Bamba v. Minn. Dep't of Human Servs., A13-1717

• Decision Date: 05 May 2014
• Docket Number: A13-1717
• Parties: Sekou Bamba, Appellant, v. Minnesota Department of Human Services, et al., Respondents.
• Court: Minnesota Court of Appeals

Sekou Bamba, Appellant, v. Minnesota Department of Human Services, et al., Respondents.

A13-1717

STATE OF MINNESOTA IN COURT OF APPEALS

Filed May 5, 2014

This opinion will be unpublished and

may not be cited except as provided by

Minn. Stat. § 480A.08, subd. 3 (2012).

Affirmed

Schellhas, Judge

Ramsey County District Court

File No. 62-CV-13-1340

Jennifer Linder Wright, Alexander Saumer (certified student attorney), University of St. Thomas Legal Services Clinic, Minneapolis, Minnesota (for appellant)

Lori Swanson, Attorney General, Patricia A. Sonnenberg, Assistant Attorney General, St. Paul, Minnesota (for respondents)

Considered and decided by Schellhas, Presiding Judge; Cleary, Chief Judge; and Klaphake, Judge.^*

UNPUBLISHED OPINION

SCHELLHAS, Judge

Appellant challenges the district court's denial of his appeal from respondent's order denying payment for appellant's long-term care. We affirm.

FACTS

Appellant Sekou Bamba is a 74-year-old man who came to the United States from Liberia in 2010 and suffered a stroke in December 2010. North Memorial Hospital treated Bamba and facilitated his admission, on January 12, 2011, to Benedictine Health Center at Innsbruck (Benedictine) for long-term care. Minnesota's Medicaid Emergency Medical Assistance (EMA) program paid for Bamba's care at Benedictine from January 2011 until January 8, 2012. But, in January 2012, respondent Minnesota Department of Human Services (DHS) notified Bamba and Benedictine that payment for his care at Benedictine would be terminated due to legislative amendments to the EMA statute in 2011, and DHS thereafter denied Benedictine's "Limited Exception Request" for EMA coverage.¹ Bamba appealed, and a human-services judge (HSJ) conducted a "fairhearing" under Minn. Stat. § 256.045, subd. 3 (2012); found that Bamba is not a United States citizen; concluded that the long-term-care services provided to Bamba are not covered by EMA; and recommended affirmance of DHS's decision to deny EMA. The Minnesota Commissioner of Human Services adopted the HSJ's recommendation, and Bamba appealed to the district court. The district court affirmed the commissioner's decision.

This appeal follows.

DECISION

Bamba argues that the commissioner's denial of EMA (1) is an error of law because DHS did not obtain approval from the federal government for a Medicaid state plan amendment before terminating his EMA coverage and (2) is not supported by substantial evidence in the record. This court may reverse or modify the agency's decision if the agency's findings, inferences, conclusions, or decisions are affected by an error of law or unsupported by substantial evidence in view of the entire record as submitted. Minn. Stat. § 14.69(d)-(e) (2012). "On appeal from the district court's appellate review of an administrative agency's decision, this court does not defer to the district court's review, but instead independently examines the agency's record and determines the propriety of the agency's decision." Johnson v. Minn. Dep't of Human Servs., 565 N.W.2d 453, 457 (Minn. App. 1997). The party challenging an agency decision bears the burden of proving that one of the grounds listed in section 14.69 entitles him to relief on appeal. Estate of Atkinson v. Minn. Dep't of Human Servs., 564 N.W.2d 209, 213 (Minn. 1997).

Commissioner's Application of 2011 Legislative Amendments

Bamba argues that DHS erred at law by implementing 2011 legislative amendments to Minn. Stat. §§ 256B.01-.84 (2010) without first submitting a state Medicaid plan amendment (SPA) to the federal Centers for Medicare & Medicaid Services (CMS). CMS is the federal agency that administers the Medicaid program. Shagalow v. State, Dep't of Human Servs., 725 N.W.2d 380, 385 (Minn. App. 2006), review denied (Minn. Feb. 28, 2007). Federal law requires states to submit an SPA to CMS when "[m]aterial changes in State law, organization, or policy, or in the State's operation of the Medicaid program" occur. 42 C.F.R. § 430.12(c)(1)(ii) (2014).²

"'[D]ecisions of administrative agencies enjoy a presumption of correctness, and deference should be shown by courts to the agencies' expertise and their special knowledge in the field of their technical training, education, and experience.'" In re Request for Issuance of SDS General Permit MNG300000, 769 N.W.2d 312, 317 (Minn. App. 2009) (quoting Reserve Mining Co. v. Herbst, 256 N.W.2d 808, 824 (Minn. 1977)). "The rationale for deference to administrative agency decisions is rooted in the separation-of-powers doctrine and the agency's training and expertise in the subject matter." Id. "But an appellate court need not defer to an agency's interpretation of its own regulation when the regulation's language is clear and understandable." Id. (citing Resident v. Noot, 305 N.W.2d 311, 312 (Minn. 1981)).

The supreme court has summarized the approach to judicial review of agency decisions concerning regulations as follows: (1) "when a decision turns on the meaning of . . . an agency's own regulation, it is a question of law that [appellate courts] review de novo"; (2) "when the language of the regulation is clear and capable of understanding, [an appellate court] give[s] no deference to the agency's interpretation and . . . may substitute [its] . . . judgment for that of the agency"; and (3) "when the relevant language of the regulation is unclear or susceptible to different reasonable interpretations, . . . [an appellate court] will give deference to the agency's interpretation and will generally uphold that interpretation if it is reasonable."

Id. (quoting In re Annandale NPDES/SDS Permit Issuance, 731 N.W.2d 502, 515 (Minn. 2007)). "[W]hen determining whether to defer to an agency, we will consider that agency's expertise and special knowledge." Id. (quotation omitted). "When an agency's decision relies on application of the agency's technical knowledge and expertise to the facts presented, deference should be afforded to the agency's decision." Id. (citing In re Review of 2005 Annual Automatic Adjustment of Charges for All Elec. & Gas Utils., 768 N.W.2d 112, 119 (Minn. 2009)).

[D]eference to an agency's interpretation of a statute is appropriate particularly when the administrative practice at stake involves a contemporaneous construction of a statute by the people charged with the responsibility of setting its machinery in motion; of making the parts work efficiently and smoothly while they are yet untried and new.

Annandale, 731 N.W.2d at 512 (quotations omitted).

Medicaid Program

"Medicaid is a cooperative federal-state program through which the Federal Government provides financial assistance to States so that they may furnish medical careto needy individuals." Developmental Servs. Network v. Douglas, 666 F.3d 540, 544 (9th Cir. 2011) (quoting Wilder v. Va. Hosp. Ass'n, 496 U.S. 498, 502, 110 S. Ct. 2510, 2513 (1990)). "To qualify for federal assistance, a State must submit to the Secretary of the Department of Health and Human Services and have approved a plan for medical assistance that complies with statutory requirements." Id. (quotations omitted). "If CMS determines that a state plan or plan amendment does not comply with those requirements, it may deny the state federal funds." Id. (citing 42 C.F.R. §§ 430.15, .18).

Minnesota's EMA Program

"Generally, Minnesota provides medical assistance 'for needy persons whose resources are not adequate to meet the cost' of a variety of medical services." A.A.A. v. Minn. Dep't of Human Servs., 832 N.W.2d 816, 819 (Minn. 2013) (quoting Minn. Stat. § 256B.01 (2012)). The Minnesota EMA program, which is part of the state medical-assistance program, is complex and is authorized by the federal Medicaid statute that governs payment for emergency medical care provided to certain citizens and noncitizens to treat their emergency medical conditions.³ 42 U.S.C. § 1396b(v) (2012); see Minn. Stat. § 256B.06, subd. 4(f) (Supp. 2013) (requiring payment for care and services furnished to noncitizens, who otherwise meet the eligibility requirements of chapter 256B, "if such care and services are necessary for the treatment of an emergency medical condition").

In 1996, Congress enacted the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), providing, in relevant part, that an alien who is not a qualified alien is ineligible for any federal benefit, subject to certain exceptions, including for treatment of an emergency medical condition. Pub. L. No. 104-193, 110 Stat. 2105, 2261-62, 2268-69 (codified in relevant part at 8 U.S.C. §§ 1611, 1621 (2012)). Under 42 U.S.C. § 1396b(v)(1) (2012), "no payment may be made to a State . . . for medical assistance furnished to an alien who is not lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law." Payment to a state for medical assistance furnished to an unqualified noncitizen is permitted only if

(A) such care and services are necessary for the treatment of an emergency medical condition of the alien, (B) such alien otherwise meets the eligibility requirements for medical assistance under the State plan approved under this subchapter . . . , and (C) such care and services are not related to an organ transplant procedure.

Id. § 1396b(v)(2) (emphasis added). An "emergency medical condition" is

a medical condition (including emergency labor and delivery) manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in—

(A) placing the patient's health in serious jeopardy,

(B) serious impairment to bodily functions, or

(C) serious dysfunction of any bodily organ or part.

Id. § 1396b(v)(3). The "emergency medical condition" also must have a "sudden onset." 42 C.F.R. § 440.255(c)(1) (2014).

A state Medicaid plan that is submitted to CMS for approval "consists of preprinted material that covers the basic requirements, and individualized...