Appeal of Huff

910 A.2d 1287, 154 N.H. 414, 2006 N.H. LEXIS 181
CourtSupreme Court of New Hampshire
DecidedNovember 28, 2006
DocketNo. 2005-856
StatusPublished
Cited by3 cases

This text of 910 A.2d 1287 (Appeal of Huff) is published on Counsel Stack Legal Research, covering Supreme Court of New Hampshire primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Appeal of Huff, 910 A.2d 1287, 154 N.H. 414, 2006 N.H. LEXIS 181 (N.H. 2006).

Opinion

DUGGAN, J.

The petitioner, Emily Huff, appeals a final decision of the New Hampshire Department of Health and Human Services Administrative Appeals Unit (AAU). The AAU concluded that special needs trust distributions function as income for purposes of Medicaid eligibility. We vacate and remand.

The following facts were found by the AAU or are uncontested. The petitioner is a disabled, young woman. On February 24, 2004, the petitioner’s mother, who also serves as her legal guardian, applied on the petitioner’s behalf for medical assistance under the Aid to the Permanently and Totally Disabled (APTD) program. As part of her application, the petitioner informed the department of health and human services (DHHS) that she was the beneficiary of a special needs trust, the Emily Huff Irrevocable Trust (the trust).

DHHS determined that the petitioner satisfied the APTD’s categorical criteria and therefore sought to determine her financial eligibility. In order to ascertain the petitioner’s financial eligibility, DHHS verified her monthly Social Security benefits and requested information concerning expenditures made by the trust. On May 7, 2004, the petitioner’s mother, who also serves as trustee for the trust, provided a list of expenditures from the trust, which included payments for: (1) federal and state taxes; (2) attorney’s fees; (3) a camp attended by the petitioner; (4) a bond required for the guardianship; and (5) a trip to Wisconsin. DHHS concluded that some of these expenditures constituted income for purposes of determining the petitioner’s financial eligibility for medical assistance. [416]*416Based upon this conclusion, DHHS determined that the petitioner qualified as medically needy, but not categorically needy; therefore, she would have to meet a spend-down requirement before she could receive Medicaid.

From DHHS’ initial determination, the petitioner appealed to the AAU. There, a hearings officer reversed DHHS’ finding as to the amount of the spend-down that the petitioner would be required to meet, but upheld DHHS’ determination that trust expenditures for the benefit, or on behalf, of the petitioner constituted income for purposes of Medicaid eligibility. The petitioner moved for reconsideration, which the hearings officer denied. The petitioner also moved to supplement the record with documents pertaining to the department’s Medicaid eligibility policies in effect on January 1,1972. The hearings officer denied this request as well, concluding that the petitioner had not followed the appropriate procedure to supplement the record or to introduce additional information as part of her motion for reconsideration.

On appeal, the petitioner argues that the AAU erred in counting trust expenditures as income for purposes of Medicaid eligibility and in denying her motion to supplement the record. The petitioner also argues that DHHS and the AAU violated her due process rights by engaging in improper rule-making and by relying on unwritten rules in adjudicating her application. DHHS counters that: (1) this matter may only be brought as a declaratory judgment action in Superior Court; and (2) the petitioner’s income was lawfully and properly calculated.

Established in 1965 as Title XIX of the Social Security Act (SSA), the Medicaid program offers federal financial assistance to states that opt to reimburse certain costs of medical treatment for needy persons. Schweiker v. Gray Panthers, 453 U.S. 34, 36 (1981). States participating in the program must develop a plan that includes reasonable standards for determining an individual’s eligibility for Medicaid and the extent of medical assistance to be provided. Id. “An individual is entitled to Medicaid if [s]he fulfills the criteria established by the State in which [s]he lives. State Medicaid plans must comply with requirements imposed both by the [SSA] itself and by the Secretary of Health and Human Services.” Id. at 36-37 (citation omitted).

“As originally enacted, Medicaid required participating States to provide medical assistance to ‘categorically needy’ individuals who received cash payments under one of four welfare programs established elsewhere in the [SSA].” Id. at 37 (citation omitted). These programs included Old Age Assistance, Aid to Families with Dependent Children, Aid to the Blind, and Aid to the Permanently and Totally Disabled. Id. at 37 n.l. Congress deemed the individuals who participated in these four [417]*417programs to be especially deserving of public assistance. Id. at 37. States were also allowed to offer assistance to the “medically needy,” meaning persons who could not pay for their medical expenses but who had “incomes too large to qualify for categorical assistance.” Id.

In 1972, Congress replaced three of the four categorical assistance programs with a new program called Supplemental Security Income for the Aged, Blind, and Disabled (SSI). Under SSI, the Federal Government displaced the States by assuming responsibility for both funding payments and setting standards of need. In some States, the number of individuals eligible for SSI assistance was significantly larger than the number eligible under the earlier, state-run categorical need programs.
The expansion of general welfare accomplished by SSI portended increased Medicaid obligations for some States because Congress retained the requirement that all recipients of categorical welfare assistance — now SSI — were entitled to Medicaid. Congress feared that these States would withdraw from the cooperative Medicaid program rather than expand their Medicaid coverage in a manner commensurate with the expansion of categorical assistance. In order not to impose a substantial fiscal burden on these States or discourage them from participating, Congress offered what has become known as the § 209(b) option. Under it, States could elect to provide Medicaid assistance only to those individuals who would have been eligible under the state Medicaid plan in effect on January 1,1972.

Id. at 38-39 (quotations and citations omitted). “Section 209(b) allowed states which had used more restrictive criteria than those subsequently enacted in SSI to continue using those more restrictive criteria after the 1974 effective date of the SSI Program.” Mowbray v. Kozlowski, 914 F.2d 593, 596 (4th Cir. 1990). Nevertheless, if a state adopted section 209(b) and retained its more restrictive standards, it was required to provide benefits for the medically needy pursuant to the plan under which it operated on January 1,1972, and which had been approved by the Federal Department of Health and Human Services. Id.; see also 42 U.S.C. § 1396a(f) (2000).

The United States District Court for the District of New Hampshire has held that “New Hampshire is a ‘§ 209(b) option’ state, and therefore the eligibility standards for medical assistance are the same as those in effect in New Hampshire on January 1,1972,” Duquette v. Dupuis, 582 F. Supp. 1365, 1368 (D.N.H. 1984) (citation omitted), under the State’s approved plan. See 42 U.S.C. § 1396a(f).

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Petition of Estate of Thea Braiterman
169 N.H. 217 (Supreme Court of New Hampshire, 2016)
Smith v. City of Franklin
987 A.2d 127 (Supreme Court of New Hampshire, 2010)
In Re Lowy (Dept. of Health & Hum. Servs.)
931 A.2d 552 (Supreme Court of New Hampshire, 2007)

Cite This Page — Counsel Stack

Bluebook (online)
910 A.2d 1287, 154 N.H. 414, 2006 N.H. LEXIS 181, Counsel Stack Legal Research, https://law.counselstack.com/opinion/appeal-of-huff-nh-2006.