Three retirees have standing to challenge the Social Security Administration's (SSA) policies that requires them to accept Medicare Part A as a condition of their receiving monthly Social Security benefits, according to the U.S. District Court in the District of Columbia. The policies at issue are contained in the SSA's Program Operations Manual System (POMS). Five retirees sued the Secretary of HHS alleging that the POMS regulations are invalid and operate to either deprive the retirees of their right to Social Security benefits or force them to “enroll in” Medicare Part A against their will.
Social Security and Medicare
In support of their position, the retirees referred to POMS 00801.002, that states, “Individuals entitled to monthly benefits which confer eligibility for Health Insurance (HI) many not waive HI Entitlement. The only way to avoid HI Entitlement is through withdrawal of the monthly benefit application. Withdrawal requires repayment of all Retirement, Survivors and Disability Insurance (RSDI) and HI benefit payments.” Other POMS provisions related to this litigation also contain similar language.
The government argued that the five retirees did not have standing because the POMS were not final agency actions, and the retirees had failed to exhaust their administrative remedies. The district court held that two retirees who had not yet received Social Security benefits do not have standing, however, the other three retirees who had received Social Security have standing because having begun to receive RSDI benefits they have a redressable injury. Furthermore, the district court held, the POMS determine the retiree rights or obligations and, therefore, the POMS constitute a final agency action that is subject to judicial review.
Although none of the retirees had received an administrative hearing, the exhaustion requirement may be excused where “an agency has adopted a policy or pursued a practice of general applicability that is contrary to the law, ” the court said. The situation faced by these retirees is a situation that is not unique only to these retirees, therefore, the requirement that they exhaust their administrative remedies would be futile. The government's motion to dismiss was denied.
Hall v. Sebelius, D.D.C., Sept. 29, 2009, ¶303,134
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