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Brister v. Dep't of Children and Families7/13/2005
Loring Brister appeals a final order affirming the denial of his March 2004 application for disability-based Medicaid benefits filed within a twelve-month period of his May 2003 application for the same type of benefits. In affirming the denial, the hearing officer's order indicates that Brister's application was properly denied for several reasons. The hearing officer concluded that the denial of Brister's 2003 application for disability benefits precluded this 2004 application even though it was based on different disabling conditions because the denial of the 2003 application was being appealed. In addition, the hearing officer also took issue with the fact that Brister failed to submit medical evidence and that Brister's ex-wife, whom he was still living with, refused to provide information on her assets and income. The precise "decision" of the hearing officer was that "Policy and Regulation indicate that [the Department] would have had to abide by the SSA decision through May 2004. Also, while under appeal, the Department must consider the case as pending and await the court's decision." We reverse and remand for a disability determination.
These issues involve the application of the law to the uncontested facts, thus our review is de novo. See Schrimsher v. Sch. Bd. of Palm Beach County, 694 So. 2d 856, 861 (Fla. 4th DCA 1997) (" e may reverse any erroneous interpretation of law, whether or not the error rises to a level of materiality, so long as the correct interpretation compels a particular action."); see also Steward v. Dep't of Children & Families, 865 So. 2d 528, 530 (Fla. 1st DCA 2003) ("An agency's final order based on a conclusion of law is subject to de novo review.").
"SSI-related Medicaid provides medical assistance to eligible individuals who are aged, blind or disabled in accordance with Title XVI and XIX of the Social Security Act and Chapter 409" of the Florida Statutes. Fla. Admin. Code R. 65A-1.709.
In 2003, the Department denied Brister's first application for disability-related benefits because the Department determined the "back injury causing constant pain" was "not severe enough to keep from working." In March 2004, while that case was still pending in the internal Department appellate process, Brister went to his local Social Security office to fill out a new application for Medicaid benefits. Shortly after the second application was completed and submitted, the Department sought information concerning Brister's ex-wife's income and assets. While legally divorced, the couple maintains a single residence with their children. The ex-wife refused to cooperate with the Department's request for additional information. Thereafter, the Department denied benefits by letter dated May 10, 2004. Brister timely sought a hearing on the matter to review the denial of benefits.
At the hearing, Brister acknowledged that his ex-wife's refusal to cooperate prevented him from receiving family-related Medicaid benefits, but argued his application for SSI -related Medicaid benefits should have moved forward to a disability determination at which time medical evidence would be submitted. Additionally, Brister claimed his 2004 application for benefits was based on new and different maladies, including "heart palpitations and irregular heartbeats, hiatal hernia . . . cervical problems causing me extreme headaches and extreme neck pain and . . . aggravating the - the bowel and - and urinary problems." At no time did Brister suggest that the 2004 application dealt with a lower back injury, which was the basis for the disability claim in the 2003 application.
The hearing officer concluded that according to Department regulations, "the Social
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