Hamby v. Neel
james.blumstein at Law.Vanderbilt.Edu
Wed Jun 2 09:34:03 PDT 2004
The Sixth Circuit (2-1, divided ideologically) held in mid-May that an applicant for TennCare (Tennessee's Medicaid demonstration program) had an entitlement, protected by procedural due process, based on their "hope to qualify" for inclusion in the program as beneficiaries. The applicants were eligible if they were "uninsurable" but had to establish that status in order to qualify for the benefit. The split panel held that applicants have an entitlement for a benefit "for which they hope to qualify." Fairly robust pre-determination procedural due process protections were then mandated.
The State of Tennessee filed a petition for rehearing en banc, which is now pending. I had this issue as part of my constitutional law final this spring -- whether an applicant for a benefit has an entitlement (under Roth) to that benefit, protected by procedural due process.
Roth itself describes an "entitlement" as a "safeguard of the security interests that a person has already acquired in specific benefits," suggesting that present enjoyment of a benefit is a prerequisite to its attaining status as an entitlement. Lujan v. G & G Sprinklers (2001) distinguishes a contract damages claim from an entitlement on the ground that a contracting party has no "present entitlement" to the money. And American Manufacturers v. Sullivan (1999), which was briefed by Michael McConnell before the Supreme Court, held that PDP did not attach to a claim for "medically necessary" medical benefits in a workers' compensation program because no entitlement under the program could exist until a determination of medical necessity had occurred -- again suggesting that no status as an entitlement exists until a person has "already acquired" the benefit.
Cases such as Goldberg v. Kelly, which protect beneficiaries to public assistance via PDP, have involved continuity of benefits by persons who are already on the public assistance program and whose benefits are cut back or eliminated. In that circumstance, the public beneficiary has "already acquired" the benefit and has present enjoyment of it. But the Supreme Court has never held whether applicants for a benefit (to which they would be entitled if they can establish that they meet the eligibility criteria) have an entitlement protected by PDP and therefore subject to appropriate procedural protection, such as notice, hearing, etc. at the application stage.
This case has extraordinary significance for public benefits programs, and I am curious whether anyone on the list has thoughts on the matter or comments on the "already acquired" issue as it relates to applicants seeking a benefit (in contrast to beneficiaries whose benefits are reduced or terminated).
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