Micone v. Department of Public Health & Human Services
258 P.3d 403
Mont.2011Background
- Joshua applied for Medicaid in 2003 without reporting Jennifer's Jump Investments interest; Department approved benefits based on incomplete asset information.
- Family benefits totaling $22,657.32 were paid from January 2003 through May 2006.
- In June 2006 the Department notified Joshua that he was ineligible for past benefits because Jennifer's Jump Investments interest exceeded the resource limit.
- A March 2008 hearing was held; the Hearing Officer found Jennifer's interest was a countable, available resource, issuing a decision February 3, 2009; the Board affirmed in April 2009; the District Court affirmed in September 2010.
- Jennifer's interest in Jump Investments is a limited partnership asset with possible transfer restrictions, and its valuation was disputed but relied on the Family Medicaid Manual; the case raises whether the Hearing Officer adhered to timing rules and whether the resource valuation was supported by substantial evidence.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Timeliness of final decision under § 2-4-623 | Micone contends the Hearing Officer's delay violated § 2-4-623. | Department argues review on different grounds; district court correctly concluded no prejudicial error. | District Court correctly held no violation of § 2-4-623. |
| Jennifer's Jump Investments as an available resource | Micone contends the resource is not available due to market/transfer hurdles and valuation disputes. | Department relied on Family Medicaid Manual; Jennifer's interest valued as available resource. | Substantial credible evidence supports Jennifer's interest as an available resource. |
Key Cases Cited
- Hofer v. State, 124 P.3d 1098 (MT 2005) (clear error review; statutory interpretation applies to MAPA standards)
- Knowles v. State ex rel. Lindeen, 222 P.3d 595 (MT 2009) (timeliness/ submission for final decision framing under SB 260)
- Timm v. Mont. Dept. of Health & Human Services, 184 P.3d 994 (MT 2008) (adopted Medicaid Manual provisions; force of law)
- Grover v. Cornerstone Constr. N.W., Inc., 91 P.3d 1278 (MT 2004) (code/standard adoption; force of law)
- Hilands Golf Club v. Ashmore, 39 P.3d 697 (MT 2002) (administrative review; timeliness considerations)