Kent County Superior Court
For Plaintiff: Elmer Gardiner, pro se
For Defendant: Gail A. Theriault, Esq.
TAFT-CARTER, J. JUSTICE/MAGISTRATE
Before the Court is the appeal of Elmer Gardiner (Appellant) from a November 19, 2013 decision of the Rhode Island Department of Human Services (DHS) denying his application to the Medicare Premium Payment Program (MPPP). The Appellant filed a timely appeal to this Court on December 13, 2013. Jurisdiction of this appeal is pursuant to G.L. 1956 § 42-35-15.
Facts and Travel
In May 2013, Appellant applied for MPPP. (Admin. Hr'g Dec. at 2; Tr. at 3, Sept. 12, 2013.) The application was reviewed by a Casework Supervisor and an Eligibility Technician. (Admin. Hr'g Dec. at 2; Tr. 3-4.) It was determined that the Appellant's gross monthly income was $1312.90. (Admin. Hr'g Dec. at 2; Tr. at 4.) The figure was automatically rounded to $1313 by the computer. Id. An unearned income disregard in the amount of $20 was then deducted from the Appellant's income leaving a monthly net income of $1293. Id. The guidelines provide that the eligible income threshold is $1292.63. Id. The Appellant's ineligibility was based on a $0.37 overage. Id.
DHS mailed a notice of ineligibility to the Appellant on June 4, 2013. (Admin. Hr'g Dec. at 2; Tr. at 3.) The ineligibility was based on excessive income as determined by § 0372.05 of the Rhode Island Department of Human Services Manual (hereinafter DHS Manual). Id. The Appellant's ineligibility was also confirmed by a separate offline calculation. (Admin. Hr'g Dec. at 2; Tr. at 12.)
On June 12, 2013, the Appellant requested an administrative hearing concerning the denial of his application. (Admin. Hr'g Dec. at 4.) A hearing was held on September 12, 2013, at which the Appellant appeared. (Tr. at 1-2.) Representatives from the George Wiley Center and the Senior Agenda Coalition also attended on behalf of the Appellant. (Tr. at 2.) Additionally, a Casework Supervisor and Eligibility Technician for DHS were present on behalf of the agency. (Tr. at 2.)
At the hearing, the Appellant testified regarding to his monthly income. He provided two bank statements as evidence of the monthly Social Security deposits totaling $1208. (Admin. Hr'g Dec. at 2; Tr. at 6.) The Appellant argued that the monthly deposit of $1208 is the net amount after a reduction for Medicare Part B premium in the amount of $104.90. (Admin. Hr'g Dec. at 2; Tr. at 7.) The Appellant did concede, however, that his gross monthly Social Security benefit totals $1312.90. (Admin. Hr'g Dec. at 2-4; Tr. at 7.) During the hearing, the Appellant also argued that Medicare rules provide for eligibility if his income totals $1313 or less a month. Id. In support of this proposition, the Appellant submitted two internet printouts from Medicare.gov and the National Council on Aging. Accordingly, Appellant concluded that his assets are within the income guidelines; therefore, he is eligible for MPPP. (Admin. Hr'g Dec. at 2; Tr. at 7-8.)
Next, the representative from the George Wiley Center testified on behalf of the Appellant concerning the income eligibility determinations made by DHS. (Tr. at 13-16.) Specifically, the representative questioned the fact that the computer adjusted the figures up rather than down. (Tr. 13-14.) The representative conceded that, even without the adjustment, Appellant's income did not meet the eligibility standard. (Tr. at 13.) The representative also discussed the agency's practice of subtracting $20 as an unearned income disregard from an applicant's gross monthly income. (Tr. 14-16.) Finally, the representative asked which agency was in charge of setting the income eligibility figures. (Tr. at 16.) The hearing officer informed the representative that it is the Social Security Administration that is in charge of the eligibility guidelines and computer program. (Tr. at 16.)
In addition, the representative from the Senior Agenda Coalition testified. (Tr. at 18.) The representative questioned whether DHS had discretion when making the eligibility determination. Id. Specifically, the representative asked if DHS can consider an applicant's need for the benefits or how much his or her income is above the income guidelines when making an eligibility determination. (Tr. at 18-19.) The hearing officer explained that eligibility determinations are made solely based upon the federal guidelines; therefore, DHS has no discretion to make an exception for an applicant whose income is only several cents over the limit. (Tr. at 20.)
On behalf of DHS, two representatives provided testimony. First, a DHS Eligibility Technician confirmed that the Appellant was ineligible. (Tr. at 4-5.) She explained that DHS received the Appellant's MPPP application on May 15, 2013, and income verification was conducted through the Social Security Administration. (Tr. at 3-4.) When it was complete, the income of $1312.90 was automatically adjusted to $1313. (Tr. at 4.) Thereafter, the Appellant's income was reduced by $20. Id. The reduction represented the unearned income disregard. Id. The end result was net income allocated to the Appellant in the amount of $1293. Id. The Eligibility Technician testified that eligibility for MPPP is $1292.63. Id. The Appellant's application was denied because his monthly income exceeded the guidelines. (Tr. at 4-5.) Finally, the Eligibility Technician explained that he performed an offline calculation of Appellant's income and verified that he was ineligible for MPPP. (Tr. at 12.)
Next, the DHS Casework Supervisor explained that her duty is to review the Eligibility Technicians' work. (Tr. at 6.) The Casework Supervisor testified that the income limits are set federally by the Social Security Administration. (Tr. at 14.) The State has no authority to change the income limits. Id. Further, she explained how and why the $20 unearned income disregard is subtracted from an applicant's gross monthly income to determine his or her countable net income for eligibility purposes. (Tr. at 15-16.) The Casework Supervisor also stated that she performed an ...