Tiggs c/o Indian hills Healthcare Group, Inc. v. Ohio Dept. of Job & Family Servs.

[Cite as Tiggs c/o Indian hills Healthcare Group, Inc. v. Ohio Dept. of Job & Family Servs., 2018-Ohio-3164.]
Court of Appeals of Ohio
EIGHTH APPELLATE DISTRICT
COUNTY OF CUYAHOGA
JOURNAL ENTRY AND OPINION
No. 106022
PERSEY TIGGS C/O INDIANHILLS HEALTHCARE GROUP, INC.
PLAINTIFF-APPELLEE
vs.
OHIO DEPARTMENT OF JOB AND
FAMILY SERVICES
DEFENDANT-APPELLANT
JUDGMENT:
AFFIRMED IN PART; DISMISSED IN PART
Civil Appeal from the
Cuyahoga County Court of Common Pleas
Case No. CV-17-874398
BEFORE: Celebrezze, J., E.A. Gallagher, A.J., and Stewart, J.
RELEASED AND JOURNALIZED: August 9, 2018
ATTORNEYS FOR APPELLANT
Michael DeWine
Ohio Attorney General
BY: Rebecca L. Thomas
Assistant Attorney General
Health & Human Services Section
30 East Broad Street, 26th Floor
Columbus, Ohio 43215
ATTORNEY FOR APPELLEE
Jennifer Coy
SB2 Inc.
1426 North Third Street, Suite 200
P.O. Box 5400
Harrisburg, Pennsylvania 17110
FRANK D. CELEBREZZE, JR., J.:
{¶1} Defendant-appellant, the Ohio Department of Job and Family Services (hereinafter
“appellant”), brings this appeal challenging the trial court’s order modifying appellant’s decision.
After a thorough review of the record and law, this court affirms in part and dismisses in part.
I. Factual and Procedural History
{¶2} Persey Tiggs (hereinafter “Tiggs”) was a Medicaid recipient residing in a
long-term care nursing facility, The Willows. In May 2013, Tiggs was adjudicated mentally
incompetent and a guardianship was appointed by the probate court. See Cuyahoga P.C. No.
2013GRD188248. In September 2015, Tiggs’s Medicaid benefits were terminated because
appellant became aware that Tiggs, as a beneficiary, had come into possession of a life insurance
policy. This policy made Tiggs financially ineligible for Medicaid because Tiggs could
liquidate the policy and receive a cash value.
{¶3} On September 12, 2015, appellant sent Tiggs a notice stating that his Medicaid
benefits were proposed to be terminated because of the life insurance policy. However, through
an error, Tiggs continued to receive Medicaid benefits through August 2016.
{¶4} On August 4, 2016, Tiggs’s guardian, a relative of Tiggs, executed a “designation of
authorized representative” form pursuant to Ohio Adm.Code 5160:1-2-08(C)(1), naming The
Willows as Tiggs’s authorized representative. On August 12, 2016, The Willows reapplied for
Tiggs’s Medicaid benefits and Tiggs’s reapplication was subsequently denied on October 20,
2016, because of the life insurance policy.
{¶5} Tiggs requested a state hearing to appeal the denial of his August 2016
reapplication. At issue was whether or not Tiggs had the ability to access the proceeds of the
life insurance policy. Under the Medicaid rules, if Tiggs had access to the policy, the policy
would be deemed a resource and because the cash surrender value of the policy ($5,289.40)
exceeded Medicaid eligibility requirements, Tiggs would be ineligible for Medicaid.
{¶6} The Willows represented Tiggs at the state hearing. The Willows, as Tiggs’s
authorized representative, argued that Tiggs was the insured under the policy but not the policy
owner. The Willows further stated that the policy owner was deceased. The Willows also
stated that at the probate level proceedings, Tiggs’s guardian inquired of the probate court
magistrate whether the magistrate would allow Tiggs access to the policy. The Willows stated
that the probate court magistrate “preferred not” to allow Tiggs to access the policy. However,
the state hearing officer noted that no proof was submitted at the hearing to support the probate
court magistrate’s statement.
{¶7} On November 14, 2016, the hearing officer overruled Tiggs’s appeal and found
that the weight of the evidence supported denial of Tiggs’s Medicaid benefits, noting the lack of
evidence demonstrating that the life insurance policy could not be accessed by Tiggs through
reasonable efforts. The state hearing decision did not address the merits of the September 2015
termination of Medicaid benefits but ruled that because Tiggs was presently not eligible for
Medicaid, his appeal of the September 2015 termination of Medicaid was moot.
{¶8} Tiggs requested an administrative appeal challenging the state hearing decision. On
appeal, Tiggs argued that the state hearing decision erred by not addressing the September 2015
termination of Tiggs’s Medicaid benefits. The administrative appeal overruled this argument
stating that because Tiggs was presently not eligible for Medicaid, his appeal of the September
2015 termination of Medicaid was moot. The administrative appeal also overruled Tiggs’s
appeal of the state hearing decision’s findings that the insurance policy was not unavailable.
The administrative appeal noted that:
[w]hile [The Willows] testified that the probate court magistrate would not allow
[Tiggs] access to the policy, there are no court documents or letters from the
magistrate in [the] state hearing record. Without some evidence to support his
claim that the policy is unavailable, we agree with the state hearing decision that
the weight of the evidence supports the denial.
{¶9} The Willows filed a notice of appeal of the administrative appeal decision to the
trial court. After holding oral arguments, the trial court issued an order modifying the December
15, 2016 administrative appeal decision. Specifically, the trial court ordered appellant to
determine if either The Willows or Tiggs’s guardian could assist in accessing the life insurance
policy. Further, the trial court ordered that if neither The Willows nor Tiggs’s guardian can
assist with accessing the life insurance policy, then appellant is ordered to refer the matter to
appellant’s legal counsel for further review.
{¶10} Appellant filed this instant appeal requesting that this court reverse the trial
court’s order and affirm the administrative appeal decision. Here, appellant raises the following
assignments of error for review:
(1) The lower court wrongly concluded that Mr. Tiggs’s nursing facility could
bring an appeal in court to challenge the termination of his Medicaid benefits.
(2) The lower court wrongly entertained the nursing home’s argument that Mr.
Tiggs’s life insurance policy was inaccessible due to his incompetence and that
this triggered a duty to assist on the part of the agency.
(3) The lower court wrongly concluded that the agency had an obligation under
Ohio Adm.Code 5160:1-2-01(F)(5) to determine whether someone was available
to assist Mr. Tiggs in accessing his life insurance policy.
II. Law and Analysis
{¶11} The Medicaid program provides “federal financial assistance to States that choose
to reimburse certain costs of medical treatment for needy persons.” Harris v. McRae, 448 U.S.
297, 301, 100 S. Ct. 2671, 65 L. Ed. 2d 784 (1980); see also Wisconsin Dept. of Health & Family
Servs. v. Blumer, 534 U.S. 473, 479, 122 S. Ct. 962, 151 L. Ed. 2d 935 (2002). Specific to the
instant case, Ohio’s Medicaid eligibility requirements are defined within R.C. Chapter 5163,
which authorizes appellant to act as the sole state agency to supervise the administration of the
Medicaid program, and to promulgate rules relating to Medicaid eligibility.
{¶12} “R.C. 5101.35 authorizes an administrative appeal from the Ohio Department of
Job and Family Services’ decision [on Medicaid eligibility issues].” Clark v. Ohio Dept. of Job
& Family Servs., 8th Dist. Cuyahoga No. 105642, 2017-Ohio-9173, ¶ 7-8. As we recently noted
in Clark:
“An appellant is first entitled to a state hearing by the ODJFS. R.C. 5101.35(B).
That decision may be appealed to the director of the ODJFS. R.C. 5101.35(C).
An appellant who disagrees with the administrative appeal decision of the director
(or the director’s designee) may appeal the decision to the court of common pleas,
pursuant to R.C. 119.12. R.C. 5101.35(C).”
Clark at ¶ 3, fn. 1, quoting Rodefer v. McCarthy, 2015-Ohio-3052, 36 N.E.2d 2221, ¶ 35 (2d
Dist.). See also George v. Ohio Dept. of Job & Family Servs., 10th Dist. Franklin No.
04AP-351, 2005-Ohio-2292, ¶ 32. The trial court must then conduct a hearing, consider the
entire record, and must affirm an agency’s decision where it is supported by “reliable, probative,
and substantial evidence and is in accordance with law.” R.C. 119.12. See also Univ. of
Cincinnati v. Conrad, 63 Ohio St. 2d 108, 109-110, 407 N.E.2d 1265 (1980). ‘“[C]ourts * * *
must give due deference to an administrative interpretation formulated by an agency that has
accumulated substantial expertise, and to which the General Assembly has delegated the
responsibility of implementing the legislative command.”’ Bernard v. Unemp. Comp. Rev.
Comm., 136 Ohio St. 3d 264, 2013-Ohio-3121, 994 N.E.2d 437, ¶ 12, quoting Swallow v. Indus.
Comm. of Ohio, 36 Ohio St. 3d 55, 57, 521 N.E.2d 778 (1988). See Jones Metal Prods. Co. v.
Walker, 29 Ohio St. 2d 173, 181, 281 N.E.2d 1 (1972) (finding that deference is afforded to an
administrative agency’s interpretation of its own rules and regulations if such an interpretation is
consistent with statutory law and the plain language of the rule itself).
{¶13} A court of appeals’ review is more limited, determining only whether the court of
common pleas abused its discretion in finding that the decision of the administrative agency was
supported by reliable, probative, and substantial evidence. Kinasz-Reagan v. Ohio Dept. of Job
& Family Servs., 164 Ohio App. 3d 458, 2005-Ohio-5848, 842 N.E.2d 1067, fn. 2 (8th Dist.),
citing Pons v. Ohio State Med. Bd., 66 Ohio St. 3d 619, 621, 614 N.E.2d 748 (1993). As the
Ohio Supreme Court stated:
In reviewing an order of an administrative agency, an appellate court’s role is
more limited than that of a trial court reviewing the same order. It is incumbent on
the trial court to examine the evidence. Such is not the charge of the appellate
court. The appellate court is to determine only if the trial court has abused its
discretion.
Lorain City School Dist. Bd. of Edn. v. State Emp. Relations Bd., 40 Ohio St. 3d 257, 260-261,
533 N.E.2d 264 (1988). Thus, when a court of appeals reviews a common pleas court’s decision
in an administrative appeal, its standard of review is far more circumscribed than that employed
by the court of common pleas. See Farran v. Cleveland Civ. Serv. Comm., 8th Dist. Cuyahoga
No. 99851, 2014-Ohio-823, ¶ 2.
{¶14} An administrative agency may also appeal a trial court’s decision; however,
such an appeal is permissible in a limited capacity. R.C. 119.12 specifically grants an
administrative agency a limited right of appeal to a court of appeals from judgments of the
common pleas court. R.C. 119.12(N) states, in relevant part:
An appeal by the agency shall be taken on questions of law relating to the
constitutionality, construction, or interpretation of statutes and rules of the agency,
and, in the appeal, the court may also review and determine the correctness of the
judgment of the court of common pleas that the order of the agency is not
supported by any reliable, probative, and substantial evidence in the entire record.
{¶15} In the instant case, because appellant is an administrative agency appealing the
trial court’s ruling, prior to addressing appellant’s assignments of error, we will consider whether
we have jurisdiction to hear appellant’s assignments of error in accordance with our limited
review pursuant to R.C. 119.12(N).
A. Jurisdiction
{¶16} Appellant in its first assignment of error argues that The Willows, as Tiggs’s
administratively designated authorized representative, had no authority to appeal to the trial court
under R.C. 5101.35. More specifically, appellant argues that pursuant to R.C. 5101.35(E), only
an “appellant” may pursue a judicial appeal of an administrative appeal decision.
{¶17} In our review of R.C. 119.12(N), we note that we have jurisdiction to hear
appellant’s first assignment of error. The trial court found that Tiggs designated The Willows to
act as his authorized representative and that The Willows was therefore able to represent Tiggs in
“all Medicaid-related matters.” Therefore, because the trial court ruled that The Willows had
standing to pursue Tiggs’s appeal, it implicitly made a finding as to the interpretation of a statute,
specifically 42 C.F.R. 435.923(b)(4). The trial court’s ruling went to the scope of the statute,
and in particular, the broadness of the phrase “all Medicaid-related matters.” Undeniably, such a
ruling goes to the interpretation of the phrase “all Medicaid-related matters,” and thus goes to an
interpretation of the statute itself. Therefore, the trial court ruling falls within one of the
appealable issues enumerated in R.C. 119.12(N).
B. Authorized Representative Standing
{¶18} Having found that we have jurisdiction to hear appellant’s first assignment of
error, we now must review the trial court’s determination that The Willows, as Tiggs’s
authorized representative, had standing to appeal to the trial court. An authorized
representative’s duties are derived from 42 C.F.R. 435.923(b) and its Ohio counterpart Ohio
Adm.Code Chapter 5160. 42 C.F.R. 435.923(b) specifically provides in relevant part that:
[a]pplicants and beneficiaries may authorize their representatives to — (1) [s]ign
an application on the applicant’s behalf; (2) [c]omplete and submit a renewal
form; (3) [r]eceive copies of the applicant or beneficiary’s notices and other
communications from the agency; (4) [a]ct on behalf of the applicant or
beneficiary in all other matters with the agency.
Ohio Adm.Code 5160-1-33 states that:
(A)(1) [a]n individual may designate any person or organization to serve as that
individual’s authorized representative. Any person serving as an authorized
representative must be at least eighteen years or older.
(2) Authority for a person or organization to act on behalf of the individual
accorded under state law, including but not limited to, a court order establishing
legal guardianship, must be treated as a written designation by the individual of
authorized representation.
(3) The designation of an authorized representative must be in writing, and must
identify what duties the individual is authorizing the representative to perform.
(4) If the designated authorized representative is unwilling or unable to accept the
responsibility of being an authorized representative, the authorized representative
must inform the administrative agency and the individual of the refusal or
withdrawal.
(B) The authorized representative: * * * (4) [s]tands in the place of the
individual. Any responsibility of the individual is a responsibility of the
authorized representative. Any action taken by the authorized representative or
failure to act will be accepted as the action or lack of action of the individual.
(5) Shares all responsibilities set out in rule 5160:1-2-08 of the Administrative
Code.
{¶19} In the instant case, appellant argues that pursuant to the relevant Medicaid federal
regulations, an authorized representative can only act on behalf of the Medicaid recipient at the
agency level, not in subsequent litigation at the trial court level. The trial court disagreed with
appellant and found that The Willows, as Tiggs’s authorized representative, was capable of
representing Tiggs in “all Medicaid-related matters,” which included the appeal of the
administrative agency decision before the trial court.
{¶20} In making this determination, the trial court relied solely upon a recent federal
court decision, Doctors Nursing & Rehab. Ctr. v. Norwood, N.D.Ill. No. 1:16-cv-9837, 2017
U.S. Dist. LEXIS 87015 (June 7, 2017). In Norwood, the nursing facility, as the authorized
representative, argued that although the federal Medicaid regulations do not explicitly allow
lawsuits by authorized representatives, the regulations do not limit a beneficiary’s power to
assign such authority. Norwood at 22. The court stated that the agency’s “restrictive
interpretation of the authorized representative relationship does not comport with the language
and purpose of the regulation.” Id. Further, the court stated that the “catch-all provision”
within 42 C.F.R. 435.923(b) is “written in broad terms” and thus a “beneficiary can choose to
authorize her representative to handle ‘all other matters with the agency.’” Norwood at 23-24,
quoting 42 C.F.R. 435.923(b). Indeed, the court added that “it is the beneficiary who sets the
limits of representation * * * and the expansive language of this provision apparently permits
beneficiaries to set these parameters quite broadly.” Norwood at 23.
{¶21} In this case, the trial court adopted the reasoning in Norwood and ruled that by
signing the “designation of authorized representative form,” Tiggs designated The Willows as his
authorized representative in all matters related to Medicaid, including Tiggs’s appeal to the trial
court.
{¶22} We note, as did the trial court, that this specific issue has not been addressed by
this court, or throughout Ohio and thus, the trial court was diligent in seeking guidance outside
the jurisdiction. In our review of the trial court’s decision, we cannot say that the trial court
misinterpreted the statute as laid out in Norwood. More specifically, we find that the trial
court’s determination that Tiggs authorized the Willows to represent him in all Medicaid-related
matters, including the appeal to the trial court, was not a misinterpretation of 42 C.F.R.
435.923(b) or Ohio Adm.Code Chapter 5160.
{¶23} In relying upon Norwood, the trial court found that appellant’s position “goes
against any notion of due process or fairness.” Appellant argued that an authorized
representative can only assist a Medicaid applicant or recipient with processes actually at the
agency level. However, the trial court did not find this interpretation persuasive and stated that
“[i]t is illogical to permit an authorized representative to pursue all matters with [appellant] only
to be stopped short when it comes to the final determination as to [Tiggs’s] benefits.”
{¶24} We note, in our review of applicable case law, that the present case is
distinguishable from this court’s decision in Santa v. Ohio Dept. of Human Servs., 136 Ohio
App.3d 190, 736 N.E.2d 86 (8th Dist.2000). In Santa, the trial court issued a judgment ruling
that a son could not appeal the termination of his mother’s Medicaid benefits. This court agreed
with the trial court’s analysis that plaintiff mother’s estate representative, and not the son, was
the real party in interest to bring the action in the trial court. However, this court noted that the
trial court did not have jurisdiction to even entertain the administrative appeal from the son and
explained that:
[t]he substantive claim for relief presented [was that mother] was eligible for
Medicaid benefits. This claim was properly advanced by the then-living [mother]
through her attorney-in-fact [her son], by virtue of the durable power of attorney.
However, upon the death of [mother] * * * the durable power of attorney given to
[son] lapsed. At that point, [son] had no legal authority to act on behalf of his
deceased mother’s interests (i.e., application for Medicaid benefits) which
survived her death.
Santa at 193. Thus, this court reversed the trial court’s judgment for lack of jurisdiction.
{¶25} “A personal representative is said to ‘stand in the shoes’ of the represented
person.” Estate of Oscar Hunter v. Ohio Dept. of Job & Family Servs., 8th Dist. Cuyahoga No.
105851, 2018-Ohio-1969, ¶ 7, citing McDonald v. State Farm Mut. Auto. Ins. Co., 8th Dist.
Cuyahoga No. 76808, 2000 Ohio App. LEXIS 3621, 18 (Aug. 10, 2000). In the instant case, we
find that the Medicaid eligibility claim, which is the substantive claim for relief presented at the
trial court, was properly advanced by the party in interest, Tiggs through his authorized
representative, The Willows. “A claim brought on behalf of a represented person depends on
the represented person’s standing to bring an action because the represented person is the real
party in interest.” Hunter at ¶ 7, citing Civ.R. 17(A).
{¶26} In support of the trial court’s interpretation, we note the plain reading of R.C.
5101.35(A)(2), which states that an “[a]ppellant” who may appeal an administrative agency’s
decision to the trial court “means an applicant, participant, former participant, recipient, or
former recipient of a family services program who is entitled by federal or state law to a hearing
regarding a decision or order of the agency that administers the program.” Furthermore, we note
that Ohio Adm.Code 5160:1-2-08(C)(1) states that “[a]n individual may designate an authorized
representative, in writing, to stand in place of the individual and act with authority on behalf of
the individual.”
{¶27} Our review of the record also demonstrates that Tiggs executed an authorized
representative form which, pursuant to Norwood, sets the limits of the authorized
representative’s representation. The authorized representative form that Tiggs executed states:
“I [Tiggs] authorize this person or company [The Willows] to do the following on my behalf:
take any action that may be needed to ensure that I receive or continue to receive the [Medicaid]
benefits indicated above.”
{¶28} Based on the foregoing analysis, we cannot say that the trial court erred in its
statutory interpretation when it found The Willows, as Tiggs’s authorized representative, had
standing to the appeal to the trial court. Accordingly, The Willows had authority to appeal to the
trial court under R.C. 5101.35 and appellant’s first assignment of error is overruled.
C. Agency Duty to Assist
{¶29} In appellant’s second assignment of error, appellant argues that the trial court
wrongly concluded that due to Tiggs’s incompetence, appellant had a duty to assist Tiggs.
Additionally, in appellant’s third assignment of error, appellant argues that the trial court wrongly
concluded that it had an obligation under Ohio Adm.Code 5160:1-2-01(F)(5) to determine
whether someone was available to assist Tiggs in accessing his life insurance policy. As these
assignments of error are interrelated, we will discuss them collectively.
{¶30} As noted above, because appellant appeals the trial court’s decision, we must
determine whether we have jurisdiction to consider this appeal pursuant to R.C. 119.12(N). The
Supreme Court of Ohio has further articulated that R.C. 119.12 “allows an agency the right to
appeal only on questions of law pertaining to state statutes as well as rules and regulations which
were promulgated by the agency.” (Emphasis added.) Miller v. Dept. of Indus. Relations, 17
Ohio St. 3d 226, 227, 479 N.E.2d 254 (1985).
{¶31} Furthermore, the Tenth District has ruled that “it is not enough that there be a final
order, nor is it enough that the appeal be on ‘questions of law’ as is true for the ordinary litigant.”
Mentor Marinas, Inc. v. Bd. of Liquor Control, 1 Ohio App. 2d 219, 222, 204 N.E.2d 404 (10th
Dist.1964). “The key is that the trial court actually rule on a question of law that pertains to the
constitutionality, construction or interpretation of a statute or agency rule.” Enertech Elec., Inc.
v. W. Geauga Bd. of Edn., 10th Dist. Franklin No. 96APE03-370, 1996 Ohio App. LEXIS 3888,
4 (Sept. 3, 1996). See also Wolff v. Ohio Dept. of Job & Family Servs., 165 Ohio App. 3d 118,
2006-Ohio-214, 844 N.E.2d 1238, ¶ 9 (10th Dist.) (where the Tenth District concluded that “the
mere application of the law to the facts does not constitute ‘interpretation’ within the meaning of
R.C. 119.12; there must be a genuine question presented and a specific finding by the trial court
as to the meaning of the statute or rule.”). See also Ramey v. Ohio State Bd. of Chiropractic
Examiners, 10th Dist. Franklin No. 94APE10-1512, 1995 Ohio App. LEXIS 3199 (Aug. 3, 1995)
(where the Tenth District concluded that the existence of a physician-patient relationship was a
question of law for the trial court but that it did not involve the constitutionality, construction, or
interpretation of a statute or agency rule, thus the appellate court lacked jurisdiction and
dismissed the agency’s appeal).
{¶32} In our review of the applicable case law, we find the aforementioned Tenth District
cases instructive and persuasive. In our review of the record, we note that the trial court’s
decision did not turn on construing or interpreting any statutes or agency rules. Miami-Jacobs
Career College v. Ohio Bd. of Nursing, 10th Dist. Franklin No. 11AP-544, 2012-Ohio-1416.
Indeed, the trial court simply analyzed Ohio Adm.Code Chapter 5160 in light of the facts of the
case and thereafter applied various applicable statutes and agency regulations to those facts. The
trial court noted that Tiggs was adjudicated incompetent in 2013, and he cannot access the
insurance policy by himself. The trial court then went on to further apply various agency
regulations to the facts of the case. In doing so, the trial court examined the Ohio
Administrative Code and concluded that it is incumbent upon appellant to “determine if another
person is available to assist with obtaining verifications or accessing the individuals’ means of
self-support.” Ohio Adm.Code 5160:1-2-01(F)(5)(a). In other words, given the specific facts
of the case, the trial court concluded that, pursuant to its analysis of the relevant agency
regulations, appellant had additional duties it failed to undertake. As such, the trial court’s
decision was undoubtedly based on a question of law. Ramey. However, the question of law
on which the trial court’s decision relied did not involve the constitutionality, construction, or
interpretation of a statute or agency rule. Id.
{¶33} Accordingly, appellant lacks statutory authority pursuant to R.C. 119.12 to bring its
appeal on its second and third assignments of error and we lack jurisdiction to consider whether
the trial court erred by finding that appellant had a duty to assist Tiggs in determining whether
or not the insurance policy was accessible to Tiggs. Miami-Jacobs Career College. Therefore,
appellant’s second and third assignments of error are disregarded.
III. Conclusion
{¶34} After a thorough review of the record and law, we cannot say that the trial court
erred in its interpretation of 42 C.F.R. 435.923(b)(4) when it found that The Willows, Tiggs’s
authorized representative, was able to represent Tiggs in all Medicaid-related matters, including
the appeal to the trial court. Furthermore, we lack jurisdiction to consider appellant’s second
and third assignment of error. Accordingly, appellant’s first assignment of error is overruled and
appellant’s second and third assignments of error are disregarded.
{¶35} Judgment affirmed in part and dismissed in part.
It is ordered that appellee recover from appellant costs herein taxed.
The court finds there were reasonable grounds for this appeal.
It is ordered that a special mandate be sent to said court to carry this judgment into
execution.
A certified copy of this entry shall constitute the mandate pursuant to Rule 27 of the
Rules of Appellate Procedure.
FRANK D. CELEBREZZE, JR., JUDGE
EILEEN A. GALLAGHER, A.J., CONCURS;
MELODY J. STEWART, J., CONCURS IN PART AND DISSENTS IN PART WITH
SEPARATE OPINION
MELODY J. STEWART, J., CONCURRING IN PART AND DISSENTING IN PART:
{¶36} I agree that The Willows has standing to represent Tiggs in this administrative
appeal and concur with that portion of the majority opinion.
{¶37} I disagree that we lack jurisdiction under R.C. 119.12(N) to consider the second
and third assignments of error in this appeal. The agency has the right to appeal questions of
law, and the issue framed by the majority — that “appellant argues that the trial court wrongly
concluded that [the agency] had an obligation under Ohio Adm.Code 5160:1-2-01(F)(5) to
determine whether someone was available to assist Tiggs in accessing his life insurance policy”
— invokes the interpretation of an administrative rule. Majority Opinion at ¶ 29. Ohio
Adm.Code 5160:1-2-01(F)(5) requires the agency to assist with accessing verifications for
Medicaid eligibility only if, among other things, the person seeking benefits “does not have a
court-appointed guardian or a person with other legal authority and obligation to act on behalf of
the individual[.]” The parties agree that Tiggs had a court-appointed guardian over his person.
The question raised by Tiggs was whether the agency had the obligation to assist him when it
was made aware that his legal guardian was unable to access the life insurance policy. This is a
question of law that is appealable under R.C. 119.12(N).
{¶38} Apart from the court of common pleas’ interpretation of an administrative rule
being appealable, this appeal should go forward because the court of common pleas decision fails
to address, consistent with the agency’s argument, whether Tiggs waived the Ohio Adm.Code
5160:1-2-01(F)(5) issue by failing to raise it in the state hearing (he raised the issue for the first
time, in a single sentence, at the end of his reply brief filed in the court of common pleas). It is
well established that the failure to raise an issue at the state hearing level waives the issue on
appeal to the court of common pleas. See State ex rel. Schlegel v. Stykemain Pontiac Buick
GMC, Ltd., 120 Ohio St. 3d 43, 2008-Ohio-5303, 896 N.E.2d 143, ¶ 17-18, citing State ex rel.
Quarto Mining Co. v. Foreman, 79 Ohio St. 3d 78, 679 N.E.2d 706 (1997); Mulhausen v. Ohio
Counselor, Social Worker & Marriage & Family Therapist Bd., 8th Dist. Cuyahoga No. 88776,
2007-Ohio-3917, ¶ 14. The majority’s narrow application of R.C. 119.12(N) bars the agency
from seeking review of whether the common pleas court erred by ignoring Tiggs’s failure to raise
the Ohio Adm.Code 5160:1-2-01(F)(5) issue. In these circumstances, this, too, is a question of
law that can be decided under R.C. 119.12(N).