Estate of Robertson Ex Rel. Robertson v. Cass County Social Services

492 N.W.2d 599, 1992 N.D. LEXIS 236, 1992 WL 340910
CourtNorth Dakota Supreme Court
DecidedNovember 24, 1992
DocketCiv. 920147
StatusPublished
Cited by16 cases

This text of 492 N.W.2d 599 (Estate of Robertson Ex Rel. Robertson v. Cass County Social Services) is published on Counsel Stack Legal Research, covering North Dakota Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Estate of Robertson Ex Rel. Robertson v. Cass County Social Services, 492 N.W.2d 599, 1992 N.D. LEXIS 236, 1992 WL 340910 (N.D. 1992).

Opinion

MESCHKE, Justice.

The Department of Human Services ruled that Lloyd Robertson's available resources exceeded eligibility limits, and denied his application for medical assistance benefits. His estate appeals a district court judgment affirming the Department’s decision. 1 We reverse and remand to the district court with directions to remand to the Department for further proceedings.

Lloyd Robertson was a married, 75 year-old person who was blind and incapacitated, and who entered the Bethany Nursing Home in Fargo before October 1, 1989. His wife, Doranna, who is also blind, continued to live in the community where she owned and operated “Dee’s Coffee Mug,” a coffee shop located in the Federal Building in Fargo.

On April 25,1990, Doranna, with the help of a Legal Assistance of North Dakota *601 [LAND] representative, applied for medical assistance benefits on Lloyd’s behalf. Do-ranna did not disclose her business checking account for Dee’s Coffee Mug when listing the couple’s assets on the application form. An eligibility specialist for Cass County Social Services discovered the account when she sent a release to the bank and found that the account had a balance of $19,966.15. Upon further inquiry, the eligibility specialist learned that the checking account balance from January 1988 through January 1990 fluctuated between $7,000 and $14,000.

The Department excluded that part of the business account it considered to be her self-employment income, but considered the remaining amount of $15,380.08 as an available, countable asset to determine Lloyd’s eligibility for medical assistance benefits. This counted amount of $15,-380.08, when added to the couple’s other nonexcludable assets, totaled $38,009.63. This total exceeded the $25,000 maximum resource allowance in effect at the time. The Department denied the application.

The notice of denial listed “excess resources” as the reason, and it further stated that “[t]his action is based on MA Manual section 510-05-35-05 ... Business accounts are countable and treated like any other accounts.” Doranna requested a hearing, claiming that “[m]y business account should not be included in determining my resource eligibility.” In correspondence with the hearing officer prior to the administrative hearing, the eligibility specialist stated that the “issue being appealed is whether business accounts for the Medicaid program are countable.” At the beginning of the administrative hearing, the hearing officer also noted that the sole question concerned “the proper interpretation of the law....” The hearing officer stated that “there are no facts in dispute” and that the question “has to do with the availability ... for medical assistance eligibility purposes of a business account.”

At the hearing, Doranna argued that the business account should not have been considered an available resource because the Catastrophic Coverage Act of 1988, at 42 U.S.C. § 1396a(r)(2), required that the methodology used by the state for determining income and resource eligibility could not be more restrictive for the aged, blind and disabled than the methodology used under the Supplemental Security Income [SSI] program. Doranna relied on a federal regulation, 20 C.F.R. § 416.1220, that, for purposes of the SSI program, exempts property essential to self-support, including liquid resources used in conjunction with the operation of a trade or business.

The hearing officer found that Lloyd “failed to demonstrate that a checking account that the county valued at $15,380.08 was exempt from consideration as an available asset when determining [Lloyd’s] medical assistance eligibility.” The hearing officer reasoned:

The federal regulations relied upon by [the LAND representative] exempt property essential to self-support, but provide that “liquid resources other than those used as part of a trade or business are not property essential to self-support.” There may be a separate and distinct issue here as to whether those regulations are applicable to so-called “209(b)” states such as North Dakota. However, the hearing officer finds it unnecessary to make a finding in that regard, for even if they were, the burden would be on [Lloyd] to demonstrate that the $15,-380 amount was, in fact, used as part of [Doranna’s] lunch stand business in order to be exempt, and no attempt was made to do that. The account was not even disclosed on the application. If [Do-ranna] had intended to claim that the account should be excluded, she would have reported it on the application, and then provided documentation to the county office relative to why she needs over $15,000 on hand to purchase supplies and pay bills related to the operation of a lunch stand.

Doranna appealed to the district court, arguing again that the Department could not apply more restrictive requirements than those employed under the SSI program. She also argued that, in any event, an existing provision of the North Dakota Ad *602 ministrative Code, at NDAC 75-02-02-23, authorized exclusion of the business account as “property which is essential to earning a livelihood.” The district court affirmed the Department’s decision, agreeing with its argument that the Department could validly apply more restrictive eligibility criteria in determining Medicaid eligibility than that used in administering the SSI program. Doranna appealed.

On appeal here, neither side argues about whether the Department’s eligibility requirements for medical assistance may be more restrictive than those under the SSI program. Instead, the Department now argues that, under its then-existing regulations, “business accounts are not automatically excluded as property essential to earning a livelihood,” and that a business account, or part of it, may be excluded if the applicant proves that “the applicant or recipient is actively engaged in using [the property] to earn income and where the total benefit of such income is derived for the applicant or recipient’s needs,” the criteria stated in NDAC 75-02-02-03.1(8). 2 The Department, however, seeks affir-mance because, as the hearing officer determined, Doranna failed to present any evidence to show what part of her business account was essential to earning a livelihood, and therefore, failed to meet the burden of proving an entitlement to benefits. We reject this argument.

Due process prescribes that the participant in an administrative proceeding be given notice of the general nature of the questions to be heard, and an opportunity to prepare and to be heard on those questions. Hentz Truck Line, Inc. v. Elkin, 294 N.W.2d 774, 780 (N.D.1980). Notice is adequate if it apprises the party of the nature of the proceedings so that there is no unfair surprise. Erovick v. Job Service North Dakota, 409 N.W.2d 629, 631 (N.D.1987). These principles are embodied in a statutory directive:

Whenever an administrative agency ... holds any contested case hearing upon ...

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Bluebook (online)
492 N.W.2d 599, 1992 N.D. LEXIS 236, 1992 WL 340910, Counsel Stack Legal Research, https://law.counselstack.com/opinion/estate-of-robertson-ex-rel-robertson-v-cass-county-social-services-nd-1992.