Plumb v. Missouri Department of Social Services, Family Support Division

246 S.W.3d 475, 2007 Mo. App. LEXIS 964, 2007 WL 1814396
CourtMissouri Court of Appeals
DecidedJune 26, 2007
DocketED 88643
StatusPublished
Cited by4 cases

This text of 246 S.W.3d 475 (Plumb v. Missouri Department of Social Services, Family Support Division) is published on Counsel Stack Legal Research, covering Missouri Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Plumb v. Missouri Department of Social Services, Family Support Division, 246 S.W.3d 475, 2007 Mo. App. LEXIS 964, 2007 WL 1814396 (Mo. Ct. App. 2007).

Opinion

OPINION

GEORGE W. DRAPER III, Presiding Judge.

Nellie Plumb (hereinafter, “Claimant”) appeals from the decision of the Missouri Department of Social Services, Family Support Division (hereinafter, “the Division”) decision denying her application to increase her spouse’s, Hugh Plumb (hereinafter, “Husband”), minimal monthly maintenance needs allowance (hereinafter, “MMMNA”). The Division appeals the circuit court’s judgment ordering it to pay Claimant’s attorney’s fees in the amount of $5,500.00. We affirm the circuit court’s judgment granting Husband an increase in his MMMNA. We reverse the circuit court’s judgment ordering the Division to pay Claimant’s attorney’s fees.

The facts are undisputed. Claimant began a period of continuous institutionalization in a nursing facility in January 2004. On July 29, 2004, Claimant applied for Medical Assistant Vendor Benefits (hereinafter, “benefits”) and submitted a Declaration of the Assessment of Assets form. 1 The Division rejected her application on September 7, 2004, finding she was ineligible based upon a determination that Claimant possessed resources in excess of the maximum allowed.

Claimant requested an administrative hearing, which was held on October 12, 2004. At the hearing, the Division presented testimony from a caseworker explaining how Claimant’s application and assets were analyzed and subsequently determined to exceed the maximum allowed in order to qualify for benefits.

Husband also testified at the hearing. Husband presented uncontradicted evidence as to his individual income and monthly expenses. Husband’s monthly expenses totaled approximately $2,861.72 per month. Since Claimant is institutionalized in a nursing home, Husband lives alone. He testified he had shelter expenses, including a mortgage, property taxes, utilities, insurance, lawn care, and subdivision fees. Husband testified he had to incur the expense for lawn care and snow removal because he is restricted medically from performing those duties due to a heart condition. Other expenses included $400 per month for food and $100 per month for clothing.

*478 The largest expense Husband incurred monthly was $672.50 in medically related expenses. After Husband detailed all of his medical expenses, Claimant’s attorney asked, “[I]f you were not awarded an increase to pay for those prescriptions costs[,] would they cause you a lot of financial stress?” Husband answered, “Well some way or the other I’ll have to make it; I’ll have to cut something out or figure some way you know I can reduce it or something.” Claimant’s attorney attempted to clarify whether Husband felt “a lot of financial strain,” to which Husband answered, ‘Well no[,] some way I’ll make it.”

The Division issued its decision on February 16, 2005, reversing its initial decision to deny benefits. The Division awarded Claimant benefits and Husband was allowed to keep all of the couple’s assets in order to attempt to increase his monthly income to meet his MMMNA. The Division recognized Husband had out-of-pocket medical expenses, health insurance premiums, medical co-payments, and other listed expenses relating to his health in the amount of $672.50 per month. However, the Division found such expenses “did not represent exceptional circumstances resulting in significant financial duress” and did not increase his MMMNA to cover those expenses.

Claimant filed a timely application for judicial review with the circuit court contesting the Division’s denial of an increase in Husband’s MMMNA. The circuit court heard oral argument and received written briefs on the issue. On July 27, 2006, the circuit court reversed the Division’s decision denying an increase in Husband’s MMMNA based upon Husband’s uncon-tradicted testimony regarding his medical expenses. The circuit court found these expenses presented significant financial duress. Further, the circuit court ordered the Division to pay Claimant’s attorney’s fees in the amount of $5,500.00, pursuant to Section 536.087 RSMo (2000). 2 Claimant, as the party aggrieved by the Division’s decision under review, filed the appellant’s brief in this Court pursuant to Rule 84.05(e). 3

When reviewing an administrative action, this Court examines the Division’s decision, not the circuit court’s judgment. Reed v. Dep’t. of Soc. Serv., 193 S.W.3d 839, 842 (Mo.App.E.D.2006). Further, we must defer to the Division’s findings of fact and consider the evidence in the light most favorable to its decision. Pulliam v. Dep’t of Soc. Serv., 96 S.W.3d 904, 906 (Mo.App.W.D.2003). Section 536.140.2 mandates we examine the Division’s decision to determine whether it was: (1) in violation of constitutional provisions; (2) in excess of the statutory authority or jurisdiction of the agency; (3) unsupported by competent and substantial evidence upon the whole record; (4) unauthorized by law; (5) made upon unlawful procedure or without a fair trial; (6) arbitrary, capricious, or unreasonable; or (7) an abuse of discretion. When reviewing the record, we must review the evidence in the light most favorable to the agency’s decision and disregard evidence that might support findings different from those of the agency. Reed, 193 S.W.3d at 842.

*479 Generally, we presume the agency’s decision is correct. Collins v. Dep’t of Soc. Serv., 141 S.W.3d 501, 503 (Mo.App. S.D.2004). “However, when the agency decision involves the interpretation of law and application of the law to undisputed facts, the court must form its own independent conclusions, and is not bound by the interpretation of the agency.” Id. at 504. Some deference, however, is appropriate when the issue involves an agency interpretation of its own regulation. Id.

First, Claimant argues the Division’s decision denying Husband an increase in his MMMNA is unsupported by competent and substantial evidence. The Division claims Claimant failed to carry her burden that Husband’s MMMNA, as determined by the Division, was insufficient and resulted in significant financial duress. Claimant argues the Division improperly held her to a higher burden of proof by requiring her to show “exceptional circumstances” resulting in significant financial duress which is not the standard codified in the Missouri regulations.

In order to properly analyze the issues raised in this appeal, we must engage in an overview of the statutes and regulations governing Medicaid eligibility for institutionalized spouses. The Medicaid Act, 42 U.S.C. § 1396 et seq. was enacted as a jointly financed federal and state program designed to provide health care to needy individuals. Wisconsin Dep’t of Health and Family Serv. v. Blumer,

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Bluebook (online)
246 S.W.3d 475, 2007 Mo. App. LEXIS 964, 2007 WL 1814396, Counsel Stack Legal Research, https://law.counselstack.com/opinion/plumb-v-missouri-department-of-social-services-family-support-division-moctapp-2007.