Case Title: Mrs. T. v. Dep't of Health & Human Servs.

Citation: 

Docket Number: 

State: maine

Court: Maine Supreme Court

Date: 2012-02-02T00:00:00Z

Document:
MAINE SUPREME JUDICIAL COURT 
 
 
 
     
    Reporter of Decisions 
Decision: 
2012 ME 13 
Docket: 
Cum-11-192 
 
Argued: 
December 12, 2011  
Decided:     February 2, 2012 
 
Panel: 
SAUFLEY, C.J., and ALEXANDER, SILVER, MEAD, GORMAN, and JABAR, JJ. 
 
 
MRS. T., AS PARENT AND NEXT FRIEND OF C.T. 
 
 
 
 
v. 
 
COMMISSIONER OF THE DEPARTMENT OF HEALTH AND HUMAN 
SERVICES 
 
 
 
MEAD, J. 
 
[¶1]  Pursuant to M.R. Civ. P. 80C, Mrs. T.1 appeals from a final judgment2 
of the Superior Court (Cumberland County, Wheeler, J.) affirming a decision of 
the Commissioner of the Department of Health and Human Services accepting the 
recommendation of an administrative hearing officer to deny Mrs. T.’s grievance 
against the Department, which sought to establish that her son, C.T., was eligible 
for certain Department-funded services.  Mrs. T. contends that the Department was 
equitably estopped from denying the services because she reasonably relied to her 
detriment on the Department’s misrepresentations that C.T. was eligible.  The 
                                         
1  The Superior Court allowed the plaintiffs to use the aliases Mrs. T. and C.T. 
 
2  Mrs. T.’s complaint in the Superior Court alleged three counts; Counts II and III were stayed 
pending a decision on Count I, which sought Rule 80C review of the Commissioner’s decision.  The court 
certified its judgment on Count I as a final judgment pursuant to M.R. Civ. P. 54(b).  We do not disturb 
that determination. 
 
2 
Department argues that the hearing officer, the Commissioner, and the court all 
correctly found that there was no causal connection between misinformation that 
Mrs. T. received and her son’s ineligibility for services, and therefore her reliance 
on the misinformation was not detrimental.  We affirm the judgment. 
I.  BACKGROUND 
 
[¶2]  The facts found by the hearing officer and the Superior Court are not 
materially disputed.  See Dep’t of Health and Human Servs. v. Pelletier, 
2009 ME 11, ¶ 15, 964 A.2d 630 (“We review a judgment on a defense of 
equitable estoppel for clear error as to factual findings . . . .”).  Mrs. T. is the 
mother of C.T., a fifteen-year-old boy with severe disabilities.  As a result of his 
disabilities and self-injurious behaviors, C.T. requires continuous one-to-one, 
trained adult supervision.  In June 2003, after unsuccessful attempts to provide 
services to C.T. in his home and at a program in New Jersey, Mrs. T. and the 
Department placed him at a residential facility in New Hampshire about two hours 
away from the family home in Maine, where he remains today.  Although the 
Department intended that C.T. live at the New Hampshire facility only until a 
suitable placement could be located in Maine, it has been unable to secure such a 
placement.  Mrs. T. has always wanted C.T. to be placed in Maine closer to the 
family home. 
 
3 
 
[¶3]  At the heart of this appeal is C.T.’s eligibility for the Department’s 
“Section 21 Home and Community-Based Waiver” program (waiver), which 
provides a funding stream to pay for necessary services in a client's home or in a 
residential center instead of in an institution.  Earl Babcock, who managed the 
waiver program for the Department, testified that at the time of the administrative 
hearing there were 2,850 people being served by the program, twelve of whom 
were children.3  Babcock’s duties included classifying applicants and making 
eligibility determinations for the program. 
 
[¶4]  Robert Barton, a regional supervisor for the Department in Children’s 
Behavioral Health Services, testified at the hearing that the children in the waiver 
program “are the very neediest kids for children’s services, very high-needs kids.”  
Barton encouraged Mrs. T. to apply for a waiver for C.T. in order to secure a 
funding stream for a Maine placement if one were found.  In January 2005, after 
initially denying Mrs. T.’s application, the Department granted C.T. a waiver.  
Although Barton termed it a “miscommunication,” Mrs. T. testified, and the 
hearing officer and the court accepted, that Barton told her C.T. now effectively 
had a lifetime waiver.  The Department made efforts to find C.T. a waiver 
placement in Maine.  However, those efforts were complicated by his high needs, 
                                         
3  Earl Babcock submitted an affidavit that was admitted at the administrative hearing.  He was 
cross-examined at a deposition held one week later; by agreement a transcript of the deposition was also 
made part of the record considered by the hearing officer. 
 
4 
funding issues, and Department regulations prohibiting the placement of minors 
with more than a five-year age difference in the same residence.  Barton told C.T.’s 
case manager and Mrs. T. to take their time in finding the right placement. 
 
[¶5]  In July 2005, the Department filed with federal authorities an 
application for renewal of the waiver program, and in the process sought to close 
the program to children but to grandfather children who were “already receiving 
services.”  A new regulation containing that change took effect on December 30, 
2007.  The current regulation states that “a person is eligible for [waiver] services 
under this Section if the person . . . [i]s age eighteen (18) or older (members 
younger than age 18 and already receiving services under this Section as of the 
effective date of this rule may continue to receive benefits under this Section)[.]”  
10-144 C.M.R. ch. 101, § 21.03-3 (effective July 1, 2010) (emphasis added). 
 
[¶6]  At the time the new restriction took effect, C.T. had been approved for 
the waiver program, but was not receiving services under the waiver.  Mrs. T. was 
not made aware of any change in C.T.’s waiver status until March 2009, when 
C.T.’s case manager learned of the new regulation.  Before then, Mrs. T. had been 
told on several occasions by Barton, and once by another Department 
representative, that C.T. was grandfathered.4  Before the new regulation took 
                                         
4  The court found that Barton’s misrepresentations were not intentional, but correctly noted that intent 
is not a factor in the equitable estoppel analysis.  See Berry v. Bd. of Trustees, Me. State Ret. Sys., 
663 A.2d 14, 19-20 n.12 (Me. 1995). 
 
5 
effect, in August 2006, Mrs. T. received a letter from a children’s systems manager 
for Children’s Behavioral Health Services, advising her that despite the 
Department’s intention to close the waiver program to minors: “Adult Services and 
Children’s Services have agreed to honor our mutual commitment to the children 
currently receiving, or those having already been approved for services in this 
waiver program.”  Earl Babcock testified that the statement in the letter was 
incorrect.  After learning in March 2009 that the waiver regarding C.T. was no 
longer effective, Mrs. T. sought and received a proposal from a residential home in 
Lewiston to provide care for C.T. contingent on funding through the waiver 
program; there is no other current source of funding for that placement. 
 
 
[¶7]  In September 2009, Mrs. T. filed a grievance with the Department 
seeking to have C.T. declared waiver-eligible, and for approval of the Lewiston 
placement funded by the waiver.  The grievance was heard by a hearing officer in 
November 2009.  The hearing officer found that C.T. was not eligible for a waiver 
and recommended that the grievance be denied, concluding that the Department 
was not equitably estopped from denying the waiver under the current regulation.  
The Commissioner accepted the hearing officer’s recommendation.  In February 
2010, Mrs. T. filed a Rule 80C petition in the Superior Court seeking review of the 
Commissioner’s action.  After hearing oral argument the court denied the petition, 
 
6 
agreeing with the hearing officer that the Department was not equitably estopped 
from denying C.T. waiver services.  This appeal followed. 
II.  DISCUSSION 
 
[¶8]  The sole issue before us is whether the hearing officer erred as a matter 
of law in finding that the doctrine of equitable estoppel is not applicable to these 
facts.  See Tenants Harbor Gen. Store, LLC v. Dep’t of Envtl. Prot., 2011 ME 6, 
¶ 8, 10 A.3d 722 (stating that when the Superior Court reviews a state agency’s 
decision in an appellate capacity, “we review the agency’s decision directly for 
errors of law, findings not supported by the evidence, or an abuse of discretion”).   
 
[¶9]  The activities of a governmental entity may be equitably estopped if 
the party asserting the doctrine, in this case Mrs. T., can prove “that (1) the 
statements or conduct of the governmental official or agency induced the party to 
act; (2) the reliance was detrimental; and (3) the reliance was reasonable.”  
Pelletier, 2009 ME 11, ¶ 17, 964 A.2d 630; see Mathieu v. Comm’r of Human 
Servs., 562 A.2d 686, 689 (Me. 1989) (stating that the party asserting estoppel has 
the burden of proof).  We consider “the totality of the circumstances, including the 
nature of the government official or agency whose actions provide the basis for the 
claim and the governmental function being discharged by that official or agency.”  
Pelletier, 2009 ME 11, ¶ 17, 964 A.2d 630 (quotation marks omitted). 
 
7 
 
[¶10]  However, when a party seeks to estop the government we have 
viewed the claim with caution.  See id. ¶ 19 (“Equitable estoppel must be evaluated 
with circumspection and applied judiciously in the context of child support actions 
brought by the Department.”); Hart v. County of Sagadahoc, 609 A.2d 282, 284 
(Me. 1992) (stating, in discussing a claim of equitable estoppel, that “[a]s a general 
proposition . . . a governmental unit is not subject to estoppel to the same extent as 
a private party”); Mathieu, 562 A.2d at 689 (stating that, as against the 
government, the doctrine of equitable estoppel “should be sparingly used”); 
Trull Nursing Home, Inc. v. Dep’t of Human Servs., 461 A.2d 490, 499 n.16 
(Me. 1983) (“Estoppel against the government should be ‘carefully and sparingly 
applied,’ especially where application would have an adverse impact on the public 
fisc.”  (citations omitted)). 
 
[¶11]  Here, the hearing officer found that the Department gave Mrs. T. 
“misinformation” concerning C.T.’s waiver status, but ultimately concluded that 
“[t]here is no evidence to support a causal link” between that misinformation and 
C.T.’s current ineligibility for a waiver—in other words, the necessary element of 
detrimental reliance was missing.  Mrs. T. argues that the hearing officer erred as a 
matter of law because in order to show detrimental reliance she is not required to 
prove that she would have succeeded in finding a Maine placement for C.T. had 
she known that his eligibility for a waiver was ending.  Rather, she asserts that it is 
 
8 
enough that she lost the opportunity to more vigorously pursue a Maine placement 
as a result of the Department’s misinformation. 
 
[¶12]  Contrary to Mrs. T.’s assertion, however, there was an almost 
three-year window of opportunity for Mrs. T. or the Department to find a 
placement between January 2005, when C.T. was approved for a waiver, and 
December 2007, when the waiver program closed to minors.  The hearing officer 
found that during that time the Department made sincere, but ultimately 
unsuccessful, efforts to locate an appropriate placement for C.T. in Maine, efforts 
that were hindered by funding limitations and regulations that restricted the age of 
clients that could be placed in the same residence.  As the party with the burden of 
proof, Mrs. T. has not shown that that finding is not supported by the evidence.5  
See Tenants Harbor Gen. Store, LLC, 2011 ME 6, ¶ 8, 10 A.3d 722. 
 
[¶13]  Furthermore, although Mrs. T. did ultimately secure a proposal from a 
potentially appropriate residential placement in Lewiston after learning in 2009 
that C.T. was no longer eligible for a waiver, there is no evidence to support a 
finding that (1) the placement was available when the waiver program closed to 
C.T. in December 2007; (2) the Department would have approved the placement; 
                                         
5  At oral argument, Mrs. T. pointed to Robert Barton’s testimony that he mistakenly believed the 
waiver program had closed to children in July 2006, and had he known it was “closing,” not “closed,” 
“we would have been . . . working very hard to move [C.T.] back.”  Although it may be reasonable to 
conclude from that statement that Barton’s urgency to find C.T. a Maine placement would have been 
different, it does not follow as a matter of proof that he would have been any more successful in doing so. 
 
9 
and (3) funding would have been available at that time.  To the contrary, Earl 
Babcock averred that “even if [C.T.] continued to be eligible for waiver services, 
the waiver program is not currently serving any new participants and his position 
on the lower priority waiting list makes it doubtful that he would receive waiver 
services in the foreseeable future.”  At his deposition Babcock testified that C.T. 
was classified as a Level 2 priority from the time he was first approved for a 
waiver, and he did not believe that a Level 2 client had ever come off the waiting 
list into the program. 
 
[¶14]  Given this record, there is no persuasive evidence that Mrs. T. would 
have successfully found C.T. a waiver placement in Maine before December 30, 
2007, had she known that C.T.’s eligibility for a waiver would end on that date.  
Accordingly, because Mrs. T. did not meet her burden to prove that her reliance on 
the misinformation given to her by the Department caused any detriment to C.T., 
the hearing officer did not err in finding that the Department was not equitably 
estopped from declaring C.T. ineligible for a waiver.  As the hearing officer 
concluded in her written decision: 
[T]he reason C.T. is not currently eligible for the waiver is not the 
result of misinformation [Mrs. T.] received from the Department.  
Rather, his ineligibility is the result of a rule change which 
unfortunately did not protect the status of a child like C.T. who had 
been found eligible, but was not receiving waiver services at the time. 
 
 
10 
 
The entry is: 
 
Judgment affirmed. 
 
 
 
 
 
 
 
 
On the briefs: 
 
Richard L. O’Meara, Esq., and Nicole L. Bradick, Esq., Murray, Plumb & 
Murray, Portland, for appellant Mrs. T. 
 
William J. Schneider, Attorney General, and James E. Fortin, Asst. Atty. 
Gen., Augusta, for appellee Department of Health and Human Services  
 
 
At oral argument: 
 
Nicole L. Bradick, Esq., for appellant Mrs. T. 
 
James E. Fortin, Asst. Atty. Gen., for appellee Department of Health and 
Human Services 
 
 
 
Cumberland County Superior Court docket number AP-10-6 
FOR CLERK REFERENCE ONLY