Burinskas v. Department of Social Services

691 A.2d 586, 240 Conn. 141, 1997 Conn. LEXIS 55
CourtSupreme Court of Connecticut
DecidedMarch 18, 1997
Docket15440
StatusPublished
Cited by57 cases

This text of 691 A.2d 586 (Burinskas v. Department of Social Services) is published on Counsel Stack Legal Research, covering Supreme Court of Connecticut primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Burinskas v. Department of Social Services, 691 A.2d 586, 240 Conn. 141, 1997 Conn. LEXIS 55 (Colo. 1997).

Opinion

Opinion

NORCOTT, J.

Under medicaid eligibility law, the resources of an institutionalized applicant may be allocated to a spouse under circumstances in which the spouse needs income “due to exceptional circumstances resulting in significant financial duress . . . .” 42 U.S.C. § 1396r-5 (e) (2) (B). The principal issue in this administrative appeal is whether the defendant, the department of social services (department), properly applied the “exceptional circumstances” standard in [143]*143refusing to allocate resources to the spouse of an institutionalized applicant. The plaintiff Mary Burinskas applied for and was denied medicaid benefits by the department. The denial was affirmed both after a fair hearing before a hearing officer and, upon request, after a reconsideration of the fair hearing decision by the same hearing officer. Thereafter, Mary Burinskas and her husband, the plaintiff Walter Burinskas,1 appealed from the department’s decision to the trial court pursuant to General Statutes § 4-183 (a), which authorizes appeals to the trial court upon exhaustion of all administrative remedies. The trial court reversed the department’s denial of medicaid benefits and remanded the case for further administrative proceedings. The department appealed from this judgment to the Appellate Court, and we transferred the appeal to this court pursuant to Practice Book § 4023 and General Statutes §51-199 (c). We affirm the judgment of the trial court in part and reverse it in part.

The following facts are relevant to this appeal. In 1994, the plaintiffs applied for medicaid benefits to defray costs associated with Mary Burinskas’ institutionalization for Alzheimer’s disease. The department, after calculating the couple’s total assets, determined that the value of Mary Burinskas’ assets exceeded the $1600 limit for program eligibility;2 see General Statutes §§ 17b-80 and 17b-264; Department of Income Maintenance, Uniform Policy Manual (1993) § 4005.10 (Uniform Policy Manual); and, on that basis, denied her application for medicaid benefits.

The plaintiffs then exercised their right to an administrative appeal before a fair hearing officer. See 42 U.S.C. [144]*144§ 1396r-5 (e) (2) (A); Uniform Policy Manual (1989) § 1570.25. At the fair hearing, they claimed that Mary Burinskas’ allocation of the couple’s assets should be decreased and Walter Burinskas’ allocation increased in order to generate income necessary to cover Walter Burinskas’ living expenses. In addition to presenting evidence regarding all of his monthly expenses,3 the plaintiffs contended that Walter Burinskas suffered from emphysema and, as a result, incurred particular expenses for snow removal, home maintenance, lawn care, and housecleaning chores that he was unable to perform himself. Under the plaintiffs’ reallocation proposal, resources would have been transferred to Walter Burinskas sufficient to reduce Mary Burinskas’ asset share to the medicaid eligibility level.

Both after the fair hearing and upon reconsideration, the hearing officer refused to recalculate Mary Burinskas’ asset share to reflect Walter Burinskas’ expenses. In his reconsideration report, the hearing officer recognized that under relevant medicaid law, resources may be allocated to the spouse of an institutionalized applicant where the spouse needs income “due to exceptional circumstances resulting in significant financial duress.” 42 U.S.C. § 1396r-5 (e) (2) (B); Uniform Policy Manual (1989) § 1570.25 (D) (3) (b). The hearing officer, in construing this standard, stated that in order for an expense to qualify under this standard, “the expense must be an exceptional circumstance . . . .” (Emphasis added.) The hearing officer then held that expenses associated with such things as snow removal and lawn care were “expected everyday expenses” and thus insufficiently exceptional to war[145]*145rant resource reallocation. The hearing officer refused to lower Mary Burinskas’ asset share below the eligibility level and declined her medicaid application.4

On appeal to the trial court, the plaintiffs claimed that the hearing officer had improperly applied the exceptional circumstances standard. They argued that the hearing officer had focused on the exceptional nature of each expense and not on the circumstances giving rise to each expense. The trial court agreed. It concluded that the hearing officer “unmistakably [had taken] his task to be determining whether an expense was exceptional,” and not whether the expense arose from exceptional circumstances. Deeming this approach “unsupported by the text” of either department regulations or federal statutes, the trial court reversed the hearing officer’s decision and remanded the case for further administrative proceedings. Additionally, the trial court awarded attorney’s fees to the plaintiffs pursuant to General Statutes § 4-184a (b).5

On appeal, the department challenges the trial court’s determinations. It contends that the hearing officer’s reconsideration report,6 read in its entirety, reveals that [146]*146the hearing officer functionally applied the proper exceptional circumstances standard and that, if the hearing officer imprecisely articulated this standard, he did so in response to the manner in which the plaintiffs had addressed their claims. The department further contends that the hearing officer’s decision was consistent with Congress’ intent, in prescribing relevant medicaid eligibility law, to prevent spousal impoverishment without guaranteeing any preset living standard. Finally, the department claims that the hearing officer’s report, even if flawed, is not “without any substantial justification” as that phrase is used in subsection (b) of § 4-184a, the attorney’s fees statute. We agree with the trial court that the hearing officer employed an improper standard in determining whether Walter Burinskas’ expenses resulted from exceptional circumstances and that, therefore, the hearing officer’s decision must be reversed. We conclude, however, that the trial court abused its discretion in awarding attorney’s fees pursuant to § 4-184a (b).

I

The department first claims that the trial court improperly reversed the decision of the administrative hearing officer. Judicial review of an agency decision is limited. See General Statutes § 4-183 (j);7 Connecticut [147]*147Alcohol & Drug Abuse Commission v. Freedom of Information Commission, 233 Conn. 28, 39, 657 A.2d 630 (1995). “[W]e must decide, in view of all of the evidence, whether the agency, in issuing its order, acted unreasonably, arbitrarily or illegally, or abused its discretion. . . . Even as to questions of law, [t]he court’s ultimate duty is only to decide whether, in light of the evidence, the [agency] has acted unreasonably, arbitrarily, illegally, or in abuse of its discretion. . . . Conclusions of law reached by the administrative agency must stand if the court determines that they resulted from a correct application of the law

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Bluebook (online)
691 A.2d 586, 240 Conn. 141, 1997 Conn. LEXIS 55, Counsel Stack Legal Research, https://law.counselstack.com/opinion/burinskas-v-department-of-social-services-conn-1997.