Bullock v. Whiteman, 68678

Decision Date10 December 1993
Docket NumberNo. 68678,68678
Parties, Medicare & Medicaid Guide P 42,088 Martha BULLOCK, et al., Appellants, v. Donna WHITEMAN, In Her Official Capacity as Secretary of the Department of Social and Rehabilitation Services, a Subdivision of the State of Kansas, Appellee.
CourtKansas Supreme Court

Syllabus by the Court

In a class action by General Assistance and MediKan recipients against the Secretary of Social and Rehabilitation Services challenging the constitutionality of proposed regulations restricting eligibility and reducing medical benefits, the record is examined and it is held the district court did not err in: (1) determining the proposed regulations were not violative of Article 7, § 4 of the Kansas Constitution; or (2) concluding said regulations were not violative of the Equal Protection Clauses of the Kansas or United States Constitutions, all as is more fully set forth in the opinion.

Lowell C. Paul, Kansas Legal Services, Inc., Topeka, argued the cause, and Marilyn Harp, Legal Services of Wichita, Wichita, was with him on the brief, for appellants.

Reid Stacey, Dept. of Social and Rehabilitation Services, argued the cause and was on the brief, for appellee.

McFARLAND, Justice.

This is a class action against the Secretary of the Department of Social and Rehabilitation Services (SRS). Plaintiffs contend that the proposed narrowing of eligibility for General Assistance (GA) benefits and reduction in MediKan benefits violate Article 7, § 4 of the Kansas Constitution and the equal protection guarantees of the Kansas and United States Constitutions. Plaintiffs are recipients of benefits under the GA and MediKan programs. The district court held in favor of defendant, and plaintiffs appeal therefrom.

When this action was commenced in December of 1989, it challenged regulations to take effect on January 1, 1990. The regulations would have eliminated all MediKan benefits and reduced GA payments by $9 per month per recipient. The issues were vigorously litigated, and, on April 9, 1991, the district court held that the proposed regulations had not been lawfully promulgated. The issues were all procedural in nature. While various post-trial motions were pending, SRS published notice of new proposed regulations concerning GA eligibility and MediKan benefits which would become effective on July 1, 1991. The litigation relative to the January 1, 1990, proposed regulations stopped in its tracks. An amended petition was filed challenging the validity of the July 1, 1991, proposed regulations. The issues before us relate wholly to the 1991 regulations.

The issues before us are as follows:

1. Does the action of SRS in seeking to eliminate cash and medical assistance to certain members of the plaintiff class violate Article 7, § 4 of the Kansas Constitution which states the respective counties of the state shall provide, as may be prescribed by law, for those inhabitants who may have claims upon the aid of society?

2. Does the action of defendant in seeking to eliminate or substantially reduce cash and medical assistance to certain members of the plaintiff class violate the equal protection guarantees of the Kansas and United States Constitutions?

At this point, some background information must be provided in order to understand the issues.

GA, a wholly state funded program, provides cash assistance to persons in need. Eligibility is determined based on need, income, and assets. See K.S.A.1992 Supp. 39-709(d)(1)(A). An applicant's income is adjusted through deductions for work and child care expenses. If the adjusted income is over a certain amount, no need is considered to be present and benefits are not available. Applicants also cannot have any more than $1,000 in nonexempt assets. Exemptions are allowed for homes, up to $1,500 in face value of life insurance, personal effects, household furnishings, keepsakes, and prepaid burial and funeral plans. K.A.R. 30-4-108(c); K.A.R. 30-4-109(c). Persons receiving GA also are eligible for MediKan, a medical benefits program. MediKan is also wholly state funded.

SRS also administers several benefit programs which are jointly funded through the federal government and the State with the former providing the bulk of the funds. A brief and highly oversimplified discussion of one of these programs is necessary to understand the role of GA and MediKan. Aid to Families with Dependent Children (AFDC) provides cash assistance to needy families with children and to pregnant women in their third trimester. The federal government has the ultimate control over the eligibility requirements and benefits available.

Social Security (SS) and Supplemental Security Income (SSI) are programs which are fully funded and administered by the federal government. SSI provides monthly cash assistance to needy persons who are age 65 and over, blind, or disabled as defined by federal law. Obtaining SS or SSI benefits based upon disability is often a lengthy process. Eligibility requires that persons be unable to engage in any substantial gainful activity due to physical or mental impairment which can be expected to result in death or last for at least 12 continuous months. 42 U.S.C. § 423(d)(1)(A) (1988).

Medicaid provides medical benefits to persons receiving cash assistance under AFDC, SSI, and SS disability and in certain other circumstances. The federal government pays 57 percent of the cost of Medicaid in Kansas.

By setting up this framework, we can place GA and MediKan in perspective. The district court made the following findings of fact relative to these programs:

"14. General Assistance ... furnishes cash assistance to needy Kansans who are not eligible for any other cash assistance program funded solely or partially with federal funds. As with AFDC, the Kansas Legislature has stated that GA recipients 'must have insufficient income or resources to provide a reasonable subsistence compatible with decency and health.' K.S.A. 39-709(d)(1)(A).

"General Assistance recipients include needy families who do not meet the technical requirements of AFDC, pregnant women (during the first two trimesters), disabled adults who have not been approved for Social Security or Supplemental Security Income disability, 'elderly' persons (aged 55-64), persons in residential drug treatment programs and persons recently released from state mental hospitals.

"During fiscal year 1990, 15,728 Kansans received GA. In December, 1989, those recipients included 876 adults and 1,176 children in families, 275 pregnant women, 3,672 disabled adults, 656 persons aged 55-64, 18 people in residential drug treatment programs, and 58 people recently released from state mental hospitals.

"15. All recipients of GA cash assistance are eligible for medical services, through the MediKan program. Children and pregnant women are also eligible for Medicaid benefits, and, therefore, participate in the Medicaid program.

"16. The GA disabled are typically single individuals with a mental or physical handicap which creates a substantial barrier to gainful employment. Many are awaiting a federal disability decision and, if they are successful, SRS will be reimbursed for their cash benefits and will receive retroactive federal matching payments for their medical assistance. Others are not sufficiently disabled to receive federal disability benefits, but still are untrained, ill-educated and often have psychological impairments or suffer from chronic drug or alcohol dependency.

"17. The GA elderly are all aged 55 through 64. Physical and mental conditions similar to those of the disabled keep them from any long-term employment. The median age is 59. The majority have done manual labor all of their lives but, because of injury or physical or mental illness, can no longer do so. Many are awaiting federal disability decisions. If they qualify for a federal disability program, reimbursement and retroactive matching payments are made to SRS by the federal government, as in the case of the GA disabled.

"18. All GA recipients must meet income and resource eligibility rules.

"19. Every applicant for or recipient of GA benefits is ineligible for assistance if that person, without good cause, refuses a referral for or offer of employment, terminates employment, or is terminated from employment for good cause."

The Secretary of SRS is authorized to adopt rules and regulations setting criteria for eligibility for GA, including consideration of factors such as age and physical or mental conditions. K.S.A.1992 Supp. 39-709(d)(1)(A).

Prior to the proposed changes, K.A.R. 30-4-90 extended GA benefits to, inter alia, "a person who has been medically determined to be physically incapacitated as set forth in K.A.R. 30-4-63(a)(2), except that the condition must only constitute a substantial handicap to gainful employment" and persons aged 55 or older. A doctor's statement was accepted as proof of incapacitation. Persons aged 55 or older did not have to show physical incapacity. K.A.R. 30-4-63(a)(2) included a provision that required the physical incapacity to extend beyond 30 days. SRS, due to budgetary constraints, proposed extending the 30-day period to 6 months and requiring persons aged 55 or older to also be physically incapacitated for the 6-month period before benefits would be granted. 10 Kan.Reg. 567 (1991). Medical services available under MediKan were sharply reduced under the proposed regulations. The district court's findings in this regard are as follows:

"8. For those who continued to be eligible for GA, the proposed regulations provided for sharply reduced MediKan benefits. Coverage for the following services was eliminated under MediKan:

a. All hospital services, except out-patient diagnostic laboratory and radiology services;

b. All physician services, except for twelve office visits per calendar year and diagnostic laboratory and radiology services;

c. Local health department...

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    • United States
    • Connecticut Supreme Court
    • June 20, 1995
    ...This is true even in states with explicit constitutional provisions regarding care for the poor. See, e.g., Kansas: 40 Bullock v. Whiteman, 254 Kan. 177, 865 P.2d 197, 202 (1993) (" 'Obviously Article 7, Section 4, does not require state support to anyone who simply claims to be needy. By i......
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    ...gainful activity due to physical or mental impairment expected to result in death or last at least 12 months. Bullock v. Whiteman, 254 Kan. 177, 179, 865 P.2d 197 (1993). The appellants analogy in this regard is The appellants contends that the district court abused its discretion when term......

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