Cheryl King v. Department of Health and Social Services, Division of Medicaid and Medical Assistance

IN THE SUPERIOR COURT OF THE STATE OF DELAWARE
CHERYL KING, )
)
Appellant, )
)
DEPARTMENT OF HEALTH ) C.A. No. K24A-04-001 RLG
AND SOCIAL SERVICES, )
DIVISION OF MEDICAID AND )
MEDICAL ASSISTANCE, )
)
Appellees. )
Submitted: August 1, 2024
Decided: October 23, 2024
MEMORANDUM OPINION AND ORDER
Upon Appeal from a Decision of the Delaware Department of Health
and Social Services, Division of Medicaid and Medical Assistance
AFFIRMED
Cheryl King, Pro Se Appellant.
Gabriela Kejner, Esquire, Department of Justice, Wilmington, Delaware. Attorney
for Appellee Unemployment Insurance Appeal Board.
GREEN-STREETT, J.
1
I. Introduction
Cheryl King appeals the decision of a Hearing Officer to uphold a
determination by the Delaware Department of Health and Social Services – Division
of Medicaid and Medical Assistance (“DMMA”) to close Ms. King’s food benefits
case.1 DMMA closed Ms. King’s benefits for “refusal to cooperate” with a quality
control inspection into Ms. King’s case.2 Ms. King contends she could not cooperate
because of her disabilities.3 As the Hearing Officer based his decision on substantial
evidence and committed no legal error, his decision is AFFIRMED.
II. Factual and Procedural Background
The Quality Control Unit (“QC”) of DMMA conducts randomized reviews of
clients receiving food benefits, randomly reviewing “80 to 90 cases each month as
part of a federal requirement.”4 On December 20, 2023, QC sent a letter to Ms. King
advising her that her account would be subject to review.5 The letter informed Ms.
King of the review process, notified her of a scheduled phone interview, and included
1
Notice of Administrative Agency Appeal, D.I. 1 (Apr. 2, 2024).
2
Answering Br. at 2.
3
Opening Br. at 2.
4
Tr. of Hearing before Hearing Officer (“Tr.”) at 15.
5
Id.
2
a list of forms Ms. King needed to complete and return to QC.6 Ms. King returned
several of the completed forms to QC before the deadline, but failed to complete the
Non-Household Member Form (the “Form”).7 The Form must be completed by a
third party who can verify the composition of Ms. King’s household.8 Ms. King
advised QC she did not have anyone who could fill out the Form on her behalf.9
During Ms. King’s scheduled phone interview, a QC reviewer inquired about
the Form.10 The QC reviewer asked if Ms. King’s adult son could fill out the Form.11
Ms. King stated her son could not fill out the form, but declined to provide further
explanation.12 At that time, Ms. King requested a Fair Hearing as provided by
federal regulations.13 A QC manager later followed up with Ms. King regarding the
Form, and Ms. King reiterated her son could not complete the Form.14 The QC
6
Id.; see Ex. 2.
7
Id. at 16.
8
Id.
9
Id.
10
Id.
11
Id. at 16-17.
12
Id. at 17.
13
Id.; see 16 Del. Admin. C. 5100-5000 (defining “Fair Hearing” as “an administrative hearing
held in accordance with the principles of due process.”).
14
Id.
3
manager advised Ms. King of several alternative people who could complete the
Form, including Ms. King’s neighbors or postal workers. Ms. King declined those
options.15 Ms. King also renewed her request for a hearing on the matter.16
On January 5, 2024, QC formally requested to sanction Ms. King’s benefits
for failure to cooperate with QC’s review.17 DMMA applied the requested sanction
and discontinued Ms. King’s benefits on January 8th.18 DMMA lifted the sanction
and reinstated Ms. King’s benefits on January 16th, pending the outcome of her
hearing.
A Hearing Officer conducted a Fair Hearing on Ms. King’s alleged failure to
cooperate on February 21, 2024.19 During the hearing, the Hearing Officer heard
testimony from the QC manager and Ms. King.20 Ms. King submitted several
exhibits, including (1) a video of her son; (2) a letter stating her son suffers from a
disability caused by a blow to the head; and (3) a video of her neighbors.21
15
Id.
16
Id.
17
Id. at 18.
18
Id.
19
Id. at 1.
20
Id.
21
Id. at 26-27.
4
Ms. King proffered a number of reasons why she could not complete the Form.
She explained her son’s disability prevented him from completing the Form; she
could not ask her neighbor to complete the Form because her neighbors are racist;
and she could not ask the postal worker to complete the Form – as suggested by QC
staff – because she “did not want to disclose [her] disability to others, or the fact that
[she is] receiving food benefits.”22 Ms. King testified she could not get the Form
completed because of her own disability.23 Ms. King did not disclose what disability
she suffers from, or why it affected her ability to find someone to complete the Form
on her behalf.
The Hearing Officer issued his written decision on March 20, 2024, upholding
DMMA’s decision to close Ms. King’s food benefits.24 He found QC offered Ms.
King “several opportunities to cooperate with having an individual not residing in
the home who knows of the household composition, to complete the Non-Household
Member Form [sic].”25 The Hearing Officer concluded Ms. King’s stated reasons
for failing to complete the Form were unpersuasive.26 Accordingly, he upheld
22
Id. at 25-26.
23
Id. at 25.
24
R. at 8.
25
R. at 16.
26
Id.
5
DMMA’s closure of Ms. King’s benefits based on Ms. King’s failure to complete the
Form.27
Ms. King appealed the Hearing Officer’s decision to this Court on April 2,
2024,28 and the Court issued a brief schedule on May 14, 2024.29 Ms. King filed her
Opening Brief on May 28, 2024.30 DMMA filed its Answering Brief on June 14,
2024.31 The brief schedule established the deadline for Ms. King to file any reply
brief as July 8, 2024.32 Ms. King did not file a reply by that deadline, and did not
request any allowance from the Court to file a reply out of time. The Court took Ms.
King’s appeal under advisement on the papers on August 1, 2024.
III. Standard of Review
Any recipient of public assistance benefits “against whom an administrative
hearing decision has been decided may appeal such decision to the Superior Court
if the decision would result in financial harm to the appellant.” 33 The appeal “shall
27
Id.
28
D.I. 1.
29
D.I. 13.
30
D.I. 14.
31
D.I. 16.
32
D.I. 13.
33
31 Del. C. § 520.
6
be on the record without a trial de novo.”34 This Court reviews the Hearing Officer’s
decision to ensure it is “supported by substantial evidence and free from legal
error.”35 “The Court is not to replace the trier of fact in an appeal of an administrative
board decision.”36 If the Hearing Officer’s decision is supported by substantial
evidence and free from legal error, it must be affirmed.37
IV. Analysis
A. Ms. King’s potential ADA-related claim is unsupported by the
Record
On appeal, Ms. King contends she did not refuse to cooperate, but rather could
not cooperate because of her disability.38 She posits the American Disabilities Act
(the “ADA”) entitles her to accommodation, and DMMA’s failure to provide that
accommodation during the review process amounts to discrimination.39 Ms. King
does not dispute the evidence relied upon by the Hearing Officer. Ms. King also
34
Id.
35
Ringgold v. Delaware Dep’t of Health & Soc. Servs., 2018 WL 7021956, at *1 (Del. Super. Dec.
21, 2018).
36
Id.37
Id.38
Opening Br. at 3.
39
Id. at 2-3.
7
does not point to any incorrect application of law made by either DMMA or the
Hearing Officer, save for her contention regarding discrimination.
“The ADA prohibits discrimination against individuals with disabilities in all
areas of public life.”40 “The ADA provides that an individual is disabled if … she
has a physical or mental impairment that substantially limits one or more of [ ] her
major life activities.”41 To advance a claim under the ADA, Ms. King must show:
(1) “she is a qualified individual with a disability;” (2) she is being “denied the
benefits of some service, program[,] or activity by reason of [ ] her disability;” and
(3) “the entity which provides the … program [ ] is a public entity.”42
The record lacks any evidence, provided by Ms. King or otherwise, of Ms.
King’s disability. Beyond her testimony that her disability prevents her from finding
someone to complete the Form, Ms. King provided no description of her disability.
Further, Ms. King provided no evidence that she requested any accommodation from
DMMA – aside from her implicit request that her failure to return the completed
Form be ignored. Thus, the Court cannot ascertain whether Ms. King possesses a
40
In re Murphy, 283 A.3d 1167, 1176 (Del. 2022).
41
Petition of Rubenstein, 637 A.2d 1131, 1136 (Del. 1994); see also 42 U.S.C.A. § 12102(2).
42
Genesis Healthcare v. Delaware Dep’t of Health & Soc. Servs., 2018 WL 3096640, at *9 (Del.
Super. June 22, 2018) (quoting Lincoln Cercpac v. Health & Hosp. Corp., 920 F.Supp. 497(S.D.N.Y. 1996)).
8
disability as recognized by the ADA, or what accommodation DMMA could have
provided.
Ms. King suggests her request that a DMMA staff member complete the Form
on her behalf should have been treated as a request for a reasonable
accommodation.43 Without any information about Ms. King’s disability or how it
affects her, the Court cannot determine if Ms. King needed such an accommodation.
DMMA informed Ms. King that its staff could not complete the Form for her, as
DMMA could not verify Ms. King’s “household composition.”44 Additionally, QC
provided Ms. King with several alternative solutions to facilitate completion of the
Form. Those suggestions included asking Ms. King’s son to complete the Form;
having Ms. King’s neighbors complete the Form on her behalf; or having a postal
worker complete the Form.45
Ms. King rejected all of those suggestions.46 Of particular note, Ms. King
declined QC’s suggestion of a postal worker because she “did not want to disclose
[her] disability to others, or the fact that [she is] receiving food benefits.”47 A review
43
Opening Br. at 1.
44
Tr. at 16.
45
Id. at 16-17.
46
Id.
47
Id. at 26.
9
of the Form reveals it contains no mention of any disability or indication that Ms.
King receives food benefits.48 The Form only requires verification of Ms. King’s
address; the names of anyone else residing with Ms. King; the relationship between
Ms. King and the person completing the Form; and the address of the person
completing the Form. Even if the Form contained a reference to food benefits, or
Ms. King’s disability, Ms. King’s disability does not prevent her from having a postal
worker complete the Form. Rather, Ms. King’s desire for privacy dissuaded her from
asking a postal worker for assistance as QC suggested. The ADA seeks to prevent
discrimination based on disabilities – not based on a desire for privacy.
Ms. King has failed to demonstrate that her undocumented disability prevents
her from utilizing the suggestions provided by QC to have the Form completed. The
Record shows QC requested a sanction on Ms. King’s benefits because of her failure
to complete the Form. As QC and DMMA did not discriminate against Ms. King
based on any disability, and as Ms. King failed to show any additional
accommodation was necessary, Ms. King’s argument based on the ADA must fail.
B. The Hearing Officer’s decision was based on substantial evidence
and free from legal error
Ms. King does not contend the Hearing Officer lacked substantial evidence to
support his decision. Upon review of the Record, the Court finds the Hearing Officer
48
See Ex. 5.
10
based his decision on substantial evidence. Ms. King’s benefits were closed because
she failed to cooperate with a QC review. Ms. King failed to cooperate because she
did not complete the Form. Her failure to complete the Form remains undisputed,
and serves as sufficient grounds for the closing of her benefits. The Court also finds
the Hearing Officer’s decision free from legal error.
V. Conclusion
The Hearing Officer’s decision is based on substantial evidence and free from
legal error. Ms. King has failed to raise an appealable issue. Her argument based
on the ADA fails because (1) Ms. King provided no documentation or description of
her disability; and (2) QC attempted to work with Ms. King on finding a way for her
to have the Form completed. Accordingly, the decision of the Hearing Officer is
AFFIRMED.
IT IS SO ORDERED.
11