Ohlson v. North Dakota Dept. of Human Services, 960012

• Decision Date: 18 July 1996
• Docket Number: No. 960012,960012
• Citation: 552 N.W.2d 73
• Parties: Debbie OHLSON, Petitioner and Appellant, v. NORTH DAKOTA DEPARTMENT OF HUMAN SERVICES and Ramsey County Social Service Board, Respondents and Appellees. Civ.
• Court: North Dakota Supreme Court

Page 73

552 N.W.2d 73

Debbie OHLSON, Petitioner and Appellant, v. NORTH DAKOTA DEPARTMENT OF HUMAN SERVICES and Ramsey County

Social Service Board, Respondents and Appellees.

Civ. No. 960012.

Supreme Court of North Dakota.

July 18, 1996.

Duane Houdek, Legal Assistance of North Dakota, Bismarck, for petitioner and appellant.

Jean R. Mullen, Assistant Attorney General, Attorney General's Office, Bismarck, for respondents and appellees.

VANDE WALLE, Chief Justice.

Debbie Ohlson appealed from a judgment affirming a Department of Human Services decision denying her claim for medical assistance as an incapacitated parent under the Aid to Families with Dependent Children (AFDC) program. We hold that the Department's decision that Ohlson was not an incapacitated parent is supported by a preponderance of the evidence. We affirm.

Ohlson and her husband have three children. Ramsey County Social Services has had an open Medicaid file on the family since 1988 because one of the children receives medical assistance for a disability. In October 1993, Ohlson began experiencing low back pain, abdominal pain, and burning on urination, and she requested medical assistance as an incapacitated parent under the AFDC program.

In January 1994, a State Review Team (SRT) found Ohlson's medical record established that, effective October 1, 1993, she had met the eligibility criteria for medical assistance as an incapacitated parent because of "[l]ow back pain, chronic" and "status post laparoscopy, 12-93." The SRT decision required a current medical report and an updated social report by April 30, 1994, to determine if Ohlson continued to be incapacitated. Ohlson had a hysterectomy in April 1994, and the SRT continued her on medical assistance from May 1, 1994, to permit her to recuperate. However, the SRT recommended her case be closed effective June 30, 1994, and her medical assistance benefits were terminated on that date.

In July 1994, Ohlson reapplied for medical assistance as an incapacitated parent, claiming back pain, burning after urination, and bowel trouble. The SRT, which then consisted of Dr. Joseph Cleary and social worker Kimberly Kinn, denied Ohlson's application, finding she was "not incapacitated (too ill to work or to perform household duties for at least 30 days)." Ohlson requested a hearing. After an administrative hearing, the hearing officer determined that the SRT decision did not comport with AFDC and Medicaid rules and regulations and recommended returning the matter to the SRT for a reassessment of incapacity. The Executive Director of the Department rejected the hearing officer's recommendation and issued the Department's order denying Ohlson medical assistance. The Executive Director concluded Ohlson had "chronic pain of [an] undetermined cause," but that she had not demonstrated her chronic pain was of such a debilitating nature as to reduce substantially or eliminate her ability to support or care for her eligible child for at least 30 days. The district court affirmed the Department's decision.

Our review of administrative agency decisions under N.D.C.C. §§ 28-32-19 and 28-32-21 requires a three-step process to determine if the agency's findings of fact are supported by a preponderance of the evidence, its conclusions of law are sustained by its findings of fact, and its decision is supported by its conclusions of law. Bohac v. Graham, 424 N.W.2d 144 (N.D.1988). In determining whether an agency's findings of fact are supported by a preponderance of the evidence, we do not make independent findings of fact or substitute our judgment for that of the agency; rather, we determine only whether a reasoning mind could have reasonably determined that the agency's factual conclusions were supported by the weight of the evidence. Id. We review the Department's decision that Ohlson was not an incapacitated parent in that context.

Federal law establishes the medical assistance program as a jointly financed federal-state program designed to provide health care for needy families with dependent children. See 42 U.S.C. §§ 601 et seq. and 1396 et seq. Each state electing to participate in the program is required to establish a plan to implement the program. 42 U.S.C. §§ 1396 and 1396a. A State plan must provide medical assistance for all individuals who are categorically needy, including individuals receiving AFDC. 42 U.S.C. § 1396a(a)(10)(A). To meet the requirements of the AFDC program, a family must have a dependent child. 42 U.S.C. § 601. A dependent child is defined as a child who is deprived of parental support or care because of physical or mental incapacity of a parent. 42 U.S.C. § 606(a). 45 C.F.R. 233.90(c)(1)(iv) defines "incapacity":

"(iv) 'Physical or mental incapacity '. 'Physical or mental incapacity' of a parent shall be deemed to exist when one parent has a physical or mental defect, illness, or impairment. The incapacity shall be supported by competent medical testimony and must be of such a debilitating nature as to reduce substantially or eliminate the parent's ability to support or care for the otherwise eligible child and be expected to last for a period of at least 30 days. In making the determination of ability to support, the agency shall take into account the limited employment opportunities of handicapped individuals." [Emphasis added].

Ohlson asserts the federal definition of incapacity entitles her to receive medical assistance for a condition that substantially reduces or eliminates her ability either to support or to care for her eligible child. She contends the Department denied her medical assistance solely because it found she could care for her child as a "homemaker" without considering whether she had a substantially reduced ability to support her child as a "breadwinner." She argues the Department's eligibility standard for incapacitated parents is more restrictive than the two-pronged, disjunctive definition for incapacity in the federal regulation and is therefore invalid under the supremacy clause of the federal constitution. See Townsend v. Swank, 404 U.S. 282, 92 S.Ct. 502, 30 L.Ed.2d 448 (1971); King v. Smith, 392 U.S. 309, 88 S.Ct. 2128, 20 L.Ed.2d 1118 (1968). See also Nelson v. Cass County Social Services, 424 N.W.2d 371, 374 n. 1 (N.D.1988).

In Nelson, the Department decided "incapacity" by identifying a parent's usual function in the family, either as a homemaker or as a breadwinner, and then considering whether the parent's condition significantly interfered with that function. In Nelson, the Department found a mother's condition did not significantly interfere with her usual function as a homemaker, but did not evaluate whether her condition also affected her ability to support the child as a breadwinner. We concluded the Department's finding about the mother's ability to care for her child as a homemaker was supported by a preponderance of the evidence. However, we said the Department's policy of restricting the inquiry to the parent's "usual" function within the home had no apparent basis in the federal regulation. See Chaffin v. Taylor, 521 F.Supp. 1344 (M.D.Fla.1981) [holding that parental incapacity is measured by both ability to support and ability to care for child]. We declined to construe the federal regulation or invalidate the Department's breadwinner/homemaker distinction, and we remanded to the Department "so that timely 'evidence' may be obtained and an appropriate decision can be made by the Department relating to the United States Department of Health and Human Services' interpretation of 45 CFR § 233.90(c)(1)(iv)." Nelson, 424...