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State, Department of Health and Social Services v. Gross

Supreme Court of Alaska

April 24, 2015

STATE OF ALASKA, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, DIVISION OF PUBLIC ASSISTANCE, Petitioner,
v.
LESTER GROSS, Respondent

Page 117

Petition for Review from the Superior Court of the State of Alaska, Third Judicial District, Anchorage, Erin B. Marston, Judge. Superior Court No. 3AN-12-09838 CI.

Kathryn R. Vogel, Assistant Attorney General, Anchorage, and Michael C. Geraghty, Attorney General, Juneau, for Petitioner.

Mark Regan, Disability Law Center of Alaska, Anchorage, for Respondent.

Before: Fabe, Chief Justice, Winfree, Stowers, Maassen, and Bolger, Justices.

OPINION

Page 118

MAASSEN, Justice.

I. INTRODUCTION

An applicant for federal disability benefits applied for state benefits that are intended to provide basic assistance while the federal application is pending. The Division of Public Assistance -- the division of the Alaska Department of Health and Social Services that administers the state program[1] -- denied these interim benefits, relying on a subset of the criteria that the Social Security Administration uses to determine eligibility for federal benefits. The superior court reversed this decision, holding that Alaska law required the Department to apply the same federal substantive criteria and procedural requirements to its determination of eligibility for state interim benefits. The Department petitioned for review, and we granted the petition.

We conclude that, while state law does not require the Department to track the federal analysis exactly when it assesses eligibility for state interim benefits, the Department's application of the law erroneously excludes a category of applicants who will be found to be disabled for purposes of federal benefits and who therefore should be entitled to interim assistance. We therefore affirm the superior court's decision in part, reverse it in part, and remand for further proceedings.

II. FACTS AND PROCEEDINGS

A. Facts

Certain persons who are disabled and unable to work are entitled to federal Supplemental Security Income (SSI) benefits administered by the United States Social Security Administration.[2] In determining whether an applicant is " disabled" and therefore entitled to SSI benefits, the Social Security Administration uses a five-step process outlined in federal regulations.[3] Steps one and two are satisfied if the Administration finds first that the applicant is not currently engaged in " substantial gainful activity" [4] and second that the applicant has a " determinable physical or mental impairment" lasting at least one year or likely to result in death, significantly limiting the applicant's " physical or mental ability to do basic work activities." [5] If these first two steps are satisfied, an individual may qualify for SSI benefits at step three, where the Administration considers whether the medical severity of the applicant's impairment " meets or equals" a disability listed in federal regulations.[6]

Page 119

Individuals who satisfy the first two steps but do not qualify for SSI benefits at step three may nonetheless qualify through steps four and five. At step four, the Social Security Administration considers whether the applicant, despite his or her impairment, can perform work he or she has done in the past; if so, the applicant is not disabled and not entitled to SSI benefits.[7] If the applicant cannot perform past work, however, the analysis proceeds to step five.

At step five the Social Security Administration considers the applicant's ability to do other work in the national economy; [8] if the applicant can perform other work, he or she is not disabled and not entitled to SSI benefits. The burden shifts at this step of the federal analysis, and the Administration, rather than the applicant, is " responsible for providing evidence that demonstrates that other work exists in significant numbers in the national economy that [the applicant] can do, given [the applicant's] residual functional capacity and vocational factors." [9] Burden-shifting requires that the Administration present the testimony of a vocational expert when other methods of proof are insufficient.[10] If the Administration fails to carry its burden, the applicant is considered disabled and entitled to SSI benefits.[11]

Determining eligibility for SSI can be a time-consuming process, lasting many months. To help alleviate hardship during the long application period, state interim assistance programs pay " assistance financed from State or local funds. .. furnished for meeting basic needs" of SSI applicants while their eligibility for federal benefits is being determined.[12] The federal government reimburses Alaska for the interim assistance payments the State makes to individuals who are ultimately found to be entitled to SSI,[13] but the State is responsible for determining the parameters of its interim assistance program, including the requirements for eligibility.[14]

Alaska's interim assistance program is governed by AS 47.25.455, which provides: " The department shall pay at least $280 a month to a person eligible for assistance under this chapter while the eligibility of the person for benefits under [the SSI Program] is being determined." [15] A regulation, 7 AAC 40.180, provides that the Department will determine whether an applicant is eligible for interim assistance based on " whether the applicant is likely to be found disabled by the Social Security Administration, including whether the applicant's impairment meets. .. [the] Social Security Administration disability criteria for the listings of impairments described in 20 C.F.R. 404, subpart P, appendix 1." [16] The regulation further specifies that, " [i]n determining whether an applicant's disability ...


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