[Cite as Poindexter v. Ohio Dept. of Job & Family Servs., 2020-Ohio-4081.]
COURT OF APPEALS FAIRFIELD COUNTY, OHIO FIFTH APPELLATE DISTRICT
LUCILLE POINDEXTER JUDGES: Hon. William B. Hoffman, P.J. Appellant Hon. Patricia A. Delaney, J. Hon. Earle E. Wise, Jr., J. -vs- Case No. 2020 CA 00005 OHIO DEPARTMENT OF JOB AND FAMILY SERVICES
Appellee O P I N IO N
CHARACTER OF PROCEEDINGS: Appeal from the Fairfield County Court of Common Pleas, Case No. 2019 CV 00337
JUDGMENT: Affirmed
DATE OF JUDGMENT ENTRY: August 11, 2020
APPEARANCES:
For Appellant For Appellee
AMY C. BAUGHMAN DAVE YOST 1426 North 3rd Street – Suite #200 Attorney General of Ohio P.O. Box 5400 Harrisburg, PA 17110 AMY R. GOLDSTEIN Assistant Attorney General Health and Human Services Section 30 East Broad Street, 26th Floor Columbus, Ohio 43215 Fairfield County, Case No. 2020 CA 00005 2
Hoffman, P.J. {¶1} Appellant Lucille Poindexter appeals the judgment entered by the Fairfield
County Common Pleas Court affirming the administrative decision of Appellee the Ohio
Department of Job and Family Services which denied her request for long-term care
Medicaid benefits.
STATEMENT OF THE FACTS AND CASE
{¶2} Appellant was admitted to Pickerington Care and Rehabilitation, a nursing
facility located in Fairfield County, in 2017. In August of 2018, she applied for Medicaid
benefits. Her application was denied on September 27, 2018, because she had too many
resources to meet the financial eligibility criteria.
{¶3} Appellant reapplied for benefits on October 26, 2018. At the time of her
application, she owned a home located in Stark County, Ohio. As of 2018, the Stark
County Auditor valued the home at $36,900. On November 11, 2018, and November 20,
2018, Fairfield County Department of Job and Family Services (hereinafter “County”) sent
Appellant a verification checklist requesting verification that the combined value of her
resources was below the Medicaid eligibility limit of $2,000.
{¶4} While the application was pending, the County learned Appellant owned a
home in Stark County, subject to a bank mortgage. The amount of the mortgage at its
inception in 2011, was $48,023. On December 10, 2018, the County requested Appellant
verify her current mortgage balance. The request form stated at the top, “If you are having
difficulty obtaining the verifications, please contact me immediately for assistance.” The
verification was due by December 20, 2018. When Appellant had not provided verification
of the mortgage balance by December 20, 2018, the County sent Appellant a second
letter requesting verification of the mortgage balance, again including the language Fairfield County, Case No. 2020 CA 00005 3
advising her to contact the County if she had difficulty obtaining the verification.
Throughout this time, Appellant had the assistance of two authorized representatives, as
well as a power of attorney. She did not request assistance from the County, and again
the verification of the mortgage balance was not provided to the County.
{¶5} On January 9, 2019, the County denied Appellant’s application for Medicaid
benefits. Appellant appealed this decision by requesting a state hearing from Appellee
pursuant to R.C. 5101.35(B). Following the state hearing, the decision of the County was
affirmed. She appealed this decision to the director of Appellee pursuant to R.C.
5101.35(C), and the decision of the state hearing officer was affirmed.
{¶6} Appellant appealed the decision of Appellee to the Fairfield County
Common Pleas Court. The trial court affirmed the administrative appeal decision of
Appellee. It is from the December 17, 2019 judgment of the Fairfield County Common
Pleas Court Appellant prosecutes this appeal, assigning as error:
I. THE COURT OF COMMON PLEAS ERRED IN ITS DECISION
BECAUSE MS. POINDEXTER DOES NOT OWN AVAILABLE
RESOURCES THAT EXCEED THE MEDICAID ELIGIBILITY LIMIT.
II. THE COURT OF COMMON PLEAS ERRED IN AFFIRMING THE
APPELLEE’S DECISION BECAUSE THE FCDJFS IMPROPERLY
PLACED THE BURDEN ON MS. POINDEXTER TO PROVIDE
VERIFICATIONS UNAVAILABLE TO HER. Fairfield County, Case No. 2020 CA 00005 4
I.
{¶7} In her first assignment of error, Appellant argues the trial court abused its
discretion in denying her request for Medicaid assistance because she does not own
available resources which exceed the eligibility limit. Specifically, she argues because
the mortgage balance of the home she owns in Stark County exceeded its valuation, it
was not a countable resource.
{¶8} When reviewing an order of an administrative agency pursuant to an R.C.
119.12 appeal, the court of common pleas applies the standard of review set forth in R.C.
119.12, reviews the entire record, and determines whether the order is supported by
reliable, probative and substantial evidence and is in accordance with the law. Young v.
Cuyahoga Work & Training Agency, Cuyahoga App. No. 79123, at 2 (July 19, 2001),
citing Univ. of Cincinnati v. Conrad, 63 Ohio St.2d 108, 110, 407 N.E.2d 1265 (1980).
When reviewing the trial court's determination regarding whether the order is supported
by such evidence, however, the appellate court determines only whether the trial court
abused its discretion. Young, supra, citing Rossford Exempted Village School District Bd.
of Educ. v. State Bd. of Educ., 63 Ohio St.3d 705, 707, 590 N.E.2d 1240 (1992). The term
“abuse of discretion” connotes more than an error of law or judgment; it implies that the
court's attitude was unreasonable, arbitrary or unconscionable. Blakemore v. Blakemore,
5 Ohio St.3d 217, 219, 450 N.E.2d 1140 (1983).
{¶9} Issues of statutory construction are reviewed de novo by a court of appeals.
Yommer v. Outdoor Enterprises, Inc, 126 Ohio App.3d 738, 740, 711 N.E.2d 296 (1998),
citing State v. Wemer, 112 Ohio App.3d 100, 103, 677 N.E.2d 1258 (1996). However, an
agency's interpretation of a statute which it has the duty to enforce will not be overturned Fairfield County, Case No. 2020 CA 00005 5
unless the agency’s interpretation is unreasonable. State ex rel. Clark v. Great Lakes
Constr. Co., 99 Ohio St.3d 320, 2003-Ohio-3802, 791 N.E.2d 974, ¶10.
{¶10} Appellant argues the court erred in finding her home was a countable
resource, as the evidence before the agency reflected a mortgage of $48,023, while its
value was only $36,900. However, while the valuation of the Stark County Auditor was
current as of 2018, the $48,023 balance of the mortgage was dated 2011. No evidence
was presented demonstrating what the balance of the mortgage was as of the time of the
application, and thus the agency could not determine the value of the property as of the
time of her request for Medicaid assistance.
{¶11} Ohio Adm. Code 5160:1-2-01(H) provides in pertinent part:
(H) Verifications.
Free access — add to your briefcase to read the full text and ask questions with AI
[Cite as Poindexter v. Ohio Dept. of Job & Family Servs., 2020-Ohio-4081.]
COURT OF APPEALS FAIRFIELD COUNTY, OHIO FIFTH APPELLATE DISTRICT
LUCILLE POINDEXTER JUDGES: Hon. William B. Hoffman, P.J. Appellant Hon. Patricia A. Delaney, J. Hon. Earle E. Wise, Jr., J. -vs- Case No. 2020 CA 00005 OHIO DEPARTMENT OF JOB AND FAMILY SERVICES
Appellee O P I N IO N
CHARACTER OF PROCEEDINGS: Appeal from the Fairfield County Court of Common Pleas, Case No. 2019 CV 00337
JUDGMENT: Affirmed
DATE OF JUDGMENT ENTRY: August 11, 2020
APPEARANCES:
For Appellant For Appellee
AMY C. BAUGHMAN DAVE YOST 1426 North 3rd Street – Suite #200 Attorney General of Ohio P.O. Box 5400 Harrisburg, PA 17110 AMY R. GOLDSTEIN Assistant Attorney General Health and Human Services Section 30 East Broad Street, 26th Floor Columbus, Ohio 43215 Fairfield County, Case No. 2020 CA 00005 2
Hoffman, P.J. {¶1} Appellant Lucille Poindexter appeals the judgment entered by the Fairfield
County Common Pleas Court affirming the administrative decision of Appellee the Ohio
Department of Job and Family Services which denied her request for long-term care
Medicaid benefits.
STATEMENT OF THE FACTS AND CASE
{¶2} Appellant was admitted to Pickerington Care and Rehabilitation, a nursing
facility located in Fairfield County, in 2017. In August of 2018, she applied for Medicaid
benefits. Her application was denied on September 27, 2018, because she had too many
resources to meet the financial eligibility criteria.
{¶3} Appellant reapplied for benefits on October 26, 2018. At the time of her
application, she owned a home located in Stark County, Ohio. As of 2018, the Stark
County Auditor valued the home at $36,900. On November 11, 2018, and November 20,
2018, Fairfield County Department of Job and Family Services (hereinafter “County”) sent
Appellant a verification checklist requesting verification that the combined value of her
resources was below the Medicaid eligibility limit of $2,000.
{¶4} While the application was pending, the County learned Appellant owned a
home in Stark County, subject to a bank mortgage. The amount of the mortgage at its
inception in 2011, was $48,023. On December 10, 2018, the County requested Appellant
verify her current mortgage balance. The request form stated at the top, “If you are having
difficulty obtaining the verifications, please contact me immediately for assistance.” The
verification was due by December 20, 2018. When Appellant had not provided verification
of the mortgage balance by December 20, 2018, the County sent Appellant a second
letter requesting verification of the mortgage balance, again including the language Fairfield County, Case No. 2020 CA 00005 3
advising her to contact the County if she had difficulty obtaining the verification.
Throughout this time, Appellant had the assistance of two authorized representatives, as
well as a power of attorney. She did not request assistance from the County, and again
the verification of the mortgage balance was not provided to the County.
{¶5} On January 9, 2019, the County denied Appellant’s application for Medicaid
benefits. Appellant appealed this decision by requesting a state hearing from Appellee
pursuant to R.C. 5101.35(B). Following the state hearing, the decision of the County was
affirmed. She appealed this decision to the director of Appellee pursuant to R.C.
5101.35(C), and the decision of the state hearing officer was affirmed.
{¶6} Appellant appealed the decision of Appellee to the Fairfield County
Common Pleas Court. The trial court affirmed the administrative appeal decision of
Appellee. It is from the December 17, 2019 judgment of the Fairfield County Common
Pleas Court Appellant prosecutes this appeal, assigning as error:
I. THE COURT OF COMMON PLEAS ERRED IN ITS DECISION
BECAUSE MS. POINDEXTER DOES NOT OWN AVAILABLE
RESOURCES THAT EXCEED THE MEDICAID ELIGIBILITY LIMIT.
II. THE COURT OF COMMON PLEAS ERRED IN AFFIRMING THE
APPELLEE’S DECISION BECAUSE THE FCDJFS IMPROPERLY
PLACED THE BURDEN ON MS. POINDEXTER TO PROVIDE
VERIFICATIONS UNAVAILABLE TO HER. Fairfield County, Case No. 2020 CA 00005 4
I.
{¶7} In her first assignment of error, Appellant argues the trial court abused its
discretion in denying her request for Medicaid assistance because she does not own
available resources which exceed the eligibility limit. Specifically, she argues because
the mortgage balance of the home she owns in Stark County exceeded its valuation, it
was not a countable resource.
{¶8} When reviewing an order of an administrative agency pursuant to an R.C.
119.12 appeal, the court of common pleas applies the standard of review set forth in R.C.
119.12, reviews the entire record, and determines whether the order is supported by
reliable, probative and substantial evidence and is in accordance with the law. Young v.
Cuyahoga Work & Training Agency, Cuyahoga App. No. 79123, at 2 (July 19, 2001),
citing Univ. of Cincinnati v. Conrad, 63 Ohio St.2d 108, 110, 407 N.E.2d 1265 (1980).
When reviewing the trial court's determination regarding whether the order is supported
by such evidence, however, the appellate court determines only whether the trial court
abused its discretion. Young, supra, citing Rossford Exempted Village School District Bd.
of Educ. v. State Bd. of Educ., 63 Ohio St.3d 705, 707, 590 N.E.2d 1240 (1992). The term
“abuse of discretion” connotes more than an error of law or judgment; it implies that the
court's attitude was unreasonable, arbitrary or unconscionable. Blakemore v. Blakemore,
5 Ohio St.3d 217, 219, 450 N.E.2d 1140 (1983).
{¶9} Issues of statutory construction are reviewed de novo by a court of appeals.
Yommer v. Outdoor Enterprises, Inc, 126 Ohio App.3d 738, 740, 711 N.E.2d 296 (1998),
citing State v. Wemer, 112 Ohio App.3d 100, 103, 677 N.E.2d 1258 (1996). However, an
agency's interpretation of a statute which it has the duty to enforce will not be overturned Fairfield County, Case No. 2020 CA 00005 5
unless the agency’s interpretation is unreasonable. State ex rel. Clark v. Great Lakes
Constr. Co., 99 Ohio St.3d 320, 2003-Ohio-3802, 791 N.E.2d 974, ¶10.
{¶10} Appellant argues the court erred in finding her home was a countable
resource, as the evidence before the agency reflected a mortgage of $48,023, while its
value was only $36,900. However, while the valuation of the Stark County Auditor was
current as of 2018, the $48,023 balance of the mortgage was dated 2011. No evidence
was presented demonstrating what the balance of the mortgage was as of the time of the
application, and thus the agency could not determine the value of the property as of the
time of her request for Medicaid assistance.
{¶11} Ohio Adm. Code 5160:1-2-01(H) provides in pertinent part:
(H) Verifications. Where manual verifications are required under rule
5160:1-2-10 of the Administrative Code, the administrative agency shall:
(1) Follow the safeguarding guidelines set forth in rule 5160-1-32 of
the Administrative Code when providing or gathering information by
telephone, in person, or in electronic or written form.
(2) Not require that an individual provide verification of unchanged
information unless the information is incomplete, inaccurate, inconsistent,
outdated, or missing from the case record due to record retention
limitations.
(3) Not request that an individual provide duplicate copies of
previously submitted verifications. Fairfield County, Case No. 2020 CA 00005 6
(4) To the extent possible, verify relevant eligibility criteria using
electronic records available through the electronic eligibility system. Where
electronic verification is not available, or electronic verification data conflicts
with the individual's attestation, request verifications as set out in rule
5160:1-2-10 of the Administrative Code.
(5) When the administrative agency is unable to verify an eligibility
criteria through electronic sources, the administrative agency will provide a
written (electronic or on paper) request for the necessary information or
verification documents.
(a) The written request shall:
(i) Include the date by which the information shall be provided to the
administrative agency;
(ii) Inform the individual that any delay in providing requested
information or documents will delay the determination of an individual's
eligibility; and
(iii) Provide information on how an individual can request assistance
in gathering the requested documents.
(a) The administrative agency shall assist the individual in obtaining
the verifications required for eligibility determination.
(b) When the normal sources of verification described in this rule
have been exhausted and no documentation can be obtained, the
administrative agency may accept the individual's statement when it is
complete and consistent with other facts and statements. The use of such Fairfield County, Case No. 2020 CA 00005 7
a statement shall be on a case by case basis when no other approach is
possible, and shall be used only in rare circumstances.
{¶12} If the individual fails to provide the requested verifications, the agency shall
deny the application. Ohio Adm. Code 5106:1-2-01(H(5)(c).
{¶13} It is undisputed Appellant failed to provide verification of the mortgage
balance despite two requests from the agency to do so. While she argues the information
was available to the county electronically, the record does not support this argument. As
the lower court noted, the county was unable to calculate the equity in the home using a
2011 mortgage balance and the auditor’s 2018 valuation, as “[t}here are many factors
that can be taken into consideration as to whether Appellant has paid additional funds
towards the principal or if Appellant is delinquent in payments toward the mortgage.”
Judgment Entry, 12/17/19, p. 2.
{¶14} We find the trial court did not err in affirming the decision of Appellee
denying Appellant’s claim for Medicaid assistance based on Appellant’s failure to provide
information necessary to verify financial eligibility. The first assignment of error is
overruled.
II.
{¶15} In her second assignment of error, Appellant argues the court improperly
placed the burden on her to provide evidence of the balance of the mortgage, rather than
properly placing the burden on the County to discover the current mortgage balance. Fairfield County, Case No. 2020 CA 00005 8
{¶16} Appellant argues 42 C.F.R. 435.948 prevented the County in this case from
requesting information from her when it was readily available from the asset verification
system or other sources. 42 C.F.R. 435.948 provides:
(a)The agency must in accordance with this section request the
following information relating to financial eligibility from other agencies in
the State and other States and Federal programs to the extent the agency
determines such information is useful to verifying the financial eligibility of
an individual:
(1) Information related to wages, net earnings from self-employment,
unearned income and resources from the State Wage Information
Collection Agency (SWICA), the Internal Revenue Service (IRS), the Social
Security Administration (SSA), the agencies administering the State
unemployment compensation laws, the State-administered supplementary
payment programs under section 1616(a) of the Act, and any State program
administered under a plan approved under Titles I, X, XIV, or XVI of the Act;
and
(2) Information related to eligibility or enrollment from the
Supplemental Nutrition Assistance Program, the State program funded
under part A of title IV of the Act, and other insurance affordability programs.
(b)To the extent that the information identified in paragraph (a) of this
section is available through the electronic service established in accordance Fairfield County, Case No. 2020 CA 00005 9
with § 435.949 of this subpart, the agency must obtain the information
through such service.
(c)The agency must request the information by SSN, or if an SSN is
not available, using other personally identifying information in the
individual's account, if possible.
{¶17} Nothing in this section prevented the County from requesting mortgage
balance information from Appellant. Further, there is no evidence in the record to
demonstrate the current mortgage balance was available to the County through the asset
verification system or any other source.
{¶18} Appellant argues the requested information was unavailable to her. The
record does not support this claim. Appellant attached an email to her brief in the trial
court which her attorney sent to Appellee on April 25, 2019, which indicates the power of
attorney, Appellant’s son, was “uncooperative” in obtaining the requested mortgage
balance. However, this email is not a part of the record as certified by the agency, and
was in fact written after her state hearing. Further, the fact her power of attorney was
uncooperative does not render the information unavailable to Appellant.
{¶19} While Appellant claims she requested the assistance of the County in
obtaining the mortgage balance information, the record does not support her claim. In a
letter submitted with her application dated September 10, 2018, Appellant stated, “I am
requesting assistance for long term care benefits.” Not only does this letter not request
assistance from the County in obtaining the mortgage balance, it was written before the
County’s request for documentation of the mortgage balance and before the existence of Fairfield County, Case No. 2020 CA 00005 10
her mortgage had been disclosed. This request for assistance appears to be a general
request for Medicaid benefits.
{¶20} Both requests the County sent to Appellant for verification of the mortgage
balance stated, “If you are having difficulty obtaining the verifications, please contact me
immediately for assistance.” Ohio Adm. Code 5160:1-2-08(B)(1)(b) provides:
(1) When applying for or receiving any medical assistance, an
individual must:
(b) Cooperate with the administrative agency in any eligibility
determination for initial or continuing coverage, audit, and quality control
process set out in this chapter of the Administrative Code. The individual
must:
(i) In completing an application or renewal for medical assistance,
answer all required questions and provide documentation requested by the
administrative agency necessary to verify the conditions of eligibility as
described in rule 5160:1-2-10 of the Administrative Code and any other
relevant eligibility criteria required under Chapter 5160:1-3, 5160:1-4,
5160:1-5, or 5160:1-6 of the Administrative Code.
(ii) Request assistance from the administrative agency when unable
to obtain requested information. The individual must provide the information
necessary to allow the administrative agency to assist the individual. Fairfield County, Case No. 2020 CA 00005 11
{¶21} Appellant failed to request assistance from the agency in obtaining the
requested information. We find the trial court did not err in affirming the decision of
Appellee, as the County did not improperly place the burden of providing the mortgage
balance information on Appellant.
{¶22} The second assignment of error is overruled.
{¶23} The judgment of the Fairfield County Common Pleas Court is affirmed.
By: Hoffman, P.J. Delaney, J. and Wise, Earle, J. concur