N.H. v. Agency for Persons With Disabilities - Medicaid Waiver Denial
Summary
The Florida District Court of Appeal affirmed the denial of a Medicaid waiver program application for N.H. The court found that the applicant failed to meet eligibility criteria for autism and intellectual disability, and that the issue was already decided in a prior administrative hearing.
What changed
The Florida District Court of Appeal affirmed a final order from the Department of Children and Families' Office of Appeal Hearings, which upheld the Agency for Persons with Disabilities' (APD) denial of N.H.'s application for the iBudget Waiver Program. The denial was based on N.H. failing to meet eligibility criteria for autism and intellectual disability, specifically the requirement that disabilities must manifest before age eighteen. This was N.H.'s second application, and the court found the issue identical to a previously litigated matter, affirming the principle of administrative finality.
This ruling means that N.H. remains ineligible for the iBudget Waiver Program based on the current application and previous determinations. Regulated entities, particularly those involved in administering similar waiver programs, should note the importance of administrative finality and the need to present new material information in subsequent applications. No specific compliance actions are required for other entities, as this is an individual case ruling.
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March 4, 2026 Get Citation Alerts Download PDF Add Note
N.H. v. Agency for Persons With Disabilities
District Court of Appeal of Florida
- Citations: None known
Docket Number: 3D2025-1298
Combined Opinion
Third District Court of Appeal
State of Florida
Opinion filed March 4, 2026.
Not final until disposition of timely filed motion for rehearing.
No. 3D25-1298
Lower Tribunal No. 24F-18985
N.H.,
Appellant,
vs.
Agency for Persons with Disabilities,
Appellee.
An Appeal from the State of Florida, Department of Children and
Families, Office of Appeal Hearings.
N.H., in proper person.
Erin W. Duncan, Chief Appellate Counsel (Tallahassee), for appellee.
Before FERNANDEZ, GORDO and GOODEN, JJ.
GORDO, J.
N.H. appeals from a final order of the Florida Department of Children
and Families’ Office of Appeal Hearings, affirming a decision by the Agency
for Persons with Disabilities (“APD”) to deny her application for enrollment in
a Medicaid waiver program. We have jurisdiction. Fla. R. App. P.
9.030(b)(1)(C). We affirm.
I.
APD administers the iBudget Waiver Program 1 to provide long-term
care services to eligible individuals who prefer to receive services in their
homes or community settings rather than in institutional facilities.
N.H. was born on January 8, 1996. In March 2019, she applied for
enrollment in the iBudget Waiver Program under the eligibility categories of
autism and intellectual disability. APD denied N.H’s application, finding she
did not meet the eligibility criteria, which require a showing that her claimed
disabilities manifested before age eighteen. N.H. timely appealed the denial.
Following a hearing before the Office of Appeals Hearings, the hearing
officer entered a final order affirming APD’s determination that N.H. failed to
meet the eligibility criteria for autism or intellectual disability. N.H. did not
seek judicial review of that final order.
1
The iBudget Florida Waiver is a Medicaid program managed by APD that
provides home and community-based services to eligible individuals with
developmental disabilities.
2
Nearly five years later, in May 2024, N.H. submitted a second
application for enrollment in the iBudget Waiver Program under the same
eligibility categories—autism and intellectual disability. APD again denied
the application and determined that she was not eligible for the requested
services. N.H. appealed the second denial and requested a hearing.
During the second administrative hearing, APD moved to dismiss the
appeal on the grounds of administrative finality, arguing N.H. failed to provide
any new information material to the eligibility determination. The hearing
officer issued a final order dismissing the appeal, finding the issue presented
in the second proceeding—N.H.’s eligibility under the autism and intellectual
disability categories—was identical to the issue decided in the prior hearing,
which had been fully and fairly litigated. The officer concluded that N.H. had
failed to demonstrate any significant change in circumstances since the first
final order. This appeal followed.
II.
“We review an agency’s conclusions of law de novo and we review the
record to determine whether competent substantial evidence supports the
agency’s decision.” G.R. v. Agency for Perss. with Disabilities, 315 So. 3d
107, 108 (Fla. 3d DCA 2020). “In doing so, ‘we give no deference to agency
interpretations of statutes or rules.’” Id. (quoting A.C. v. Agency for Health
3
Care Admin., 322 So. 3d 1182, 1187 (Fla. 3d DCA 2019)). “In interpreting a
state statute or rule, a state court or an officer hearing an administrative
action pursuant to general law may not defer to an administrative agency’s
interpretation of such statute or rule, and must instead interpret such statute
or rule de novo.” Art. V, § 21, Fla. Const.
III.
N.H. argues her second application for services presented a materially
different issue and the hearing officer therefore improperly dismissed her
appeal.
The rule of administrative finality provides that “orders of administrative
agencies must eventually pass out of the agency’s control and become final
and no longer subject to modification.” Peoples Gas Sys., Inc. v. Mason,
187 So. 2d 335, 339 (Fla. 1966). “This rule assures that there will be a
terminal point in every proceeding at which the parties and the public may
rely on a decision of such an agency as being final and dispositive of the
rights and issues involved therein.” Id.
To overcome the doctrine of administrative finality, a subsequent
application must be supported by new facts, changed conditions, or
additional submissions material to the original agency determination. See
Fla. Power & Light Co. v. Beard, 626 So. 2d 660, 662 (Fla. 1993) (“[T]his
4
Court has recognized exceptions to the doctrine of administrative finality
based on a significant change of circumstances or a demonstrated public
interest.”). “A significant change in circumstances occurs when there has
been a change in the facts or circumstances that led to the original agency
decision.” M.N. v. Agency for Perss. with Disabilities, 395 So. 3d 231, 238
(Fla. 5th DCA 2024).
Here, the record shows N.H. sought identical relief in both
proceedings—a determination that she satisfies the statutory and regulatory
criteria for a developmental disability under the autism or intellectual
disability categories. 2 In each proceeding, however, N.H. failed to establish
a critical statutory requirement: manifestation of the claimed developmental
disability before the age of eighteen.3 Because N.H. did not demonstrate
2
A “developmental disability” must: (1) be attributable to a qualifying
condition, including autism or intellectual disability; (2) manifest before age
eighteen; and (3) constitute a substantial handicap reasonably be expected
to continue indefinitely. § 393.063(11), Fla. Stat. “Intellectual disability”
requires significantly subaverage intellectual functioning with concurrent
adaptive deficits, manifesting before age eighteen. § 393.063(24), Fla. Stat.
“Autism” is defined as a neurologically based developmental disability of
extended duration with onset in infancy or childhood and characterized by
significant impairments in social interaction, communication, and behavior.
§ 393.063(5), Fla. Stat.
3
While N.H. submitted two additional items of evidence—a clinical report
and a physician’s note—neither provides new information establishing
manifestation of a qualifying developmental disability before the age of
eighteen.
5
any significant change in circumstances in her second Medicaid waiver
application, we find there is competent substantial evidence to support the
hearing officer’s findings. Accordingly, we are compelled to affirm. See
Pumphrey v. Dep’t of Child. & Fams., 292 So. 3d 1264, 1267 (Fla. 1st DCA
2020) (affirming dismissal of a subsequent Medicaid application where no
significant change in circumstances had been shown); M.M. v. Agency for
Health Care Admin., 337 So. 3d 449, 449 (Fla. 3d DCA 2022) (“We are not
free to substitute our judgment for that of a hearing officer, nor may we
reweigh the evidence presented at the administrative hearing. Our review is
limited to whether the hearing officer’s findings are supported by competent,
substantial evidence.”); J.J. v. Agency for Perss. with Disabilities, 174 So. 3d
372, 372 (Fla. 3d DCA 2014) (“We are prohibited by statute from substituting
our own judgment regarding the disputed facts when the administrative
findings are based on competent, substantial evidence.”).
Affirmed.
6
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