Toby Douglas, director of the Department of Health Care Services, has rejected another proposed decision by an administrative law judge over an appeal of eligibility for the Community Based Adult Services program. According to stakeholders, it is the first rejection based on eligibility criteria.
Douglas earlier had rejected — or “alternated” as it’s known in the appeals system — two other proposed decisions based on the legal question of whether the department had the right to reverse face-to-face assessments of eligibility by nurses. After a Department of Social Services administrative law judge issued a proposed decision that DHCS did not have that right, Douglas disagreed, and rejected those proposed decisions.
In a more recent case, Douglas rejected an appeal based not just on the singular legal question but on the merits of the individual case, according to Elissa Gershon, a Disability Rights California attorney.
“This is the first one we’ve seen where DHCS has also alternated the factual finding,” Gershon said. Several other decisions have alternated the legal question, and a few others have upheld eligibility, she said.
“But this one is unusual in that it also overturned the eligibility finding,” Gershon said. “It’s the only one I’m aware of where DHCS overturned the factual finding of eligibility like that.”
It is unclear how many decisions have been rendered by Douglas. DHCS officials have declined to comment about the appeal decisions, both last week and yesterday. The department has not released the details of how many decisions have been rendered, or what those decisions have been.
Department of Social Services officials said 36 proposed decisions have been submitted to Douglas. So far, 89 appeals have been heard by DSS administrative law judges out of a total of 2,194 pending appeal cases, DSS officials said.
Gershon said she is uncertain about the number of Douglas decisions so far, but did say she knows of at least three cases in which Douglas upheld eligibility for appellants.