Flachs v. Ill. Dep't of Human Servs.
| Decision Date | 20 August 2021 |
| Docket Number | 4-20-0349 |
| Parties | ALBERTA FLACHS, by Her Attorney in Fact, LOWELL A. FLACHS, Plaintiff-Appellant, v. THE ILLINOIS DEPARTMENT OF HUMAN SERVICES, and GRACE HOU, in Her Official Capacity as Secretary of Human Services, Defendants-Appellees. |
| Court | United States Appellate Court of Illinois |
This Order was filed under Supreme Court Rule 23 and is not precedent except in the limited circumstances allowed under Rule 23(e)(1).
Appeal from the Circuit Court of Adams County No. 19MR117 Honorable Scott D. Larson, Judge Presiding.
¶ 1 Held: Plaintiff forfeited review of her claim challenging the sufficiency of the notice issued by the Department of Human Services following its decision to deny her application for welfare benefits. The Department of Human Services did not violate federal or state regulations or plaintiffs right to due process in denying plaintiffs request to reopen her application for welfare benefits.
¶ 2 In September 2017, plaintiff, Alberta Flachs, filed an application for Medicaid benefits to help cover her long-term-care expenses. On March 3, 2018, defendant, the Illinois Department of Human Services (the Department) denied plaintiffs application because she failed to submit certain information to verify her eligibility for benefits. Five days later, Lowell Flachs, acting as plaintiff s power of attorney, requested the Department reopen plaintiffs application and submitted documents to the Department that he believed demonstrated plaintiffs eligibility for benefits. On January 9, 2019, the Department denied plaintiffs request to reopen her application. Plaintiff filed an administrative appeal, which was dismissed for lack of jurisdiction. Plaintiff then sought administrative review in the trial court, and the court affirmed the Department's dismissal.
¶ 3 On appeal, plaintiff argues the Department's March 3 2018, notice of decision and the Department's denial of her request to reopen her Medicaid application did not comply with requirements set forth in federal regulations and the Illinois Administrative Code and denied her due process. We affirm.
¶ 5 Plaintiff is a resident of Sunset Home, a long-term care facility located in Quincy, Illinois. On September 15, 2017 plaintiff applied for medical assistance through Medicaid to help cover her long-term care expenses.
¶ 6 On September 22, 2017, the Department sent plaintiff and Sunset Home a document titled "Instructions to Client," which stated that, to confirm her eligibility for medical benefits, plaintiff was required to submit: (1) statements relating to her banking and other financial accounts, (2) a prepaid burial contract, if she had one, (3) if applicable, verification that her burial expenses were funded by her life insurance policy, (4) information related to a vehicle she owned, (5) information related to any property she owned which had been sold or given away, (6) copies of her health insurance cards, (7) proof of any power of attorney, and (8) a Department form to be filled out. The Instructions to Client document further stated: "If we do not hear from you by [October 2, 2017], we will not be able to decide if you qualify and your application may be denied."
¶ 7 On February 6, 2018, the Department sent plaintiff, Sunset Home, and Lowell Flachs a document titled "Verification Checklist" requesting: (1) bank statements from plaintiff's checking account covering certain periods, (2) verification of a certain life insurance policy or annuity referenced in a checking account statement plaintiff had previously submitted, (3) a pension statement covering a certain period, (4) information related to the sale of her vehicle, and (5) the "origin of deposits over $500 made into [plaintiff's] checking acc[ount]." The checklist also stated: "If you do not respond by Feb[ruary] 16, 2018, your SNAP, Cash and/or Medical benefits could be reduced, cancelled, or denied."
¶ 8 The record does not indicate that plaintiff or anyone acting on her behalf submitted any documents to the Department in response to the February 6, 2018, verification checklist prior to February 16, 2018.
¶ 9 On March 3, 2018, the Department sent plaintiff, Sunset Home, and Lowell a notice of decision denying her application for medical assistance (the Notice). The Notice stated:
The Notice also explained how to request an appeal of the Department's decision and listed resources for free legal assistance.
¶ 10 Five days later, on March 8, 2018, Lowell, acting as plaintiff's power of attorney, sent the Department an email which stated, In the email, Lowell included documents related to plaintiff's life insurance policy, bank accounts, prepaid burial contract, vehicle, and annuity. Immediately thereafter, the Department responded, stating,
¶ 11 On January 9, 2019, the Department contacted Sunset Home by telephone and informed a representative of the facility that the Department had denied plaintiff's request to reopen her application and that plaintiff's application for benefits remained denied. The Department did not otherwise contact plaintiff, Lowell, or Sunset Home regarding plaintiff's request to reopen her application.
¶ 12 On January 24, 2019, plaintiff filed an administrative appeal with the Department's Bureau of Hearings. On the appeal request form, plaintiff's authorized representative indicated that plaintiff was appealing the "Denial of Re-open conveyed by phone call on or about 1-9-19" and that she requested a fair hearing because "[her] application/request was denied and [she] disagree[d] with this." During the first hearing on plaintiff's appeal, plaintiff's representative argued the Department's failure to provide written notice of its decision not to reopen plaintiff's application was "constitutionally deficient under the Regulations." In response, the Department argued the Bureau of Hearings lacked jurisdiction over plaintiff's claim because she failed to appeal the Department's decision denying her application for benefits within 60 days of March 3, 2018, the date of the Notice, as required under section 10.282(a) of Title 89 of the Illinois Administrative Code (Code) (89 Ill. Adm. Code 10.282(a) (1997)). The administrative law judge continued the proceeding to allow plaintiff's representative to file a brief in support of plaintiff's argument, which brief was filed on March 1, 2019.
¶ 13 On May 22, 2019, the administrative law judge conducted a hearing to determine whether the Bureau of Hearings lacked jurisdiction over plaintiff's appeal, as alleged by the Department. During this hearing, plaintiff's representative argued the Bureau of Hearings had jurisdiction over plaintiff's appeal either because the appeal was filed within 60 days of January 9, the date the Department denied her request to reopen her application, or because the Department's reopen process violated plaintiff's right to due process. The Department's representative testified that the Department "review[ed] this case for a potential reopen and found that *** it did not meet the requirements for a reopen as not all missing verifications were provided within 60[ ]days of the denial." Additionally, the Department's representative testified that the reopening process "does not affect [an applicant's] right to appeal the decision on the medical case or change any deadlines to file an appeal of the Application that was denied for failure to provide the required information or verification." The representative concluded that the Department was not required to give notice of its decision not to reopen plaintiff's application because the decision did not constitute a denial of eligibility for benefits. Finally, the Department's representative acknowledged the Notice did not include a list of items plaintiff failed to produce but testified "the verification checklist had already been provided at that point."
¶ 14 After the hearing, the administrative law judge found that the Bureau of Hearings did not have jurisdiction over plaintiff's appeal because it was not filed within 60 days of the Notice, as required under regulation. On May 29 2019, Grace Hou, the Secretary of the Department, issued a final administrative decision dismissing plaintiff's appeal and upholding the decision...
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