Opinion
21-P-1025
11-03-2022
EILEEN COPPINGER[1] v. EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES.
Summary decisions issued by the Appeals Court pursuant to M.A.C. Rule 23.0, as appearing in 97 Mass.App.Ct. 1017 (2020) (formerly known as rule 1:28, as amended by 73 Mass.App.Ct. 1001 [2009]), are primarily directed to the parties and, therefore, may not fully address the facts of the case or the panel's decisional rationale. Moreover, such decisions are not circulated to the entire court and, therefore, represent only the views of the panel that decided the case. A summary decision pursuant to rule 23.0 or rule 1:28 issued after February 25, 2008, may be cited for its persuasive value but, because of the limitations noted above, not as binding precedent. See Chace v. Curran, 71 Mass.App.Ct. 258, 260 n.4 (2008).
MEMORANDUM AND ORDER PURSUANT TO RULE 23.0
Eileen Coppinger, the special personal representative of the estate of Mary Wilson, appeals from a Superior Court judgment entered for the defendant on cross motions for judgment on the pleadings. We affirm.
Background. On September 2, 2015, Mary Wilson, a nursing home resident, began to receive MassHealth long-term care benefits. Mindy Jackson, Wilson's granddaughter, held a power of attorney and became Wilson's MassHealth authorized representative on August 26, 2015. MassHealth sent all eligibility notices to Jackson at her Hyde Park address; none were returned as undeliverable.
On January 25, 2017, Coppinger, as the business office manager of the nursing home, submitted a MassHealth long-term care eligibility review application on Wilson's behalf. On May 3, 2017, MassHealth issued requests to Wilson and Jackson at the same mailing address for additional information about Wilson, with a due date of June 2, 2017. MassHealth did not timely receive the verifications necessary for Wilson's long-term care benefits and denied her application on June 8, 2017. The notices of denial sent to Wilson and Jackson (notice) explained that the reason for the denial was the failure to provide MassHealth with the information it had requested. However, the notice also erroneously referred to an application for long-term care benefits Wilson filed on November 3, 2016. The notice provided two options for curing the deficiencies of the application: within thirty days, the applicant could either send MassHealth at least some of the information it had previously requested, or ask for a fair hearing.
The November 3, 2016, date referred to an application for community benefits that Jackson had submitted on behalf of Wilson, even though Wilson was ineligible for these benefits because she lived in a long-term care facility. Notwithstanding the error, Wilson was approved for community benefits on January 24, 2017. MassHealth subsequently compounded that error by terminating Wilson's long-term care benefits as of April 10, 2017. MassHealth later cured the error and made Wilson retroactively eligible for long-term care benefits from April 11, 2017, to June 7, 2017.
The hearing officer did not credit Jackson's statement in her affidavit that she had never received the June 8, 2017 notice of ineligibility. See Andrews v. Civil Serv. Comm'n, 446 Mass. 611, 616 (2006) (credibility determinations of hearing officer are entitled to deference). The hearing officer also rejected the representation of Wilson's attorney that no application for benefits had been filed on November 3, 2016.
Almost one year later, on or about May 30, 2018, Coppinger "appealed" the denial of benefits. The Massachusetts Office of Medicaid's board of hearings (board) dismissed the appeal because Coppinger was not "an applicant, member, nursing home resident, or authorized representative." Coppinger, on behalf of Wilson, appealed, and a judge of the Superior Court remanded the case to the board for a hearing. After a hearing, the board upheld the denial of benefits on the ground that the June 8, 2017 notice was adequate under MassHealth's regulations and thus, the appeal request was untimely. Upon return to the Superior Court, ruling on cross motions for judgment on the pleadings, a different judge denied Coppinger's motion, allowed the defendant's motion, and affirmed the board's decision on remand. This appeal followed.
Jackson named Coppinger as Wilson's Medicaid authorized representative on May 24, 2018.
Wilson, through her attorneys, filed a second complaint seeking judicial review and raising the same claims as her earlier complaint. The two actions were consolidated by the Superior Court.
Discussion. On appeal, Coppinger contends that the notice was defective, characterizing it as a due process violation. Here, Coppinger had the burden "to demonstrate the invalidity of the administrative determination." Andrews v. Division of Med. Assistance, 68 Mass.App.Ct. 228, 231 (2007). In evaluating the administrative determination, we "give 'due weight to the experience, technical competence, and specialized knowledge of the agency, as well as to the discretionary authority conferred upon it.'" Springfield v. Department of Telcomm. &Cable, 457 Mass. 562, 567 (2010), quoting G. L. c. 30A, § 14 (7). The agency's decision must, however, be supported by "substantial evidence," see G. L. c. 30A, § 14 (7), which is defined as "such evidence as a reasonable mind might accept as adequate to support a conclusion." G. L. c. 30A, § 1 (6). Reasonable interpretations by an agency of its own regulations must generally be respected. See DeCosmo v. Blue Tarp Redev., LLC, 487 Mass. 690, 700-701 (2021). Judges must also defer to an agency's discretionary "choice between two fairly conflicting but debatable views" reflecting reasonable evidence. Molly A. v. Commissioner of Dep't of Mental Retardation, 66 Mass.App.Ct. 267, 284 (2007).
On May 3, 2017, MassHealth notified Wilson and Jackson that it required additional information to continue providing benefits to Wilson. These notifications further advised that Wilson's benefits could be terminated if the necessary information was not received by June 2, 2017. Coppinger does not deny that Jackson failed to send the additional documentation. Rather, she contends that because the notice of denial was defective, the appeal was not untimely.
The defendant acknowledged that the notice contained a "minor clerical error"; however, it also claimed that the notice provided Jackson with sufficient information about the need to respond within a specific time frame with the requested documentation. Despite the error, the notice of ineligibility plainly stated that the reason for the denial was the applicant's failure to provide eligibility information in a timely fashion by June 2, 2017. We also note that the notice included two options for moving forward with the eligibility process, a telephone number to call with questions about the notice, a detailed explanation of how to appeal the determination through the fair hearing process, the deadline for submitting a request, and a blank fair hearing request form.
On this record, Coppinger failed to meet her burden of demonstrating that the administrative decision was invalid. See Andrews, 68 Mass.App.Ct. at 231. Although the June 8, 2017 notice contained an erroneous reference to the November 3, 2016 application for community benefits, it was adequate for due process purposes. MassHealth sent written notice to Wilson and Jackson, who held power of attorney, to the address at which Jackson admitted she lived. It provided Jackson with notice of the ineligibility determination, the reason for the action (i.e., the failure to provide information necessary for MassHealth to make the determination), a description of the two ways through which Jackson could correct the situation, and an explanation of her right to request a fair hearing. See 130 Code Mass. Regs. § 610.026(A) (2019) (governing adequacy of notice requirements). See also 130 Code Mass. Regs § 516.008(A), (C), (D) (2017) (requiring MassHealth to provide all applicants, members, and authorized representatives with written notice of eligibility determinations, reason for adverse decisions, and information about rights to fair hearing). The notice also cited to the regulation supporting the action. See 130 Code Mass. Regs § 515.008(A) (2014) (requiring applicants and members to cooperate with MassHealth by providing information necessary to establish and maintain eligibility).
To the extent that Coppinger argues that the notice was defective under the Federal Medicaid regulations, so far as appears, she raised this argument for the first time on appeal to the Superior Court. Were the issue properly before us, we would conclude that she has not established any violation of these "nearly identical" regulations. On the view we take of the case, given the adequacy of the notice, Coppinger was not deprived of the right to a fair hearing under Federal law. The cases Coppinger cites are not to the contrary.
While Coppinger elected to pursue a fair hearing, she did not do so in the required time frame. Specifically, the notice of denial advised that a request for a fair hearing must be filed within thirty days after receipt of written notice from MassHealth of its intended action. See 130 Code Mass. Regs. § 610.015(B)(1) (2019). It is undisputed that Coppinger did not make this request until over ten months after the deadline. We therefore conclude that the hearing officer's finding and conclusion -- that the June 8, 2017 notice was adequate and the appeal untimely -- was supported by substantial evidence, free from constitutional violation, and was not arbitrary or capricious. See G. L. c. 30A, § 14 (7) (a), (e), (g). Accordingly, the judge did not err in allowing the defendant's motion for judgment on the pleadings and in denying Coppinger's cross motion.
Because we conclude that the appeal was not timely, to the extent Coppinger argues that Wilson was eligible for long-term benefits and the application was erroneously denied on the merits, we do not reach this argument. The board was similarly not required to reach the merits of the denial. See Connors v. Annino, 460 Mass. 790, 797 (2011) (failure to file timely administrative appeal deprives boards and courts of jurisdiction to consider appeals).
Judgment affirming board of hearing's October 31, 2019 remand decision, affirmed.
The panelists are listed in order of seniority.