Godaire v. Dep't of Soc. Servs.

174 Conn.App. 385

165 A.3d 1257

Raymond GODAIRE

v.DEPARTMENT OF SOCIAL SERVICES et al.

AC 39068

Appellate Court of Connecticut.

Argued April 18, 2017

Officially released June 21, 2017^*

Raymond Godaire, self-represented, the appellant (plaintiff).

Tanya Feliciano DeMattia, assistant attorney general, with whom, on the brief, was George Jepsen, attorney general, for the appellees (defendants).

Alvord, Sheldon and Norcott, Js.

ALVORD, J.

The self-represented plaintiff, Raymond Godaire, appeals from the trial court's dismissal of his appeal from the final decision of the defendant the Department of Social Services (department).¹ The decision appealed from discontinued the plaintiff's benefits under the department's Medical Assistance to the Aged, Blind, and Disabled program (program or Husky C) on the ground that he had not met the program's spenddown requirements. On appeal, the plaintiff claims that the court improperly (1) concluded that the transfer of his administrative appeal from the judicial district of New London to the judicial district of New Britain did not violate his due process rights by denying him reasonable access to the courts, and (2) failed to conclude that his appeal should be sustained because the hearing officer's decision was based on "faulty records" and "records changed by the department ...." We reverse the judgment of the trial court for the reason that substantial rights of the plaintiff have been prejudiced because the hearing officer's decision was made upon unlawful procedure. See General Statutes § 4–183(j).²

The following facts, as found by the hearing officer or as undisputed in the record, and procedural history are relevant to the resolution of the plaintiff's claims. By notice dated January 28, 2015, the department advised the plaintiff that his medical assistance under Husky C was to be discontinued on January 31, 2015, due to his failure to "complete the review process." The plaintiff, aged eighty-two at that time, requested an administrative hearing to contest the department's action. On February 2, 2015, prior to the scheduled hearing, the department completed the plaintiff's "redetermination" and concluded that he was eligible for the program's benefits "under a spenddown totaling $1929.72 for the period March, 2015 through August, 2015."³ The plaintiff was sent notice of that redetermination.

The administrative hearing was held before a hearing officer on April 1, 2015. At the hearing, the plaintiff represented that he had been in the process of completing some dental work when he received the department's notice that he was required to meet a spenddown requirement before the dental work could continue. According to the plaintiff, the department had previously advised his dentist that it would pay for the making of his false teeth. When the plaintiff reached the time for his last appointment, which had been scheduled for the first or second week of February, 2015, the dentist was notified by the department that the plaintiff's benefits had been discontinued. As a result of this notification, the plaintiff's appointment was canceled and all work on the false teeth ceased.

The department's Eligibility Services Specialist, Gary Sardo, read the Medicaid hearing summary into the record at the April 1, 2015 hearing. The summary sets forth the issue as follows: "[The plaintiff] receives $1182 monthly in [Social Security Administration] benefits. His income is in excess of the monthly gross limit for S99 Medicaid eligibility. [The plaintiff's] period of eligibility runs from March 1, 2015, to August 31, 2015 . His current spenddown amount is $1929.72. [The plaintiff] does not agree with the fact that he is on a spenddown." (Emphasis added.) Also part of the administrative record was a notice for spenddown, dated March 30, 2015, which advised the plaintiff: "Your income is too high for you to receive medical assistance now. However, you may still receive medical assistance from March, 2015, to August, 2015 . To be eligible, you must show us that you have medical bills that you owe or have recently paid. When your bills total $1929.72, your eligibility for medical assistance will begin." (Emphasis added.)

The plaintiff told the hearing officer that he had submitted the requisite medical bills for the period from August, 2014, through January 31, 2015. As acknowledged by Sardo at the hearing, the department employee who assisted the plaintiff had "reinstated [the benefits] for one month, February [2015] ...." A letter from the department to the plaintiff dated February 18, 2015, titled "Appeal Resolution Notice," appears to confirm this statement. Referring to the discontinuance of the program's benefits, the letter advised: "Our records show that since the time you requested this hearing, the agency has taken the following action to address the above mentioned matter that you have appealed: Benefits reinstated." Despite these documents indicating that the plaintiff's benefits had been reinstated for the month of February, 2015, and that the new redetermination period would run from March, 2015, through August, 2015, Sardo told the hearing officer that the department's reinstatement of the plaintiff's benefits for one month "would need to be corrected." The hearing officer inquired: "Then let me ask, if the department should have begun the spenddown February 1, why wasn't any action taken to correct that prior to today's hearing?" Sardo responded: "I just noticed it."

Later during the hearing, the hearing officer asked Sardo if he would "be able to pull off the Connect system [the plaintiff's] actual redetermination and any supporting documents that he submitted with that." Sardo responded that he would. At the very end of the hearing, the hearing officer stated: "And then also make sure, Mr. Sardo, since you'll be submitting that redetermination and supporting documents along with the shelter screen and the ... fee screen, that you make copies to send to Mr. Sardo [sic] as well, so that he knows what I'm looking at as well." Sardo responded that he would get the requested documents to the hearing officer by the end of the day. Following the hearing, a "corrected" financial eligibility screen print was submitted to the hearing officer that indicated that the plaintiff's redetermination period "begin date" was February, 2015, and "end date" was July, 2015. In the hearing officer's notice of decision dated April 28, 2015, she made the following finding of fact: "On April 1, 2015, the department corrected the spenddown period from March, 2015, through August, 2015, to February, 2015, through July, 2015. No change made to spenddown amount." The hearing officer denied the plaintiff's appeal, concluding that "the department correctly determined [that the plaintiff] must meet a spenddown to receive [the program's] coverage beginning February, 2015."

On June 11, 2015, the plaintiff, who resides in New London, filed this administrative appeal from the hearing officer's decision in the Superior Court for the judicial district of New London, pursuant to General Statutes § 4–183. The court transferred the appeal to the Tax and Administrative Appeals Session in the judicial district of New Britain. The plaintiff filed an objection to the change of venue on June 25, 2015, which was overruled by the court on June 26, 2015. Oral argument on the merits of the appeal was scheduled for March 11, 2016. The court permitted the plaintiff to appear at the courthouse in New London and to participate in the hearing by way of closed-circuit television.

In his administrative appeal, the plaintiff alleged, inter alia, that (1) "on February 2, 2015, [the] Husky C spenddown extended through [the] last day of February, 2015," (2) "on April 1, 2015, [the] ‘Hearing Summary’ [provided that] ... Husky C extended through [the] last day of February, 2015," (3) "the hearing officer and [Sardo] ... opened the hearing after [the] plaintiff was gone on April 1, 2015, to change [the] plaintiff's Husky C eligibility date ... to make the decision to discontinue [the] plaintiff's Husky C medical [benefits] within the right time frame, thus denying [the] plaintiff coverage for his false teeth," (4) " [General Statutes] § 4–183... permits modification or reversal of an agency's decision if substantial rights of the appellant have been prejudiced because the administrative findings ... conclusions, or decisions are ... made upon unlawful procedure," (5) the department "canceled payment for [the] plaintiff's false teeth on [January 31, 2015], and this date would not hold up if [the] plaintiff had coverage [until] the end of February, 2015," (6) "the office manager [at New London Dental Care] called [the department] and was told [that the department] would pay for the false teeth. Work was begun to make [the] plaintiff's false teeth. [The plaintiff's] last appointment before [he] received [his] false teeth fell on [February 9, 2015]. [The plaintiff] called [the department] and told [it that] the appointment fell on a date beyond [his] coverage date. [The department] said the date would be changed so [the plaintiff] could get [his] false teeth, from [August, 2014], to [January 31, 2015], changed to [August, 2014], to [February, 2015]," and (7) "the hearing officer's decision was made under unlawful procedures ...." (Citations omitted; internal quotation marks omitted.)

Prior to the March 11, 2016 hearing before the court, the plaintiff filed a prehearing brief in which he set forth his claims and arguments. In the section titled "Statement of the Case," the plaintiff made the following representations: "[The] plaintiff was granted Husky C ... coverage from August, 2014, to January, 2015. [The] plaintiff was allowed to have his upper teeth pulled with the understanding that New London Dental [Care] would make up an upper plate to replace the teeth which were removed. [The department] notified New London Dental [Care] that [the department]...