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Estate of Hunter v. Ohio Department of Job and family Services

Court of Appeals of Ohio, Eighth District, Cuyahoga

May 17, 2018

ESTATE OF OSCAR HUNTER PLAINTIFF-APPELLANT
v.
OHIO DEPARTMENT OF JOB AND FAMILY SERVICES DEFENDANT-APPELLEE

          Civil Appeal from the Cuyahoga County Court of Common Pleas Case No. CV-15-852977

          ATTORNEYS FOR APPELLANT Joseph F. Petros W. Cory Phillips Rolf Goffman Martin Lang, L.L.P.

          ATTORNEYS FOR APPELLEE Michael DeWine Ohio Attorney General James Andrew Stevens Amy R. Goldstein Assistant Attorneys General Health and Human Services Section

          BEFORE: Stewart, P.J., Blackmon, J., and Jones, J.

          JOURNAL ENTRY AND OPINION

          MELODY J. STEWART, P.J.

         {¶1} Plaintiff-appellant estate of Oscar Hunter appeals from a common pleas court decision affirming an Ohio Department of Jobs and Family Services ("agency") dismissal of his administrative appeal from the denial of Medicaid benefits on grounds that it was untimely filed. The estate's two assignments of error collectively claim that the court erred because the agency did not give it proper notice that the claim had been denied.

         {¶2} Our standard of review from decisions by the court of common pleas in administrative appeals is limited: we can only determine whether the court of common pleas abused its discretion. Bartchy v. State Bd. of Edn., 120 Ohio St.3d 205, 2008-Ohio-4826, 897 N.E.2d 1096, ¶ 41. We do, however, address questions of law de novo, with no deference to the court of common pleas. Big Bob's, Inc. v. Ohio Liquor Control Comm., 151 Ohio App.3d 498, 2003-Ohio-418, 784 N.E.2d 753, ¶ 15 (10th Dist).

         {¶3} The facts are undisputed. Hunter was admitted to a nursing home on July 30, 2013, and that same day applied for Medicaid long-term care services. The agency denied the application in April 2014 because Hunter did not meet the financial requirements for benefits. The nursing home filed a request for a state hearing[1] on the application, but the agency dismissed the request in December 2014 because the nursing home failed to provide documentation showing that it had been authorized to proceed as Hunter's representative. The agency notified Hunter that "[u]nless you request an administrative appeal, dismissal is a final and binding decision on your request for state hearing." Hunter took no further appeal from the dismissal.

         {¶4} After securing the necessary permission to act as Hunter's representative, the nursing home filed a second application for long-term care services on August 5, 2014. The agency approved the application effective August 1, 2014. The estate sought a state hearing on whether the application should have been made effective from July 30, 2013, when Hunter filed his first application for benefits. The request for a hearing was denied.

         {¶5} The estate appealed to the court of common pleas, arguing that the agency failed to properly process the July 2013 application for medical assistance by not seeking and reviewing required financial documents, failing to explore all medical assistance options, and failing to give proper notice that the July 2013 application had been dismissed. The agency argued that it correctly denied Hunter's August 2014 request to backdate his Medicaid eligibility to July 2013. It maintained that Hunter's failure to appeal the July 2013 decision waived his claims of procedural defects, and that Hunter could not bootstrap challenges to the July 2013 application for benefits in an appeal from the separate August 2014 application. The court summarily denied Hunter's appeal, finding the agency's decision to be supported by reliable, probative, and substantial evidence and issued in accordance with law.

         {¶6} The estate argues that the agency could not "dismiss" the July 2013 request for a state hearing because dismissal was not an available dispositional option. It maintains a request for a state hearing can only be denied if (1) the request is untimely, or (2) the request was not made by the individual or authorized representative. See Ohio Adm.Code 5101:6-5-03(C).[2]The estate concedes that Hunter's request for a state hearing in the first application for benefits was made by his nursing home, who was not an authorized representative, and thus lacked standing to request a state hearing. Citing authority for the proposition that dismissals for want of standing do not have preclusive effect because they are not decided on the merits, see, e.g., State ex rel. Coles v. Granville, 116 Ohio St.3d 231, 2007-Ohio-6057, 877 N.E.2d 968, ¶ 51, the estate claims that the dismissal of the state hearing on the first application for benefits was not a decision on the merits, but a recognition of a procedural defect that effectively meant that the July 2013 request for a state hearing had never been properly requested.

         {¶7} Hunter plainly had standing to request a state hearing because he had "a sufficient stake in an otherwise justiciable controversy to obtain judicial resolution of that controversy." Cleveland v. Shaker Hts., 30 Ohio St.3d 49, 51, 507 N.E.2d 323 (1987). He may have lacked the mental capacity to request a state hearing (he had a legal guardian at the time), necessitating that the request be made by a personal representative. A personal representative is said to "stand in the shoes" of the represented person. McDonald v. State Farm Mut. Auto. Ins. Co., 8th Dist. Cuyahoga No. 76808, 2000 Ohio App. LEXIS 3621, 18 (Aug. 10, 2000). A claim brought on behalf of a represented person depends on the represented person's standing to bring an action because the represented person is the real party in interest. See Civ.R. 17(A); Ohio Adm.Code 5101:6-3-02(A)(1) ("A state hearing may only be requested by or on behalf of an individual applying for or receiving benefits").

         {¶8} It is true that the nursing home in this case was not properly authorized as Hunter's personal representative for the state hearing on the July 2013 application for benefits. Its attempt to seek a state hearing did not bind Hunter. Nevertheless, without further appeal, the state hearing decision became final and binding. Even if we consider the nursing home's request for state hearing to be a nullity, Hunter was nonetheless required to adhere to the 90-day time limit for seeking a state hearing. See Ohio Adm.Code 5101:6-3-02(B)(1) ("The individual shall be allowed ninety calendar days to request a hearing on any action or inaction").

         {¶9} The estate argues that it could validly raise objections to the rejection of the state hearing in the July 2013 decision in the August 2014 request for a state hearing because the ...


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