Appeals to the Court of Appeals – Medicaid

There is no automatic right to appeal from the Superior Court to the Court of Appeals. An application for the right to file an appeal is necessary. If it is granted, then appeals follow the typical appeal process. O.C.G.A. § 5-6-35 provides the rule for discretionary appeals:

(a) Appeals in the following cases shall be taken as provided in this Code section:

(1) Appeals from decisions of the superior courts reviewing decisions of … state and local administrative agencies, and lower courts by certiorari or de novo proceedings;  …

(b) All appeals taken in cases specified in subsection (a) of this Code section shall be by application in the nature of a petition enumerating the errors to be urged on appeal and stating why the appellate court has jurisdiction. The application shall specify the order or judgment being appealed and, if the order or judgment is interlocutory, the application shall set forth, in addition to the enumeration of errors to be urged, the need for interlocutory appellate review.

(c) The applicant shall include as exhibits to the petition a copy of the order or judgment being appealed and should include a copy of the petition or motion which led directly to the order or judgment being appealed and a copy of any responses to the petition or motion. An applicant may include copies of such other parts of the record or transcript as he deems appropriate. No certification of such copies by the clerk of the trial court shall be necessary in conjunction with the application.

(d) The application shall be filed with the clerk of the Supreme Court or the Court of Appeals within 30 days of the entry of the order, decision, or judgment complained of and a copy of the application, together with a list of those parts of the record included with the application, shall be served upon the opposing party or parties as provided by law, except that the service shall be perfected at or before the filing of the application. …

(e) The opposing party or parties shall have ten days from the date on which the application is filed in which to file a response. The response may be accompanied by copies of the record in the same manner as is allowed with the application. The response may point out that the decision of the trial court was not error, or that the enumeration of error cannot be considered on appeal for lack of a transcript of evidence or for other reasons.

(f) The Supreme Court or the Court of Appeals shall issue an order granting or denying such an appeal within 30 days of the date on which the application was filed.

(g) Within ten days after an order is issued granting the appeal, the applicant, to secure a review of the issues, shall file a notice of appeal as provided by law. The procedure thereafter shall be the same as in other appeals.

(h) The filing of an application for appeal shall act as a supersedeas to the extent that a notice of appeal acts as supersedeas.

(Emphasis added).

The complete appeal process is summarized in Cook v. Glover, 295 Ga. 267 (2014).

We granted certiorari in Cook v. Bottesch, 320 Ga. App. 796 (740 SE2d 752) (2013) to consider whether the Court of Appeals properly interpreted 42 USC § 1396p … In this case, the Georgia Department of Human Services, Family and Children Services (“DFCS”) granted appellee Jerry L. Glover’s application for Medicaid benefits but imposed a multi-month asset transfer penalty …. Glover appealed the penalty to an Office of State Administrative Hearings Administrative Law Judge (“ALJ”) who issued an initial decision reversing the penalty. DFCS thereafter filed a request for agency review by the Georgia Department of Community Health (“DCH”), the state agency responsible for administering Georgia’s Medicaid program, and DCH issued a final decision upholding the penalty. Pursuant to OCGA § 50-13-19 of the Administrative Procedure Act, Glover then sought judicial review from the Superior Court of Hall County which affirmed the final agency decision. The Court of Appeals granted Glover’s application for discretionary appeal and reversed the superior court, ….

As with appeals to the Superior Court, the Court of Appeals limits its review to whether the record supports the initial decision of the local governing body or administrative agency. Ga. Dep’t of Cmty. Health v. Freels, 258 Ga. App. 446 (2002).

When an administrative agency decision is appealed, judicial deference is to be afforded the agency’s interpretation of statutes it is charged with enforcing or administering and the agency’s interpretation of rules and regulations it has enacted to fulfill the function given it by the legislative branch. See Pruitt Corp. v. Ga. Dep’t of Cmty. Health, 284 Ga. 158 (2008). Agency deference may be due a statute, rule or regulation, but it is not due a departmental manual, the terms of which had not undergone the scrutiny afforded a statute during the legislative process or the adoption process through which all rules and regulations must pass.

The final decision of the administrative agency is not entitled to affirmance on the basis that there is “any evidence to support it.” Pruitt, supra. Judicial review of an administrative decision requires the court to determine that the findings of fact are supported by “any evidence” and to examine the soundness of the conclusions of law that are based upon the findings of fact. Although a reviewing court may not substitute its judgment for that of the agency as to the weight of the evidence on questions of fact, the Court may reverse or modify the decision if substantial rights of the appellant have been prejudiced because the administrative findings are clearly erroneous. While the judiciary accepts the findings of fact if there is any evidence to support the findings, the court may reverse or modify the Department’s decision if substantial rights of the appellant have been prejudiced because the administrative decision is: (1) in violation of constitutional or statutory provisions; (2) in excess of the statutory authority of the agency; (3) made upon unlawful procedure; (4) affected by other error of law. Thus, the court is statutorily required to examine the soundness of the conclusions of law drawn from the findings of fact supported by any evidence, and is authorized to reverse or modify the agency decision upon a determination that the agency’s application of the law to the facts is erroneous. A determination that the findings of fact are supported by evidence does not end judicial review of an administrative decision. Id.