Arkansas Department of Health and Human Services v. Honorable Vann Smith
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SUPREME COURT OF ARKANSAS
No.
ARKANSAS DEPARTMENT OF
HEALTH AND HUMAN SERVICES,
PETITIONER,
VS.
HONORABLE VANN SMITH.,
RESPONDENT,
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Opinion Delivered September 13, 2007
A PETITION FOR WRIT OF
PROHIBITION, OR, IN THE
ALTERNATIVE, WRIT OF
CERTIORARI TO THE CIRCUIT
COURT OF PULASKI COUNTY,
ARKANSAS, NO. DR2005-2845,
HONORABLE VANN SMITH,
CIRCUIT JUDGE
WRIT OF PROHIBITION
GRANTED.
TOM GLAZE, Associate Justice
The Arkansas Department of Health and Human Services (DHHS), petitions this court
for a writ of prohibition instructing the Circuit Court of Pulaski County that it is without
jurisdiction to grant Karen Blaylock’s request for an increase of her Medicaid Community
Spouse Monthly Income Allowance (CSMIA) and Medicaid Community Spouse Resource
Allowance (CSRA) until her husband applies for Medicaid.
Karen Blaylock’s husband, Alan Blaylock, became disabled in 1986; he suffered further
injuries when he was beaten during a home-invasion robbery in 2005. As a result of the 2005
injuries, Alan required twenty-four-hour care and supervision to meet his daily needs, and he
was institutionalized at Timber Ridge Ranch in early 2005.
On July 15, 2005, Karen filed an amended petition in the Pulaski County Circuit
Court, seeking an order of support prior to applying for Medicaid benefits to help cover
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Alan’s long-term care costs. DHHS, as the entity responsible for administering the Arkansas
Medicaid program, was granted permission to intervene in the Blaylocks’ suit. After being
allowed to intervene, DHHS filed a motion for summary judgment, contending that, because
Alan had not applied for Medicaid and DHHS had made no determination of his eligibility
for benefits, Karen and Alan had failed to exhaust their administrative remedies. Accordingly,
DHHS argued that the circuit court lacked jurisdiction over the matter.
On November 22, 2005, the circuit court denied DHHS’s motion for summary
judgment. In that order, the court determined that it had jurisdiction, finding that the
Medicare Catastrophic Coverage Act (MCCA), 42 U.S.C. § 1396r-5, and the Arkansas
Medical Services Manual provided implied authority for the court to allocate property outside
an action for divorce or separate maintenance. In addition, the court found that the Blaylocks
did not need to exhaust their administrative remedies prior to seeking a court order, because
cases from other jurisdictions had found that Congress provided two alternative means by
which a community spouse might obtain a higher resource or income allowance calculated
under the MCCA — 1) through an administrative hearing under 42 U.S.C. § 1396r5-(e), or
2) by judicial order. Given these two alternative routes, the court found that it was within
Karen’s discretion to choose which method she wanted to use to obtain a higher allowance.
Following the circuit court’s denial of DHHS’s motion for summary judgment, DHHS
sought a writ of prohibition from our court on January 4, 2006.1
Prohibition is an
1
On May 16, 2006, Karen provided this court with documentation that Alan had
passed away and that she had been lawfully appointed by the circuit court as administratix
of his estate. However, the documentation did not contain an order of revivor from the
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extraordinary writ that is appropriate only when the trial court is wholly without jurisdiction.
Manila Sch. Dist. No. 15 v. Wagner, 357 Ark. 20, 159 S.W.3d 285 (2004). The writ is
appropriate only when there is no other remedy, such as an appeal, available. Id. Prohibition
is a proper remedy when the jurisdiction of the trial court depends upon a legal rather than
a factual question. Id. However, prohibition is never issued to prohibit a trial court from
erroneously exercising its jurisdiction. Id.
In its first point, DHHS argues that the circuit court lacked jurisdiction to consider
Karen’s petition because of a failure to exhaust her administrative remedies. Generally, the
doctrine of exhaustion of administrative remedies provides that no one is entitled to judicial
relief for a supposed or threatened injury until the prescribed statutory administrative remedy
has been exhausted. See Centerpoint Energy Resources Corp. v. Circuit Court of Miller County,
___ Ark. ___, ___ S.W.3d ___ (June 7, 2007); Austin v. Center Point Energy Arkla, 365 Ark.
138, 226 S.W.3d 814 (2006). A basic rule of administrative procedure requires that an agency
be given the opportunity to address a question before a complainant resorts to the courts.
Austin, supra; Dixie Downs, Inc. v. Arkansas Racing Comm’n, 219 Ark. 356, 242 S.W.2d 132
circuit court. We remanded the matter to the circuit court in order to determine whether
such an order was appropriate. See Ark. Dep’t of Human Servs. v. Smith, 366 Ark. 584, ___
S.W.3d ___ (2006) (per curiam).
The circuit court subsequently determined that Alan’s death did not extinguish the
cause of action and that revivor was appropriate. DHHS, joined by Karen, then asked this
court to reinstate the petition. We granted the motion to reinstate the petition to this
court’s active docket on April 5, 2007, and directed the parties to supplement the record
with the order of the circuit court on remand within fifteen days of that date, stating that
we would “decide the case on the original briefs.” See Ark. Dep’t of Human Servs. v.
Circuit Court of Pulaski County, 369 Ark. 345, ___ S.W.3d ___ (2007) (per curiam).
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(1951). Where a party has failed to exhaust his or her administrative remedies, the trial court
lacks jurisdiction over the suit. See Staton v. American Mfrs. Mut. Ins. Co., 362 Ark. 96, 207
S.W.3d 456 (2005).
The issue before us is (1) whether Karen was entitled to proceed directly to circuit
court to obtain an order of support, or (2) whether she was first required to avail herself of the
administrative procedures set out in the Medicaid Catastrophic Coverage Act. DHHS urges
this court to adopt the latter approach and conclude that, because Karen did not exhaust her
administrative remedies, the circuit court lacked jurisdiction to consider her petition.
Before addressing this specific issue, however, it is necessary to examine the
complexities of the MCCA on which Karen’s petition was premised.
The federal Medicaid program provides funding to States that reimburse
needy persons for the cost of medical care. See Social Security Act, tit. XIX,
as added, 79 Stat. 343, and as amended, 42 U.S.C. § 1396 et seq. (1994 ed. and
Supp. V) “Each participating State develops a plan containing reasonable
standards ... for determining eligibility for and the extent of medical assistance”
within boundaries set by the Medicaid statute and the Secretary of Health and
Human Services. Schweiker v. Gray Panthers, 453 U.S. 34 (internal quotation
marks omitted); § 1396a(a)(17) (1994 ed.) [footnote omitted]. In formulating
those standards, States must “provide for taking into account only such income
and resources as are, as determined in accordance with standards prescribed by
the Secretary, available to the applicant.” § 1396a(a)(17)(B) (emphasis added).
Wisconsin Department of Health & Family Services v. Blumer, 534 U.S. 473, 479 (2002).
The objective of the MCCA was to protect married couples when one spouse is
institutionalized in a nursing home, so that the spouse who continues to reside in the
community (the so-called “community spouse”) is not impoverished and has sufficient income
and resources to live independently. See, e.g., Chambers v. Ohio Dep’t of Human Servs., 145
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F.3d 793, 798 (6 th Cir. 1998) (citing H.R. Rep. No. 100-105(II), 100th Cong., 2d Sess. at
65 (1988), reprinted in 1988 U.S.C.C.A.N. 857, 888). In essence, the MCCA allows a couple
to avoid having to spend all of the couple’s assets on the institutionalized spouse’s long-term
medical and custodial care before the institutionalized spouse is eligible for Medicaid benefits.
Under the MCCA, which governs the treatment of income and resources for
institutionalized spouses, income is allocated between spouses pursuant to a complex formula.
See 42 U.S.C. § 1396r-5(b) & (d). That formula provides that “no income of the community
spouse shall be deemed available to the institutionalized spouse.” 42 U.S.C. § 1396r-5(b)(1).
The effect of the formula is to preserve the community spouse’s income for that spouse, thus
avoiding “pauperization” of that spouse, and to prevent that spouse’s income from affecting
the determination of whether the institutionalized spouse qualifies for Medicaid. See Blumer,
534 U.S. at 480. Section 1396r-5(b)(2) then sets out the rules to be used “[i]n determining
the income of an institutionalized spouse or community spouse for purposes of the posteligibility income determination described in subsection (d) of this section.” (Emphasis added.)
Subsection (d) then provides a number of exceptions to those rules; those exceptions
are “designed to ensure that the community spouse and other dependents have income
sufficient to meet basic needs.” Blumer, 534 U.S. at 481. Among those exceptions are the
“Minimum Monthly Maintenance Needs Allowance” (MMMNA), 42 U.S.C. § 1396r5(d)(3); the Community Spouse Monthly Income Allowance (CSMIA), 42 U.S.C. § 1396r5(d)(2); and the Community Spouse Resource Allowance (CSRA), 42 U.S.C. § 1396r5(f)(2).
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These last two allowances are at issue in the instant case, as Karen’s petition sought an
order increasing her CSMIA and CSRA. Under the MCCA, the CSMIA comes into play
when the income of the community spouse is insufficient to yield an income equal to or
above the MMMNA. The CSMIA allows the community spouse to deduct the amount of
that shortfall from the institutionalized spouse’s income; the amount so deducted is then not
considered “available” to the institutionalized spouse. As a result, Medicaid will pay a greater
portion of the institutionalized spouse’s medical expenses than it would absent the CSMIA
provision. See Blumer, 534 U.S. at 482.
In addition, for purposes of establishing the institutionalized spouse’s Medicaid
eligibility, a portion of the couple’s assets is reserved for the community spouse. This reserved
amount is the CSRA, which is determined by calculating the total of all of a couple’s assets,
and then allocating half to the community spouse. The CSRA is considered unavailable to
the institutionalized in the eligibility determination, but all resources above that amount must
be spent before eligibility can be achieved. See Blumer, 534 U.S. at 483.
As just mentioned, Karen sought an order from the circuit court establishing her
CSMIA and CSRA; DHHS, however, contended that the circuit court lacked jurisdiction
to entertain Karen’s petition. The crux of DHHS’s argument is that, in enacting the MCCA,
Congress did not create an independent, original cause of action in state courts whereby
potential Medicaid applicants could get a preemptive court order attributing and allocating
assets in anticipation of a future application for Medicaid. Because the Blaylocks had not
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applied for Medicaid, DHHS contends that their attempt to pursue relief in state court is
without a jurisdictional foundation. We agree.
The circuit court determined that, under the MCCA, it had the “implied authority”
to make a pre-Medicaid-eligibility-determination allocation of the Blaylocks’ assets. That
decision was premised largely on two provisions in the MCCA that refer to a “court order.”
Section 1396r-5(d)(5) declares that, “[i]f a court has entered an order against an institutionalized
spouse for monthly income for the support of the community spouse, the community spouse
monthly income allowance for the spouse shall be not less than the amount of the monthly
income so ordered.” (Emphasis added.) In addition, section 1396r-5(f)(3) provides that, “[i]f
a court has entered an order against an institutionalized spouse for the support of the community
spouse, section 1396p of this title shall not apply to amounts of resources transferred pursuant
to such order for the support of the spouse or a family member[.]” (Emphasis added.)
DHHS counters, however, that reading the statute in its entirety makes it clear that any
allocation of a couple’s assets can only occur after a determination of Medicaid eligibility has
been made. For example, DHHS notes language from § 1396r-5(b)(2) that speaks of the
attribution of income “for purposes of the post-eligibility income determination.” (Emphasis
added.) Similarly, § 1396r-5(d)(1) permits deductions or allowances from the institutionalized
spouse’s income “after an institutionalized spouse is determined . . . to be eligible for medical
assistance.” (Emphasis added.)
Congress has declared that “the determination of eligibility for medical assistance under
the [State] plan [for medical assistance] shall be made by the State or local agency administering the
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State plan[.]” 42 U.S.C. § 1396a(a)(5) (emphasis added). In Arkansas, that agency is the
Department of Health & Human Services. See, e.g., Ark. Code Ann. § 25-10-129(a)(2)(C)
(Repl. 2002) (recognizing that DHHS “is presently charged with, among other things, all
welfare activity in the state, including . . . [m]edical assistance.”); Ark. Code Ann. § 20-10129(a)(4) (declaring it the legislature’s intent to give DHHS the authority to adopt rules in
conformity with federal laws); Ark. Code Ann. § 20-77-101(a) (Repl. 2001) (referring to the
“Medicaid medical assistance program administered by the Department of Human Services”).
DHHS accordingly reasons that it is the only body empowered or authorized to make
Medicaid determinations, including determinations concerning the allocation of assets within
the context of the CSRA and CSMIA.
Karen responds primarily by pointing to § 1396r-5(f)(2) & (3). Subsection (f) generally
deals with permitting the transfer of resources to the community spouse; section 1396r-5(f)(2)
defines the CSRA in part as the “amount by which . . . the greatest of . . . the amount
transferred under a court order under paragraph (3) exceeds the amount of resources otherwise
available to the community spouse[.]” Paragraph (3) of subsection (f), as mentioned above,
declares that “if a court has entered an order against an institutionalized spouse for the support of the
community spouse, section 1396p of this title shall not apply to amounts of resources transferred
pursuant to such order for the support of the spouse or a family member[.]”
Focusing on the above highlighted language, Karen then goes on to argue that
Congress used the word “shall” in § 1396r-5(f)(3), thereby making the language mandatory.
However, what Karen’s argument fails to recognize is that the word “shall” does not actually
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appear to direct DHHS to apply the court’s order. Reading the statute closely reveals that
what the Medicaid-administering agency “shall” do is to not apply 42 U.S.C. § 1396p to
resources transferred pursuant to such order. Section 1396p deals with liens, adjustments and
recoveries, and transfers of assets. That statute discusses when a lien may be imposed against
the property of an individual who has been receiving medical assistance.
Moreover, the fallacy in Karen’s reliance on subsections (f)(2) and (f)(3) becomes
apparent when one reads § 1396r-5(f)(1), which provides as follows:
An institutionalized spouse may, without regard to section 1396p(c)(1)
of this title, transfer an amount equal to the community spouse resource
allowance (as defined in paragraph (2)), but only to the extent the resources of
the institutionalized spouse are transferred to (or for the sole benefit of) the
community spouse. The transfer under the preceding sentence shall be made as soon
as practicable after the date of the initial determination of eligibility, taking into account
such time as may be necessary to obtain a court order under paragraph (3).
(Emphasis added.) The emphasized language makes it clear that the transfers between an
institutionalized spouse and a community spouse, as specified in this statute, must all transpire
after a determination has been made about the institutionalized spouse’s Medicaid eligibility.
Given this language, we must conclude that DHHS’s argument is correct. As discussed
above, Congress has declared that Medicaid eligibility “shall be made by the State or local
agency administering the State [Medicaid] plan.” See 42 U.S.C. § 1396a(a)(5). In Arkansas,
that agency is DHHS; in turn, DHHS has promulgated the rules and regulations governing
Medicaid applications and eligibility. See Ark. Code Ann. § 20-10-129(a)(4). Thus, because
DHHS is the entity charged with administering the Arkansas Medicaid Program, it — rather
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than the circuit court — is the sole entity that may determine whether a Medicaid applicant
is eligible for Medicaid, as well as for any of the deductions or allowances permitted under the
MCCA.
Moreover, the MCCA provides a means for administrative review of DHHS’s
decisions regarding eligibility. Under 42 U.S.C. § 1396r-5(e), if the applicant disagrees with
DHHS’s decision, that person can seek a review of that decision. Under § 1396r-5(e)(1),
once the Medicaid-administering agency determines eligibility for benefits, the State is to
notify the applicant and the spouse of the amount of allowances and how those allowances
were computed. If either spouse disagrees with DHHS’s determination, § 1396r-5(e)(2)
provides for a review of that decision, as follows:
(A) In general
If either the institutionalized spouse or the community spouse is
dissatisfied with a determination of —
(i) the community spouse monthly income allowance;
(ii) the amount of monthly income otherwise available to the community spouse
(as applied under subsection (d)(2)(B) of this section);
(iii) the computation of the spousal share of resources under subsection
(c)(1) of this section;
(iv) the attribution of resources under subsection (c)(2) of this section;
or
(v) the determination of the community spouse resource allowance (as defined
in subsection (f)(2) of this section);
such spouse is entitled to a fair hearing described in section 1396a(a)(3) of this
title with respect to such determination if an application for benefits under this
subchapter has been made on behalf of the institutionalized spouse. Any such
hearing respecting the determination of the community spouse resource
allowance shall be held within 30 days of the date of the request for the
hearing.
(Emphasis added.)
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Should the applicant then still disagree with DHHS’s determinations, at that point, the
applicant may seek judicial review under the Administrative Procedures Act, Ark. Code Ann.
§ 25-15-101 et seq. (Repl. 2002).2 Only at that point — i.e., once the applicant has exhausted
his or her administrative remedies — does the state court system come into play. This
conclusion comports with our court’s consistent holdings that administrative agencies are
better equipped than courts, by specialization, insight through experience, and more flexible
procedures to determine and analyze underlying legal issues affecting their agencies. See, e.g.,
Ark. Dep’t of Health & Human Servs. v. R.C., 368 Ark. 660, ___ S.W.3d ___ (2007); Wright
v. Ark. State Plant Bd., 311 Ark. 125, 842 S.W.2d 42 (1992).
In sum, DHHS is the sole entity charged with administering Medicaid and determining
eligibility for Medicaid benefits. The fact that Congress used language to the effect of “if a
court has entered an order of support” — without any further explanation of the
circumstances in which such an order might be entered — is insufficient to confer
jurisdiction, even impliedly, on the circuit court. This is particularly so when one considers
that sections 1396r-5(d)(5) & (f)(3) only generally reference an order of spousal support; they
do not mention a court-ordered CSRA, CSMIA, or MMMNA. One who wishes to apply
for Medicaid must go through the process established by Congress and the State and cannot
do an “end run” around that process by seeking a preemptive court order of spousal support.
The Blaylocks failed to avail themselves of their administrative remedies, let alone
2
Ark. Code Ann. § 20-10-129(c) (Repl. 2002) provides that “[a]ll rules
promulgated pursuant to this section shall be promulgated in conformity with the Arkansas
Administrative Procedures Act, § 25-15-201[.]”
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exhaust them, and as such, the circuit court was utterly without jurisdiction to consider the
Blaylocks’ petition. Further, because DHHS was without another available remedy, such as
an appeal (as this case comes to us after the denial of a motion for summary judgment — a
non-appealable order), the writ of prohibition will lie in this case. See Ouachita Railroad v.
Circuit Court of Union County, 361 Ark. 333, 206 S.W.3d 811 (2005) (“a writ of prohibition
is a proper remedy for lack of subject-matter jurisdiction in the trial court even when a
petitioner is not entitled to an appeal from a denial of a motion for summary judgment”);
Ramirez v. White County Circuit Court, 343 Ark. 372, 38 S.W.3d 298 (2001) (“if there is no
jurisdiction, the only way petitioners can obtain review by this court is by way of a petition
for a writ of prohibition. Therefore, a petition for writ of prohibition is a proper method to
obtain review of jurisdiction by this court”).
Because we grant DHHS’s petition for writ of prohibition on this point, it is
unnecessary to address any remaining issues.
Petition for writ of prohibition granted.
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