Federal District court judge Rosemary Collyer of the U.S. District Court in the District of Columbia has handed down an opinion that enables a case to continue requesting enjoinment of the Social Security Administration and Department of Health and Human Services from enforcing rules making receipt of an individual's Social Security retirement benefits contingent upon enrolling in Medicare part A.

The case, Hall vs. Sebelius Civil Action No. 08-1715, was filed in October 2008. The plaintiffs are five retirees who allege that the Social Security Administration's (SSA) regulations regarding Medicare Part A, as stated in the SSA's Program Operations Manual System (POMS) are invalid and operate either to deprive Plaintiffs of their right to Social Security benefits or to force them to enroll in Medicare Part A against their will. The defendants--Kathleen Sebelius, Secretary of the Department of Health and Human Services ("HHS") and Michael J. Astrue, Commissioner of the SSA, had filed a motion to have the case dismissed.

According to Judge Collyer's opinion, three of the POMS challenged in the suit state that a Social Security claimant may withdraw from Medicare Part A by withdrawing application for monthly benefits, but may not withdraw only from Medicare Part A while retaining the monthly benefits.

The Government defendants moved to dismiss the complaint arguing that plaintiffs lack standing to pursue these claims (in other words that they had been injured), that the POMS provisions are not final agency actions as required for judicial review under the Administrative Procedure Act, and that plaintiffs failed to exhaust their administrative remedies. Judge Collyer found that three of the plaintiffs in fact were receiving Social Security benefits and wish to continue the benefits but also to opt-out of Medicare Part A. Assuming that the POMS do in fact prevent them from declining Medicare Part A as alleged, those three plaintiffs have standing for the claim.

The judge also determined that the POMS were final agency actions--definitive actions that have undergone extensive review and are the consummation of the agency's decision making process. The POMS are definitive because the SSA issued them only after extensive review, the judge said, and also met the other requirement for final agency action because the POMS determine rights and create legal consequences.

The judge did say that the plaintiffs had failed to exhaust administrative remedies which would be fatal to their claims unless the Court determined the exhaustion requirement should be excused for exceptional circumstances. One such circumstance occurs when Plaintiffs can demonstrate an agency has adopted a policy or pursued a practice of general applicability that is contrary to the law. In the plaintiffs' situation, the policy they are challenging is not the Social Security Act or federal regulations but rules apparently created by the SSA and expressed in the POMS. Therefore, the judge held that exhaustion of remedies is futile for the plaintiffs and will be excused.

The case will then proceed to hear a summary judgment motion by the defendants.

Judge Collyer's opinion may be accessed at:

https://ecf.dcd.uscourts.gov/cgi-bin/show_public_doc?2008cv1715-21

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