Rick Earl v. Dr. Raquel Hatter, Commissioner, Tennessee Department of Human Services

• Court: Court of Appeals of Tennessee
• Decided: November 19, 2012
• Docket: M2011-00914-COA-R3-CV
• Status: Published

Opinion

IN THE COURT OF APPEALS OF TENNESSEE AT NASHVILLE January 27, 2012 Session

RICK EARL, ET AL. v. DR. RAQUEL HATTER1 , COMMISSIONER, TENNESSEE DEPARTMENT OF HUMAN SERVICES, ET AL.

Appeal from the Chancery Court for Davidson County No. 101213III Ellen H. Lyle, Chancellor

No. M2011-00914-COA-R3-CV - Filed November 19, 2012

Married couple sought judicial review of decision of Department of Human Services holding that they were not eligible for medicaid under an amendment to the Social Security Act known as the “Pickle Amendment.” Upon consideration of the record we affirm the judgment of the Chancery Court.

Tenn. R. App. P. 3 Appeal as of Right; Judgment of the Chancery Court Affirmed

R ICHARD H. D INKINS, J., delivered the opinion of the court, in which F RANK G. C LEMENT, J R. and A NDY D. B ENNETT, JJ., joined.

Lenny L. Croce, Oak Ridge, Tennessee, for the Appellants, Rick Earl and Wanda Earl.

Robert E. Cooper, Jr., Attorney General and Reporter; Carolyn E. Reed, Assistant Attorney General, for the State of Tennessee.

OPINION

This case involves the interpretation and application of an amendment to the Social Security Act commonly known as the Pickle Amendment, which is codified at 42 U.S.C. § 1396(a) and made a regulation at 42 C.F.R. 435.135; it has been adopted in Tennessee at Tenn. Comp. R. & Regs. 1240-03-02-.02(2)(m). Specifically, we are asked to determine

1 This case originally named then-Commissioner, Virginia T. Lodge, as defendant. Present Commissioner, Dr. Raquel Hatter, has been substituted in accordance with Rule 19(c), Tenn. R. App. P. 19(c). whether, by application of the Pickle Amendment, either Rick Earl or Wanda Earl or both, are eligible for Medicaid.2

On October 8, 2009, the Department of Human Services (“the Department”) sent Mr. Rick Earl and Mrs. Wanda Earl (“the Earls”) notice that their Medicaid coverage would terminate. On October 23, 2009, the Earls appealed the termination of their coverage. Their benefits were continued pending the outcome of the appeal. Administrative hearings were held on February 18, 2010 and April 1, 2010.

The proof at the hearing was that Mrs. Earl was deemed disabled in 1994 and became eligible for and received Supplemental Security Income (“SSI”).3 Her receipt of SSI ended in 2002 when she became entitled to and received Old Age, Survivors, and Disability Insurance (“OASDI”).4 Mrs. Earl’s OASDI benefits ended in 2008 when her youngest child attained the age of 16. At the time of the administrative hearing, Mrs. Earl was not receiving SSI or OASDI benefits; she had no income. Mr. Earl was deemed disabled in 2001, and became eligible for both OASDI and SSI benefits. Mr. Earl received SSI until October 2002. At the time of the administrative hearing, Mr. Earl received OASDI benefits of $1,070 per month.

On May 19, 2010, the DHS hearing officer issued an Initial Order affirming the termination of Mr. and Mrs. Earl’s Medicaid eligibility. The initial Order became final on June 3, 2010, and on July 25, the Earls filed a Complaint and Petition for Judicial Review 2010 in the chancery court.

In the chancery court action, the Earls argued they were eligible for Medicaid benefits as a couple in accordance with the “Pickle Amendment.” The trial court reviewed the administrative record and issued an opinion and order on March 22, 2011 in which it made findings of fact and held:

2 Medicaid is a federal program that reimburses states for providing medical care to those who cannot afford it. See 42 U.S.C.A. § 1396. 3 Supplemental Security Income (SSI) is a federal income supplement program designed to help the aged, blind, and disabled people; those who qualify for SSI are eligible for Medicaid. See 42 U.S.C. § 1381 et seq. 4 Old Age Survivors and Disability Insurance is a program established under Title II of the Social Security Act; in order to receive OASDI benefits, one must have a work history or be the dependent of a worker. See, e.g. 42 U.S.C. §402. Ms. Earl was entitled to received OASDI as dependent of Mr. Earl because she did not have a work history and was the mother of the parties’ minor child.

-2- Applying to these facts of record the essential elements of the federal Pickle Amendment set out above, the Court concludes that Mr. Earl is eligible for Pickle amendment consideration because (1) he is a current recipient of OASDI, (2) he did have SSI and OASDI at one point since April 1977 for at least one month, and (3) he has received COLA increases. Mrs. Earl, however, is not eligible for Pickle Amendment/Medicaid eligibility because (1) she is not receiving OASDI. The only Social Security related benefit she has received since losing SSI (due to household income) was mother’s benefits on behalf of her children, which ended February 2008. The significance of the foregoing analysis of Mr. Earl as the “eligible” spouse and Mrs. Earl as the “ineligible” spouse is that it is the premise for determining whether the Petitioners’ countable income is analyzed for Pickle Amendment/Medicaid eligibility under the individual benefit rate or the couple benefit rate.

The court continued its analysis by examining the formulas for determining the Earl’s household income and determined that their income, as calculated under the regulations, exceeded the individual benefit rate and disqualified them from Medicaid eligibility.

The court also considered the Earl’s argument that the requirements for Medicaid eligibility under the Pickle amendment in Tennessee’s regulation differed from the federal regulation. The court noted that the Tennessee regulation does not “reproduce the Pickle Amendment provisions verbatim, but the Tennessee regulation does reference them with the statement ‘(Commonly known as the Pickle Amendment.)’” and concluded that the Tennessee regulations “incorporate[] by reference the explicit terms of the Pickle Amendment, including its requirement that eligibility depends upon receipt of OASDI benefits.” The court affirmed the DHS’ ruling and held that the Earls do not qualify for Medicaid. The Earls appeal.

II. Standard of Review

Judicial review of decisions of an administrative agency is governed by the narrow, statutorily defined standard at Tenn. Code Ann.§ 4-5-322(h) rather than the broad standard of review used in other civil appeals. Willamette Indus., Inc. v. Tennessee Assessment Appeals Comm’n, 11 S.W.3d 142, 147 (Tenn. Ct. App. 1999) (citing Wayne Cnty v. Tennessee Solid Waste Disposal Control Bd., 756 S.W.2d 274, 279-80 (Tenn. Ct. App. 1998)). Specifically, Tenn. Code Ann. §4-5-322(h) provides that this court may reverse or modify the decision of the agency only if the petitioner’s rights have been prejudiced because the administrative findings, inferences, conclusions, or decisions are: (1) In violation of constitutional or statutory provisions;

-3- (2) In excess of the statutory authority of the agency; (3) Made upon unlawful procedure; (4) Arbitrary or capricious or characterized by abuse of discretion or clearly unwarranted exercise of discretion; or (5)(A) Unsupported by evidence that is both substantial and material in the light of the entire record.

Tenn. Code Ann. § 4-5-322(h)(1)-(5)(A). We will generally defer to the decision of an administrative agency when it is acting within its area of specialized knowledge, experience and expertise. Wayne County v. Tennessee Solid Waster Disposal Control Board, 756 S.W.2d 274,279 (Tenn. Ct. App. 1988).

III. Discussion As noted by DHS in its brief, the issue presented is “whether DHS correctly interpreted and applied the Pickle Amendment to the facts when it determined that the Earls are not eligible for medicaid coverage.” After careful study of the administrative record and the parties’ briefs, we are persuaded that the decision of the trial court should be affirmed. Moreover, because we find that the opinion of the trial court adequately states the facts and the law on the issues presented in this appeal, we adopt the opinion as the opinion of this Court and include it as an appendix to this opinion.

For the foregoing reasons, the judgment of the trial court is affirmed.

___________________________________ RICHARD H. DINKINS, JUDGE

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