Shell v. Ohio Dept. of Job & Family Servs.

Citations

• 2024 Ohio 160

Syllabus

R.C. 5101.35 administrative appeal due deference Medicaid benefits Ohio Adm.Code 5160:1-3-05.1 resource limit countable resources life insurance policy Ohio Adm.Code 5101:6-2-03, notice statutory interpretation reasonable efforts exclusion. In an administrative appeal, the trial court erred in finding that ODJFS's decision to deny Medicaid benefits to appellant was supported by reliable, probative, and substantial evidence. Courts are not required to give \due deference\ to administrative agencies. An agency interpretation is simply one consideration a court may sometimes take into account in rendering the court's own independent judgment as to what the law is. Appellant received defective notice of the denial of her claim for Medicaid benefits because the notice did not properly notify her of the reason she was denied. The notice did not give appellant any indication which of her resources put her over the resource limit and cited an existing administrative code section that did not exist at the time appellant filed for benefits. The reasonable-efforts exclusion in former Ohio Adm.Code 5160:1-3-05.1(C)(6) does not cover personal property and does not apply in this case. Appellant did not have the ability to access the cash surrender value of her life insurance policies because she had executed an irrevocable assignment of the policies to a funeral home. Under Ohio Medicare law, an irrevocable assignment of a life insurance policy means that the policy is excluded as a countable resource. Therefore, the life insurance policies were not countable resources and appellant was under the resource limit.