D]epartment is responsible for maintaining uniformity in the administration of
public welfare, including general assistance, throughout the Commonwealth.”).
Here, there is no proof that Ramirez is either a citizen of the United States or a
lawfully admitted alien. Consequently, he is ineligible under Pennsylvania law for
GA medical benefits to cover his long-term care at Garden Spring.
9
III. Conclusion
Therefore, as both federal and Pennsylvania law bar Ramirez from receiving
GA medical benefits, we affirm the Department’s December 26, 2019 ruling on the
aforementioned, alternate grounds.
__________________________________
ELLEN CEISLER, Judge
Judge Crompton did not participate in the decision of this case.
10
IN THE COMMONWEALTH COURT OF PENNSYLVANIA
Jose Ramirez, :
Petitioner :
:
v. : No. 60 C.D. 2020
:
Department of Human Services, :
Respondent :
ORDER
AND NOW, this 22nd day of January, 2021, Respondent Department of
Human Services’ December 26, 2019 ruling is AFFIRMED.
__________________________________
ELLEN CEISLER, Judge