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Stanley v. R.I. Executive Office of Health and Human Services

Superior Court of Rhode Island

June 21, 2016

CHERYL STANLEY
v.
R.I. EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES JAMES SENAY
v.
R.I. EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

         Providence County Superior Court

          For Plaintiff: Gretchen M. Bath, Esq.

          For Defendant: Gail A. Theriault, Esq. Benjamin C. Copple, Esq. Cindy A. Soccio, Esq.

          DECISION

          CARNES, J.

         This matter is before the Court for decision on the consolidated appeal of two decisions of the Rhode Island Executive Office of Health and Human Services (OHHS), which found the appellants ineligible to receive benefits under the state's Medicare Premium Payment program (MPP) as a Qualified Medicare Beneficiary (QMB).[1] Jurisdiction is pursuant to G.L. 1956 § 42-35-15.

         I

         Facts

         Appellant Cheryl Stanley is a Medicare beneficiary with a monthly income of $1480. She lives with Elmer Stanley, her husband of thirty-four years. In November of 2014, she applied for payment assistance, and the OHHS denied her application in December 2014. The agency informed her that her countable income of $1460 (Social Security Income of $1480 minus the $20 standard deduction) exceeded the "qualified standard of $1312.88" for one person, and thus her application was being denied. She maintains that her application should have been considered according to the income guidelines for a two-person household. The parties are in agreement that if the guidelines for a two-person household had been used in considering her application, said application would have been approved.

         In the other consolidated case, appellant James Senay is a Medicare beneficiary who had been receiving MPP benefits since 2012, during which time OHHS applied the guidelines for a two-person household. OHHS terminated such benefits in February 2015, informing him that his countable income of $1695 (Social Security Income of $1715 minus the $20 standard deduction) exceeded the "qualified standard" for a one-person household, which was $1312.88. Appellant Senay maintains that his application should have been considered according to the income guidelines for a two-person household. The parties are similarly in agreement that if the guidelines for a two-person household had been used in considering his application, said application would have been approved. The Court notes that Mrs. Senay passed away March 31, 2015, and therefore the "household size" of Mr. Senay is only at issue for March 2015 on this administrative appeal. Senay Compl. ¶ 9, Def. Ex. 15 at 19. Further relevant facts as set forth in the record are discussed infra.

         II

         Standard of Review

         The review of a decision by a state agency by this Court is governed by the Administrative Procedures Act. Section 42–35–15(g) of the act provides that:

"The court shall not substitute its judgment for that of the agency as to the weight of the evidence on questions of fact. The court may affirm the decision of the agency or remand the case for further proceedings, or it may reverse or modify the decision if substantial rights of the appellant have been prejudiced because the administrative findings, inferences, conclusions, or decisions are:
"(1) In violation of constitutional or statutory provisions;
"(2) In excess of the statutory authority of the ...

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