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Mall v. Department of Public Welfare

Commonwealth Court of Pennsylvania

May 12, 2014

Grace J. Mall, Petitioner
v.
Department of Public Welfare, Respondent

Submitted March 14, 2014

Appealed from No. 513662763-002M. State Agency: Department of Public Welfare.

Maripat Pileggi, Philadelphia, for petitioner.

Addie A. Abelson, Assistant Counsel, Harrisburg, for respondent.

BEFORE: HONORABLE BONNIE BRIGANCE LEADBETTER, Judge, HONORABLE PATRICIA A. McCULLOUGH, Judge, HONORABLE ROCHELLE S. FRIEDMAN, Senior Judge. OPINION BY SENIOR JUDGE FRIEDMAN.

OPINION

ROCHELLE S. FRIEDMAN, Senior Judge

Grace J. Mall petitions for review of the March 22, 2013, final administrative order of the Department of Public Welfare's (DPW) Bureau of Hearings and Appeals (BHA), affirming the decision of an administrative law judge (ALJ) to sustain Mall's appeal in part and deny it in part. The ALJ concluded that Mall's appeal was timely filed and that Mall was ineligible for medical assistance (MA) benefits because her household income exceeded the MA income limit. We vacate the BHA's order and remand for further proceedings.

On March 7, 2012, Mall submitted an application for MA to the Philadelphia County Assistance Office (CAO). Mall is unemployed; her husband works as a baggage handler at Philadelphia International Airport. Both were 72 years old at the time of the application. Mall submitted with her application proof of her husband's earnings of $1,141 per month. On March 12, 2012, the CAO denied Mall's application because her husband's income exceeded the MA program limit for a two-person household.

Mall appealed to the BHA, which appointed an ALJ to conduct an evidentiary hearing. At the March 4, 2013, hearing, CAO caseworker Tamika DeBatt testified that she denied Mall's application because Mall's monthly household income exceeded the income limits for the TD and PD[1]

Page 314

categories of MA. (N.T., 3/4/13, at 18-19, 23.) DeBatt also testified that DPW's Operations Memorandum 090603 (Operations Memorandum) provides that lawful, permanent residents are ineligible for federally funded categories of MA during their first five years in the United States. ( Id. at 24-25.) DeBatt explained that because Mall had lived in the United States for fewer than five years at the time of her application, Mall could not be considered for the Healthy Horizons Categorically Needy Program (Healthy Horizons).[2] ( Id. at 22-24, 27.)

On March 15, 2013, the ALJ issued an opinion and order upholding the denial of benefits and concluding that Mall's household income exceeded the income limits for state-funded TD and PD benefits. The ALJ acknowledged Mall's position that the CAO should have considered her eligibility for Healthy Horizons as follows:

[Mall's counsel argued] that the only authority cited by the CAO for finding [Mall] ineligible in the Healthy Horizons category is the Operations Memorandum 090603 . . . and that the cited Memorandum is not consistent with promulgated regulations in the Pennsylvania Code. [Mall's counsel] argued that there is no five-year waiting period in the Pennsylvania Code for lawful permanent residents. As stated in Operations Memorandum 090603, Section 403 of Title IV of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 prohibits States from using federal funds to provide MA benefits to certain qualified aliens, including lawful permanent residents, during their first five years in the U.S. (Public Law 04-193 § 403(a); 8 U.S.C. § 1613(a)). However, she contended that PRWORA does not prohibit States from providing any type of MA benefit to qualified aliens, including lawful permanent residents, in their first five years in the U.S., despite the lack of federal funding to pay for those benefits. . . . She further argued that the funding source is irrelevant to the Pennsylvania Code's Healthy Horizons eligibility standards . . . and therefore, [Mall] and her husband, whose income is below the [Healthy Horizons] income limit for two persons, should be approved for the [Healthy Horizons] category of MA.

(ALJ Op. at 5-6.) Ultimately, however, the ALJ declined to consider these issues, finding them " not relevant to [Mall's] eligibility determination, since a hearing officer may not render a decision on the validity of a Departmental regulation nor may [a hearing officer] invalidate or modify a Departmental ...


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