In re the Matter of Sokkhan Ka and the Commissioner of Human Services.

This opinion will be unpublished and
may not be cited except as provided by
Minn. Stat. § 480A.08, subd. 3 (2018).

STATE OF MINNESOTA
IN COURT OF APPEALS
A19-0402

In re the Matter of Sokkhan Ka and the Commissioner of Human Services.

Filed September 3, 2019
Affirmed
Johnson, Judge

Ramsey County District Court
File No. 62-CV-18-4262

Sokkhan Ka, Shoreview, Minnesota (pro se appellant)

Keith Ellison, Attorney General, Ali P. Afsharjavan, Assistant Attorney General, St. Paul,
Minnesota (for respondent Commissioner of Human Services)

Considered and decided by Ross, Presiding Judge; Johnson, Judge; and Reilly,
Judge.
U N P U B L I S H E D O P I N I O N
JOHNSON, Judge
Sokkhan Ka asked the Minnesota Department of Human Services (DHS) to pay the
fees charged by a medical provider for medical services. The commissioner of human
services determined that Ka is not entitled to the payment he seeks in light of the law
governing the health -care-benefits program for which he was eligible when the medical
services were provided. On judicial review, the district court affirmed the commissioner’s
decision. We conclude that the commissioner did not err in her decision concerning Ka’s

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eligibility for health-care benefits and that the district court did not err by affirming that
decision. Therefore, we affirm.
FACTS
On October 6, 2017, Ka applied to DHS for health-care benefits through the
MinnesotaCare program and selected HealthPartners as his managed -care organization.
See Minn. Stat. § 256L.12 (2018). On the same day, DHS sent Ka a written notice stating
that he was eligible for MinnesotaCar e benefits, effective October 1, 2017. On October
13, 2017, DHS sent Ka a written request for information concerning his projected annual
income in 2017. Ka responded by faxing information to DHS seven days later.
On November 3, 2017, DHS sent Ka a written request for information concerning
his projected annual income in 2018. The written request stated that his MinnesotaCare
benefits would be terminated on December 31, 2017, if he did not respond within 30 days.
Ka did not respond within 30 days. On December 21, 2017, DHS sent Ka written notice
that his MinnesotaCare benefits were terminating on December 31, 2017 , because he did
not timely respond to the request for information concerning his projected annual income
in 2018 . On Thursday, December 28, 2017, after normal business hours, Ka f axed
information to DHS concerning his projected annual income in 2018. DHS did not process
the information on the following day, Friday, December 29, 2017, the last business day of
the year. Ka’s eligibility for MinnesotaCare benefits terminated on Sunday, December 31,
2017.
Meanwhile, Ka was experiencing pain in his head and jaw. In December 2017, Ka’s
dentist referred him to Minnesota Craniofacial Center (MCC) for specialized treatment.

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Based on an examination on December 21, 2017, a dentist at MCC diagnosed Ka with
temporomandibular joint dysfunction. Ka elected non-surgical treatment, specifically, the
installation of an occlusal orthotic device. Ka sought pre-approval from HealthPart ners,
but HealthPartners informed him that pre-approval was not required. An appointment was
scheduled for Tuesday, January 2, 2018. On that date, the device was installed. On January
15, 2018, Ka had a follow-up appointment at MCC.
On January 22, 2018 , Ka’s authorized representative contacted DHS to follow up
on the information that Ka had sent by fax on December 28, 2017. The authorized
representative was informed that Ka’s eligibility for MinnesotaCare benefits had
terminated on December 31, 2017, because DHS had not receive d and processed the
requested information concerning Ka’s projected annual income in 2018 within 30 days .
DHS requested that K a re-apply and re -submit the requested information. Ka did so on
February 5, 2018. On February 8, 2018, DHS approved Ka’s application for
MinnesotaCare benefits in 2018, effective March 1, 2018 , the first day of the following
month. At the same time, DHS enrolled Ka in a different health-care-benefits plan, a fee-
for-service plan, for the period of January 1, 2018, to February 28, 2018.
In January 2018, MCC submitted claim s to HealthPartners for payment for the
services it provided to Ka in that month, but HealthPartners rejected the claims because he
was not eligible for MinnesotaCare bene fits on the dates services were provided . On
February 14, 2018, MCC sent Ka a bill for $2,763 for the services that it provided to him
in January 2018.

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On February 22, 2018, Ka filed an administrative appeal with DHS in which he
sought benefits under the MinnesotaCare program for the services provided by MCC in
January 2018. On April 17, 2018, an employee in DHS’s Health Care Compliance and
Appeals Unit wrote a memorandum to a human-services judge to “explain[] the reasons
why [DHS] has not paid for [the] services Sokkhan Ka received in January 2018, and why
fee-for-service . . . funds cannot be used to pay for this request.” The memorandum states
that Ka was not eligible for MinnesotaCare benefits in January and February of 2018, that
the fee-for-service program has not denied a request for payment because no claim has
been submitted, that MCC is not an enrolled provider in the fee -for-service program, and
that the device that MCC installed is not included in the ben efits of the fee-for-service
program.
On April 20, 2018, the human-services judge held an evidentiary hearing via
telephone, at which Ka’s authorized representative appeared on his behalf. The April 17,
2018 memorandum was marked as an exhibit. On June 11, 2018, the human-services judge
issued a nine -page order with two recommendations: that the commissioner affirm the
department’s decision that Ka is eligible for MinnesotaCare benefits in 2018 effective
March 1, 2018 , and that the commissioner affirm the department’s decision that Ka is
eligible for fee-for-service benefits for the period of January 1, 2018, to February 28, 2018.
On the following day, a representative of the c ommissioner adopted the human-services
judge’s findings of fact, conclusions of law, and recommended order as the final decision
of the department.

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Ka then commenced an action in the district court to seek judicial review of the
commissioner’s decision. See Minn. Stat. §§ 256.045, subd. 7, 256L.10 (2018). In March
2019, the district court filed an order affirming the commissioner’s decision. Ka appeals.
D E C I S I O N
Ka argues that the district court erred by affirming the commissioner’s decision. He
contends that he is entitled to relief on the ground t hat DHS delayed its processing and
approval of his application for MinnesotaCare benefits in 2018, which caused his eligibility
to be terminated, which caused him to incur medical expenses that otherwise would have
been paid by the MinnesotaCare program.
Although Ka has appealed to this court from a judgment of the district court, this
court reviews the decision of the commissioner independently, without giving deference to
the district court ’s decision. See In re Review of 2005 Annual Automatic Adjustment of
Charges for All Elec. & Gas Utils., 768 N.W.2d 112, 118 -119 (Minn. 2009); Zahler v.
Minnesota Dep’t of Human Servs., 624 N.W.2d 297, 301 (Minn. App. 2001), review denied
(Minn. June 19, 2001). Our review of the commissioner’s decision is conducted pursuant
to the Minnesota Administrative Procedure Act (MAPA). See Minn. Stat. § 14.63 (2018);
Estate of Atkinson v. Minn esota Dep’t of Human Servs. , 564 N.W.2d 209, 213 (Minn.
1997); Zahler, 624 N.W.2d at 301. Under MAPA, t his court may reverse or modif y an
administrative decision only if it (a) violates constitutional provisions , (b) exceeds the
authority of the agency , (c) was made using unlawful procedure , (d) was affected by an
error of law , (e) is unsupported by substantial evidence , or (f) is arbit rary or capricious.
Minn. Stat. § 14.69 (2018).

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We begin by noting the incongruity between Ka’s request to DHS, the issues
decided by the human-services judge and the commissioner, the arguments made by the
parties to the district court, the issues decided by the district court, and the arguments made
by the parties on appeal. Ka made a specific request to DHS for payment of the February
14, 2018 invoice that MCC had sent to him. The human-services judge decided generally
that Ka was eligible for fee -for-service benefits in January and February of 2018 and
eligible for MinnesotaCare benefits on March 1, 2018, and thereafter. The human-services
judge did not decide specifically whether DHS is required to pay MCC for the services it
provided to Ka in January 2018. The commissioner adopted the human-services judge’s
decision verbatim. In the district court, Ka reiterated his specific request that DHS pay the
MCC bill. In a memorandum of law, the commissioner addressed the substance of Ka’s
specific request by arguing that the services received by Ka were not included in the
benefits provided by MinnesotaCare and that MCC was not an approved MinnesotaCare
provider. The district court resolved the parties’ arguments by ruling that Ka “fail[ed] to
identify which statutory grounds are satisfied thus entitling him to reversal” and “failed to
present sufficient legal justification to reverse or modify” the commissioner’s decision. On
appeal, Ka responds to the district court’s reasoning by contending t hat DHS did not
comply with three statutory provisions governing the MinnesotaCare program. In
response, the commissioner argues that the human-services judge and the commissioner
properly determined that Ka was eligible for fee -for-service benefits in Ja nuary and
February of 2018 and eligible for MinnesotaCare benefits on March 1, 2018, and thereafter.
The commissioner argues further that Ka’s request that DHS “pay his outstanding medical

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claims” is “not properly before the Court.” But t he issues that t he commissioner now
argues are not properly before this court are the same issues that the commissioner argued
on the merits to the district court. Thus, the commissioner has forfeited the argument that
judicial review is limited to the two general issues decided by the human-services judge
and the commissioner.
A person is eligible for MinnesotaCare benefits if the commissioner of human
services determines “ that the individual meets the eligibility criteria for the applicable
period of eligibility.” Minn. Stat. § 256L.05, subd. 2a (2018). The commissioner must
verify certain information to determine eligibility, including the applicant’s annual gross
income. See Minn. R. 9506.0030, subp. 2(A) (2017); see also Minn. Stat. §§ 256L.04, .07
(2018). Eligibility for MinnesotaCare benefits becomes effective on “the first day of the
month following the month in which eligibility is approved and the first premium payment
has been received.” Minn. Stat. § 256L.05, subd. 3(a) (2018). The commissioner must re-
determine an applicant’s eligibility for MinnesotaCare on an annu al basis. Id., subd. 3a
(2018). The commissioner must determine an applicant’s eligibility wi thin 45 days of the
date on which an application is received. Minn. Stat. § 256L.05, subd. 4 (2018).
In this case, DHS requested information from Ka on November 3, 2017, concerning
his eligibility for MinnesotaCare benefits in 2018. The request stated that his
MinnesotaCare benefits would be terminated on December 31, 2017, if he did not respond
within 30 days. Ka did not respond within 30 days. DHS terminated Ka’s MinnesotaCare
benefits effective December 31, 2017 . Ka submitted the requested information o n
December 28, 2017. DHS approved Ka’s application for MinnesotaCare benefits in 2018

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on February 8, 2018, which was within the statutory 45-day period after he submitted the
information. DHS determined that Ka is eligible for MinnesotaCare benefits effective
March 1, 201 8, the first day of the following month . In the administrative appeal, the
commissioner determined that DHS complied with the relevant statutes in processing Ka’s
application for MinnesotaCare benefits in 2018. The commissioner also determined that,
in light of the two-month gap in Ka’s eligibility for MinnesotaCare benefits, DHS properly
provided Ka with fee-for-service benefits for the months of January and February of 2018.
Ka does not contend that the commissioner erred in determining the dates of his
eligibility for MinnesotaCare benefits and fee -for-service benefits. Rather, he contends
that DHS delayed in reviewing and processing the information that he faxed to DHS on
December 28, 2017, which caused him to lose eligibility for MinnesotaCare benefits and,
consequently, to become personally liable for the fees incurred at MCC in January 2018.
Ka is correct insofar as he asserts that DHS did not immediately process the information
that he faxed to DHS on December 28, 2017. Indeed, the human-services judge found that
DHS “delay[ed]” by not processing the information until February 8, 201 8. The district
court used the same terminology. Nonetheless, DHS’s processing of the information was
not untimely as a matter of law. The applicable statute provides that the department must
determine an applicant’s eligibility within 45 days. Id. Ka ’s argument is based on the
premise that DHS should have determined his eligibility within only one day of receiving
information about his projected income in 2018. Both the commissioner and the district
court determined that the department did not violate any statute or administrative rule by
not processing the requested information so quickly.

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On appeal, Ka attempts to overcome the commissioner’s and the district co urt’s
reasoning by contending that DHS did not comply with three statutory provisions
governing the MinnesotaCare pr ogram. We question whether these statutory provisions
are relevant to the argument he made to the human-services judge and to the district court
or whether they are offered in support of arguments that are being made for the first time
on appeal. In any event, the statutes do not establish that Ka is entitled to the relief he
seeks.
First, Ka contends that DHS did not comply with a statute s tating, “ The
commissioner shall establish procedures to analyze and correct problems associated with
medical care claims preparation and processing under the medical assistance and
MinnesotaCare programs ,” which includes a duty to “ analyze impediments to t imely
processing of claims, provide information and consultation to providers, and develop
methods to resolve or reduce problems.” Minn. Stat. § 256.9655, subd. 1(2) (2018). This
statute appears to be concerned solely with the processing of claims, not the processing of
applications and the determination of an applicant’s eligibility for benefits. Ka does not
explain how the commissioner failed to comply with th e statute, and we perceive no
obvious non-compliance.
Second, Ka contends that DHS did not com ply with a statute stating that “[t] he
commissioner or county agency shall use electronic verification through MNsure as the
primary method of income verification ” and that, “[i] f there is a discrepancy between
reported income and electronically verified income, an individual may be required to
submit additional verification to the extent permitted under the Affordable Care Act .”

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Minn. Stat. § 256L.05, subd . 2 (2018) . This statute is of no assistance to Ka because
electronically verified income is not in tended to replace reported incom e but merely to
supplement it.
Third, Ka contends that DHS did not comply with a statute that provides, “An
enrollee’s eligibility must be redetermined on an annua l basis.” Minn. Stat. § 256L.05,
subd. 3a(a). He contends that, because he first applied for MinnesotaCare benefits in
October 2017, DHS was not permitted to re -determine his eligibility until October 2018.
But the same statute provides, “Beginning July 1, 2017, the commissioner shall adjust the
eligibility peri od for enrollees to implement renewals throughout the year according to
guidance from the Centers for Medicare and Medicaid Services. ” Id. There is nothing in
the administrative record concerning any relevant guidance from the Centers for Medicare
and Medicaid Services. Without any such information, we cannot determine whether DHS
violated the statute by attempting in November and December of 2017 to re-determine Ka’s
eligibility for MinnesotaCare benefits in 2018.
We note that Ka does not contend that DHS is mistaken in its determination that the
fee-for-service program does not require DHS to pay the fees charged by MCC. He
apparently concedes that the benefits he would have received if he had been enrolled in the
MinnesotaCare program in January 2018 are not available in the fee-for-service program.
Accordingly, we need not discuss the benefits that are available to persons in the fee -for-
service program. The commissioner’s decision that Ka was ineligible for Mi nnesotaCare
benefits in January 2018 is determinative of Ka’s request that DHS pay the MCC bill.

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In sum, the district court did not err by affirming the commissioner’s decision.
Affirmed.