Sheely v. Wisconsin Department of Health & Social Services

442 N.W.2d 1, 150 Wis. 2d 320, 1989 Wisc. LEXIS 78
CourtWisconsin Supreme Court
DecidedJune 21, 1989
Docket87-2121
StatusPublished
Cited by28 cases

This text of 442 N.W.2d 1 (Sheely v. Wisconsin Department of Health & Social Services) is published on Counsel Stack Legal Research, covering Wisconsin Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Sheely v. Wisconsin Department of Health & Social Services, 442 N.W.2d 1, 150 Wis. 2d 320, 1989 Wisc. LEXIS 78 (Wis. 1989).

Opinion

DAY, J.

This is a review of a decision by the court of appeals, Sheely v. DHSS, 145 Wis. 2d 328, 426 N.W.2d 367 (Ct. App. 1988), which reversed a judgment 1 for costs and fees against the Wisconsin Department of Health and Social Services (DHSS) by the Circuit Court for Juneau County, Honorable Wallace A. Brady, Judge. Linda Sheely (Sheely) petitioned the circuit court for an award of costs and attorney's fees pursuant to sec. 814.245(3), Stats 1985-86. 2 The circuit court held that a "circuit court can award fees to the prevailing party on *323 review, whether or not costs are available within the administrative proceedings." It also concluded that DHSS's position that Sheely was not "disabled" was not "substantially justified" and awarded costs and attorney's fees to Sheely.

The court of appeals reversed; holding DHSS was not a party in the action, and that "there is no express statutory authorization allowing attorney fees and costs to be taxed against a state agency acting in its adjudicative capacity." Id. 145 Wis. 2d at 333, 335. We reverse because we hold DHSS was a party to this action and sec. 814.245(3), Stats., permits costs to be assessed against a state agency which has taken a position not substantially justified in its adjudicative capacity. We further hold that the circuit court had jurisdiction to determine whether costs could be assessed and that it correctly concluded the position advocated by DHSS was not substantially justified. We conclude Sheely is permitted to collect fees and costs pursuant to sec. 814.245(3).

Four principal issues are presented. First, did the circuit court have jurisdiction to award costs and fees pursuant to sec. 814.245(3), Stats.? We hold the circuit court did have jurisdiction. The circuit court retains jurisdiction to assess costs and fees pursuant to sec. 814.245(3) once it has remanded a decision by DHSS back for further proceedings and it need not explicitly state it is retaining such jurisdiction. Second, was DHSS a party to the action as described in sec. 814.245(3)? We hold that DHSS was a party when the circuit court held the determination by DHSS was invalid and remanded the cause back to DHSS. Third, may fees and costs be *324 assessed against DHSS pursuant to sec. 814.245 if it was acting in its "adjudicative" capacity? We hold the statute makes no distinction between the different "functions" of a state agency. Here, DHSS may be assessed costs. Fourth, was the determination by DHSS that Sheely was not "disabled" substantially justified? We conclude it was not.

The facts are undisputed. In September of 1985, Sheely applied to the Juneau County Department of Social Services (Juneau County) 3 for Medical Assistance (M.A.), also known as Medicaid.

Medicaid is a joint federal and state program which provides payment for medical services to eligible persons. The program was created in 1965 under Title XIX of the Social Security Act to provide assistance to both categorically needy and medically needy individuals . . .. Wisconsin's plan includes both groups.

*325 Swanson v. Health and Social Services Dept., 105 Wis. 2d 78, 83, 312 N.W.2d 833 (Ct. App. 1981) (footnotes omitted).

The "categorically needy" are those individuals or families who are eligible for medicaid because they are eligible for Aid to Families with Dependent children ("AFDC") or Supplemental Security Income ("SSI") benefits . . .. Also included within this class are individuals who are excluded from AFDC or SSI because of an eligibility requirement that does not apply to medicaid. The "medically needy" are those individuals not receiving AFDC or SSI, but whose income and resources, in comparison to their medical expenses, are within the limits established by the Department of Health and Human Services . . .. Coverage of this latter class of persons is optional for a state which participates in the program.

Crippen v. Kheder, 741 F.2d 102, 103 (6th Cir. 1984). See also Rousseau v. Bordeleau, 624 F. Supp. 355 (D. R.I. 1985).

Sheely applied as "medically needy" under sec. 49.47(4), Stats. 4 Ms. Sheely also applied to the Social Security Administration for Supplemental Security Income (SSI). 5

Based on her medical record, the State Bureau of Social Security Disability Insurance (BSSDI), a division *326 of DHSS, determined that Sheely was not "disabled." This determination was based on federal law which interpreted the federal Title XVI definition of "disability" as contained in 42 USC sec. 1382c(a)(3). Relying on this determination, Juneau County denied Sheely's application for M.A. in December of 1985. See Sheely, 145 Wis. 2d at 331.

Ms. Sheely appealed for an administrative hearing to review the determination by Juneau County. In a decision designated "a final administrative decision of the [DHSS]," a hearing examiner held "[t]he determination of [BSSDI] must be sustained." Sheely then requested a rehearing of the decision by DHSS pursuant to sec. 227.12, Stats. This request was denied by "a final administrative decision of the [DHSS]'.' on March 31, 1986.

Ms. Sheely next petitioned the Circuit Court of Juneau County "to review a final decision of the Wisconsin Department of Health and Social Services (DHSS) dated March 31,1986.” DHSS was named the defendant and appeared in court as such. In a memorandum decision dated October 2, 1986, the circuit court held the hearing examiner "failed to apply the correct legal standards to all the facts of the case." It found the hearing examiner "relied on the Medical Vocational Guidelines, known as the "grid" (See 20 C.F.R., part 404, subpart P, Appendix 2) to find that jobs existed which Sheely could perform. However, some of [Sheely's] impairments,. . . were non-exertional. Because of these non-exertional disabilities, the grid should not have been used." The case was remanded back to DHSS for further proceedings.

Subsequent to the circuit court's order, but prior to any further proceedings, a federal administrative law judge found Sheely "had been under a 'disability' as *327 defined in the Social Security Act." Consequently, Sheely became eligible for SSI benefits. 6 This determination also made Sheely eligible for M.A. under sec. 49.46(1)(a)4, Stats. 7 Sheely's attorney notified the state hearing examiner of the federal decision and stated the matter would be moot and DHSS could "close [its] file." A decision by DHSS dated May 15,1987, ordered "that the instructions of the Circuit Court for Juneau County be considered complied with and [its] file on the matter closed." This decision was also labeled a "final administrative decision of the [DHSS]."

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Bluebook (online)
442 N.W.2d 1, 150 Wis. 2d 320, 1989 Wisc. LEXIS 78, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sheely-v-wisconsin-department-of-health-social-services-wis-1989.