Elliott v. State Department of Social & Rehabilitation Services

597 P.2d 679, 3 Kan. App. 2d 494, 1979 Kan. App. LEXIS 226
CourtCourt of Appeals of Kansas
DecidedJuly 13, 1979
DocketNo. 49,900
StatusPublished
Cited by1 cases

This text of 597 P.2d 679 (Elliott v. State Department of Social & Rehabilitation Services) is published on Counsel Stack Legal Research, covering Court of Appeals of Kansas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Elliott v. State Department of Social & Rehabilitation Services, 597 P.2d 679, 3 Kan. App. 2d 494, 1979 Kan. App. LEXIS 226 (kanctapp 1979).

Opinion

Foth, C.J.:

The issue in this case is whether Kansas may refuse to furnish medical assistance to an otherwise eligible Kansas resident who chooses to receive care in another state. We hold that it may if the choice is in fact voluntary.

Elaine Elliott was born in Kansas in 1921, the daughter of Kansas natives who throughout her lifetime have been residents of Kansas. She was a retarded child, and has been adjudged to be an incapacitated person. She attended school only one year. Otherwise she remained at home until 1962, when her parents decided to institutionalize her. In that year, as her judicially appointed legal guardians, the parents placed Elaine in a long term care home at Bethpage Mission in Axtell, Nebraska, where she has since remained. In 1977 the parents applied for medical assistance from the state department of social and rehabilitation services. Assistance was denied at the local level and the denial was affirmed by the state appeals committee of SRS after a hearing under K.S.A. 75-3306. Elaine’s parents appealed to the district court, which upheld the decision of the appeals committee, and they have now appealed to this court.

Absent statutory authority to the contrary, judicial review of administrative decisions, even when made by an agency exercis[495]*495ing quasi-judicial functions, is limited to determining as a matter of law whether: (1) the tribunal acted fraudulently, arbitrarily or capriciously; (2) the administrative order is substantially supported by evidence; and (3) the tribunal’s action was within the scope of its authority. Woltje v. Kansas Public Employees Retirement System, 225 Kan. 495, 592 P.2d 872 (1979); Behrmann v. Public Employees Relations Board, 225 Kan. 435, 591 P.2d 173 (1979); Stephens v. Unified School District, 218 Kan. 220, 546 P.2d 197 (1975). That limitation is applicable here.

The district court examined the decision of the appeals committee in the light of the controlling subsections of K.A.R. 30-6-10, promulgated by the secretary of SRS, and found it reasonable. Subsection I defines residence. On this aspect the district court concluded that “[ujnder the record in this case, the applicant would probably have to be considered as meeting the residency requirement.” SRS admits this much in its brief. The court noted, however, that there is a separate physical presence requirement in Subsection J which the appellant obviously does not meet:

“J. Physical presence. An applicant or recipient must be living in the state of Kansas.
“Exception: A person receiving medical care including long-term care outside of Kansas whose health would be endangered by the postponement of medical services until his or her return to the state or if travel to return to Kansas would endanger his or her health may be determined eligible for participation in the medical assistance program if such individual is a resident of Kansas and all other eligibility factors are met. Persons receiving care on an ongoing basis in a care facility in a state other than Kansas, and who do not return to a care facility in Kansas when they are able to do so, shall no longer be eligible to participate in the Kansas medical assistance program. For persons who are minors or who are under guardianship the actions of the parent or guardian shall be deemed to be the actions of the child or ward in determining whether or not the person is remaining outside the state voluntarily.”

On the basis of this subsection the court held:

“[T]he Appeals Committee had a valid basis for denying medical assistance under their regulation requiring physical presence and the State Department of Social and Rehabilitation Services has the authority to promulgate such a regulation. The evidence is insufficient to bring the applicant under the exceptions to the physical presence regulation.”

On appeal two basic arguments are made in support of Elaine’s eligibility. First, it is contended that the local SRS office denied assistance because of an erroneous finding that she was a nonresident. While that may be true, the decisions of both the appeals [496]*496committee and the district court were based on administrative requirements that, with certain limited exceptions, recipients of medical assistance must be physically present in Kansas. The district court clearly assumed that she was a resident of Kansas. Thus any flaw in the reasoning of the local office did not figure in the decision now under review.

Her second contention is that she is eligible even under the administrative requirement, now embodied in K.A.R. 30-6-10 J, quoted above. The regulation was designed to comport with the federal regulations controlling the contents of state plans for administering medical assistance financed under the Social Security Act, and specifically former 45 C.F.R. § 248.40 (1976). Two circumstances are recognized where medical assistance will be granted to a resident who is outside the state: where immediate treatment is medically required; and where travel to the home state would endanger the patient’s health. (The federal regulation had a third element, an emergency illness or accident, which was covered by the first portion of the Kansas regulation.) The trial court found that Elaine had not shown that she fit either exception; there was no immediacy in her situation, and while she was well adjusted in her Nebraska environment there was no evidence that a move would be harmful to her health. The record supports these findings. The burden was on her to establish that she came within an exception. Cf. State v. White, 213 Kan. 276, 280, 515 P.2d 1081 (1973); City of Winfield v. Board of County Commissioners, 205 Kan. 333, Syl. ¶ 2, 469 P.2d 424 (1970). Under accepted rules of appellate review we cannot disturb what are essentially negative findings. Highland Lumber Co., Inc. v. Knudson, 219 Kan. 366, Syl. ¶ 5, 548 P.2d 719 (1976).

There is, however, one additional facet to this case. Effective July 1, 1978, the legislature spoke directly to cases such as Elaine’s in L. 1978, ch. 159, § 3. That enactment added a new subsection to the statutory requirements for assistance, which now appears as K.S.A. 1978 Supp. 39-709(e):

“(e) A person who is receiving medical care including long-term care outside of Kansas whose health would be endangered by the postponement of medical care until his or her return to the state or whose health would be endangered by travel to return to Kansas, may be determined eligible for medical assistance if such individual is a resident of Kansas and all other eligibility factors are met.

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Bluebook (online)
597 P.2d 679, 3 Kan. App. 2d 494, 1979 Kan. App. LEXIS 226, Counsel Stack Legal Research, https://law.counselstack.com/opinion/elliott-v-state-department-of-social-rehabilitation-services-kanctapp-1979.