ADMINISTRATIVE HEARINGS
COUNTY OFGATES / 05 DHR 0759
PRINCESS WATSON
Petitioner,
vs.
DIVISION OF MEDICAL SERVICES
THIRD PARTY RECOVERY SECTION
Respondent. / )
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) / ORDER GRANTING
SUMMARY JUDGMENT
FOR RESPONDENT
This matter comes before the undersigned on a Motion for Summary Judgment filed by the North Carolina Department of Health and Human Services, Division of Medical Assistance (“Department”) on July 27, 2005.
ISSUE
Whether Respondent properly denied Petitioner’s request to waive the recovery of Medicaid benefits from the Estate of Dorothy M. Taylor on the basis of undue or substantial hardship?
UNDISPUTED FINDINGS OF FACT
1.Terris Taylor is the son of Dorothy M. Taylor
2.Respondent has filed a claim against the Estate of Dorothy M. Taylor.
3.Petitioner submitted to Respondent a request to waive Respondent’s claim against the Estate of Dorothy M. Taylor upon the basis that recovery would result in an undue or substantial hardship to Terris Taylor.
4.By letter dated April 18, 2005, Respondent denied Petitioner’s request to waive Respondent’s claim against the Estate of Dorothy M. Taylor on the basis that the income of Terris Taylorexceeds 75 percent of the Federal Poverty Level.
5.The net income of Terris Tayloris greater than $9,464.00.
CONCLUSIONS OF LAW
1.The parties are properly before the Office of Administrative Hearings (“OAH”), and OAH has subject matter jurisdiction in this contested case.
2.N.C. Gen. Stat. § 108A-70.5 establishes the Medicaid Estate Recovery Plan to recover from the estates of medical assistance recipients an equitable amount of the State and federal shares of the cost paid the recipient. Medical assistance means “medical care services paid for by the North Carolina Medicaid Program on behalf of the recipient.” N.C. Gen. Stat. § 108A-70.5.
3.N.C. Gen. Stat. § 108A-70.5(d) provides that the Department “shall adopt rules pursuant to Chapter 150B of the General Statutes to implement the Plan, including rules to waive whole or partial recovery when this recovery would be inequitable because it would work an undue hardship.”
4.10A N.C.A.C. 21D .0502 entitled “UNDUE HARDSHIP” states:
(a) Recovery shall be waived if enforcement of the claim will cause undue or substantial hardship to the surviving heirs of the decedent.
(b) Undue or substantial hardship shall include the following:
(1) Real or person property included in the estate is the sole source of income for a survivor and the net income derived is below 75 percent of the federal poverty level for the dependents of the survivor(s) claiming hardship, or
(2) Recovery would result in forced sale of the residence of a survivor who lived in the residence for at least 12 months immediately prior to and on the date of the decedent’s death and who would be unable to obtain an alternate residence because the net income available to the survivor and his spouse is below 75 percent of the federal poverty level and assets in which the survivor or his spouse have an interest are valued below twelve thousand dollars ($12,000).
5.According to the applicable Federal Poverty Guidelines, the federal poverty level for an individual is an annual net income of $9,570.00, 75 percent of which is $7,177.50. In this case, the undisputed facts establish that the net income available to Terris Taylor exceeds 75 percent of the federal poverty level.
6.No genuine issue of material fact exists and summary judgment in favor of Respondent is proper as a matter of law.
Based upon the foregoing undisputed Findings of Fact and Conclusions of Law, the undersigned makes the following:
DECISION
WHEREFORE, it appearing to the undersigned that there are no genuine issues of material fact and Respondent is entitled to judgment as a matter of law pursuant to Rule 56 of the North Carolina Rules of Civil Procedure, Summary Judgment is hereby GRANTED.
ORDER
It is hereby ordered that the agency serve a copy of the final decision on the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC 27699-6714, in accordance with N.C. Gen. Stat. § 150B-36(b3).
NOTICE
The decision issued by the undersigned Administrative Law Judge hereby disposes of all issues in this contested case. The parties have the right to file exceptions and to present written arguments to the agency making its final decision. N.C. Gen. Stat. § 150B-36(a). The agency making the final decision in this contested case is the North Carolina Department of Health and Human Services, Division of Medical Assistance. The agency is required to serve a copy of the final decision upon each party and to furnish a copy to each party’s attorney of record and the Office of Administrative Hearings. N.C. Gen. Stat. § 150B-36(b3). In accordance with N.C. Gen. Stat. § 150B-36(d), if the agency making the final decision does not adopt the Administrative Law Judge’s decision, it shall set forth the basis for failing to adopt the decision and shall remand the case to the Administrative Law Judge for hearing.
This the 25thday of January, 2006.
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Julian Mann, III
Chief Administrative Law Judge
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