Dept. of Health v. Campbell, 89

• Decision Date: 09 May 2001
• Docket Number: No. 89,89
• Citation: 771 A.2d 1051,364 Md. 108
• Parties: DEPARTMENT OF HEALTH AND MENTAL HYGIENE v. Minnie CAMPBELL, et al.
• Court: Maryland Court of Appeals

771 A.2d 1051

364 Md. 108

DEPARTMENT OF HEALTH AND MENTAL HYGIENE v. Minnie CAMPBELL, et al.

No. 89, Sept. Term, 1999.

Court of Appeals of Maryland.

May 9, 2001.

Elizabeth M. Kameen, Asst. Atty. Gen. (J. Joseph Curran, Jr., Atty. Gen. of Maryland and Heidi A. Moylan, Asst. Atty. Gen., on brief) of Baltimore, for appellant.

Richard B. Stofberg (J. Michael Holloway and Michael A. Stanley, Law Offices of Arthur L. Drager, on brief) of Baltimore, for appellees.

Argued before BELL, C.J., ELDRIDGE, RODOWSKY,¹ WILNER, CATHELL, HARRELL, and THEODORE G. BLOOM, (Retired, Specially Assigned) JJ.

BELL, Chief Judge.

This case presents the issue of whether guardianship commissions and attorneys' fees of an attorney appointed guardian of the property of mentally incompetent Medicaid recipients constitute available income under the Maryland Medicaid Assistance Program, specifically whether such fees qualify as a personal needs allowance.² We shall hold, contrary to the conclusion of the Circuit Court for Baltimore City, that they are not.

The Medicaid program, a jointly funded collaboration between a State and the federal government providing medical assistance to low income persons unable to afford to pay for their medical care, is a voluntary program, in which a State may elect, but is not compelled, to participate. 42 U.S.C. § 1396 et seq.; 42 C.F.R. §§ 430-456. When a State elects to participate in the Medicaid program, it is required to develop, and submit for federal approval by the Health Care Financing Administration (hereinafter "HCFA"), the federal agency that administers the Federal Medical Assistance Program, 42 U.S.C. § 1396, a State Medicaid Plan for the provision of medical assistance that complies with the Medicaid Act and the regulations promulgated by the Secretary of the Department of Health and Human Services. 42 U.S.C. § 1396; 42 C.F.R. § 430-456. If HCFA approves the State plan, then the State qualifies for federal funding. After the plan receives federal approval, alteration of it without federal approval, would jeopardize its federal funding. 42 U.S.C. § 1396(c).

Maryland has chosen to participate in the Medicaid program. It does so through the Maryland Medical Assistance Program, operated by the appellant. See Md. Code (1982, 2000 Repl.Vol.) § 15-103 of the Health General Article. The Medical Assistance program provides reimbursement for the cost of health care services provided to certain indigent persons, i.e. "for indigent individuals or medically indigent individuals."³ § 15-103(a)(2)(i). See COMAR 10.09.24.01 (including aged, blind or disabled persons within the category of persons for whom eligibility may be determined); COMAR 10.09.24.03D(4) (including "an aged, blind or disabled person" in the list of the "Medically Needy").

Thus, in Maryland, an individual who is aged, blind, or disabled, COMAR 10.09.24.03D(4),⁴ and has an income that does not exceed $ 2500, Health Gen. § 15-109(b)(1), COMAR 10.09.24.08L and M, qualifies for Medical Assistance benefits. An individual with assets that exceed the resource limit, but whose income is insufficient to meet the cost of care, may enter a long-term care facility, such as a nursing home. Such an individual is required to contribute all of his or her "available income" to the nursing facility to pay for the cost of care, with the program making up the difference. COMAR 10.09.24.10D (3);⁵ see 42 C.F.R. § 435.832(a).

The Maryland Medical Assistance Program regulations do not define "available income." COMAR 10.09.24.10D(2), however, prescribes how to determine "available income." And the regulations define income as "any property or service received by a person in cash or in-kind which can be applied directly, or by sale or conversion, to meet basic needs for food, shelter, and medical expenses." COMAR 10.09.24.02B(23)(a). Thus, available income is the difference between total income and any allowable deductions. See id. For institutionalized recipients, the following deductions are allowed from the recipient's total income to determine available income: (1) a personal needs allowance ⁶; (2) a spousal or family allowance; (3) a residential maintenance allowance for a single person; and (4) incurred medical expenses that are not subject to payment by a third party. See COMAR 10.09.24.10D(2)(a)-(d).

I.

Arthur L. Drager is the guardian of the property⁷ for each of seven Medicaid recipients (the appellees).⁸ Each appellee is a resident of a nursing facility and receives Medicaid benefits to help pay for his or her care. The present controversy began when Mr. Drager requested that the Maryland Medical Assistance Program ("Program") of the Department of Health and Mental Hygiene (the appellant) deduct his guardianship commissions with respect to his wards from their available incomes.⁹ He sought commissions in the following amounts: $522.78 for Minnie Campbell, $294.62 for Lillian Cheatham, $416.27 for Melster Dystart, $ 689.04 for Mahalia LaCruze, $263.42 for Thomas Roundtree, $925.36 for Vivian Tazewell, and $829.37 for Daisy Watts. These requests were denied by the Medicaid Program, which advised Mr. Drager that the Department has "no provisions in [the] regulations to allow for such deductions."

Mr. Drager, on behalf of the appellees, appealed to the Office of Administrative Hearings (OAH), arguing that the commissions should be permitted as part of the personal needs allowance of each Medicaid recipient, that the Administrative Law Judges should follow prior OAH, Board of Review, and Circuit Court decisions that permitted the deduction of such commissions, and that public policy considerations required a ruling favorable to the appellees. appellant's decision, concluding that it had correctly held that the guardianship commissions are not a part of the personal needs allowance and, thus, are not a permissible deduction in calculating a Medicaid recipient's available income.¹⁰ The appellees' other arguments were also rejected. The Board of Review, to which the decisions were appealed, affirmed.

The appellees sought judicial review in the Circuit Court for Baltimore City, and the cases were consolidated for hearing. Pressing the same arguments they had made before the ALJs, the appellees sought, in the Circuit Court, not just the deduction of the guardianship commissions, but attorneys' fees to be paid on the same basis. Accepting their argument that guardianship commissions should be deducted from a recipient's income as a part of the personal needs allowance, the Circuit Court reversed. As to the guardianship commissions, the court ordered:

"that the guardianship commissions calculated in accordance with the Annotated Code of Maryland, Estates and Trusts Article Sections 13-218 and 14-103, and approved by the Trust Clerk for the Circuit Court for Baltimore City for services rendered on behalf of [the named appellee] shall not be considered as `available income' as set forth in COMAR 10.09.24.10D and shall be deducted prior to the calculation of available income for [the named appellee]...."

and

"That the Baltimore City Department of Social Services Long Term Medical Assistance Unit be and is hereby directed to allow guardianship commissions in [a stated amount] to be paid unto Arthur L. Drager for services rendered by him in his capacity as Guardian of the Property of [the named appellee]."

The trial court reasoned:

"[I]n our guardianship docket, a lot of indigent people would be out on the street but for our appointing guardians and having Counsel represent the guardian, and then be able to get the benefits that they're entitled to under the law. So, I don't view it as sort of gilding the lily, I view it as essential to life and to living, and, therefore I will sign the Orders authorizing the fees be paid."

The court also granted the appellee's request for, and ordered the Department to allow, a counsel fee of $600, for each case.

We issued the writ of certiorari on our own motion, while this case was pending in the Court of Special Appeals. We now reverse the judgment of the Circuit Court for Baltimore City.

II.

Our review of a decision by the Department of Health and Mental Hygiene, an administrative agency of the State, is governed by Md.Code (1984, 1999 Repl.Vol.) § 10-222 of the State Government Article, section (h) of which provides:

"(h) In a proceeding under this section, the court may:

"1. remand the case for further proceedings;

"2. affirm the decision of the agency; or

"3. reverse or modify the decision if any substantial right of the petitioner may have been prejudiced because a finding, conclusion, or decision of the agency:

* * *

"c) results from an unlawful procedure;

"d) is affected by any other error of law;

"e) is unsupported by competent, material, and substantial evidence in light of the entire record as submitted; or

"f) is arbitrary or capricious."

Thus, the issue for the reviewing court is whether the administrative agency committed an error of law, or whether its decision is supported by substantial evidence, or is "arbitrary or capricious." Insurance Comm'r of State of Md. v. Equitable Life Assurance Soc'y of U.S., 339 Md. 596, 614-15, 664 A.2d 862, 871-72 (1995).

The question whether guardianship commissions are an allowable deduction from a Medical Assistance recipient's available income under COMAR 10.09.24.10D(2)(d), as a "personal needs allowance," is solely one of law. As to the review of questions of law, we have pointed out, see Office of People's Counsel v. Maryland Public Service Comm'n, 355 Md. 1, 14, 733 A.2d 996, 1003 (1999) (quoting Commissioners of Cambridge v. Eastern Shore Public Serv. Co., 192 Md. 333, 339, 64 A.2d 151, 154 (1949)) and citing Mayor & Council of Crisfield v. Public Serv. Comm'n, 183 Md. 179, 189, 36 A.2d 705, 710 (1944) and Baltimore Gas and Elec. Co. v. Dep't of Health and Mental Hygiene, 284 Md. 216, 230-31, 395 A.2d 1174, 1181 (1979), that "[q]uestions of...