Ciampa v. Schweiker

• Decision Date: 14 April 1981
• Docket Number: Civ. A. No. 80-725-MA.
• Citation: 511 F. Supp. 670
• Parties: John CIAMPA et al., Plaintiffs, v. Richard S. SCHWEIKER et al., Defendants.
• Court: U.S. District Court — District of Massachusetts

511 F. Supp. 670

John CIAMPA et al., Plaintiffs, v. Richard S. SCHWEIKER et al., Defendants.

Civ. A. No. 80-725-MA.

United States District Court, D. Massachusetts.

April 14, 1981.

Peter V. Berns, Law Student, William H. Simon, Legal Services Institute, Jamaica Plain, Mass., Gerald Tutor, Cambridge & Somerville Legal Services, Cambridge, Mass., for plaintiffs.

Andrew M. Wolfe, Dept. of Justice, Washington, D. C., Joan C. Stoddard, Asst. Atty. Gen., Boston, Mass., for defendants.

MEMORANDUM AND ORDER

MAZZONE, District Judge.

This is an action for declaratory and injunctive relief against federal and state administrators of the Medicaid program, challenging their interpretation of an amendment to the Medicaid legislation, the "Pickle Amendment," 42 U.S.C.A. § 1396a (note), on statutory and equal protection grounds. The plaintiffs are a class of certain persons residing in Massachusetts and receiving Old Age, Survivors and Disability Insurance benefits (OASDI) (commonly known as "Social Security"), whom we describe in greater detail below. The plaintiffs, who are not receiving Medicaid, claim that the Pickle Amendment requires the defendants to classify them as automatically eligible for Medicaid. They challenge a federal regulation at 42 C.F.R. § 435.135 (1979) and state regulations in the Massachusetts Public Assistance Policy Manual (MPAPM) ch. I § F ¶ 2.b.(4) (to be codified in 106 C.M.R. § 325.030(B)(1)d.) and ch. IV § B ¶ ___ ___(1)(c) at pp. 13-14 (to be codified in 106 C.M.R. § 338.020(C)) (both promulgated November 20, 1980). The defendant, Richard S. Schweiker, is Secretary of the Department of Health and Human Services. The defendant, John D. Pratt, is Commissioner of the Massachusetts Department of Public Welfare. Jurisdiction is proper under 28 U.S.C. § 1331(a).¹ The parties have moved for class certification, and both parties have filed motions for summary judgment.

It appears from the memoranda, affidavits, and exhibits filed by both parties that there is no genuine issue as to any material fact.² The case may therefore be disposed of on summary judgment. Fed.R.Civ.P. 56(c); Hahn v. Sargent, 523 F.2d 461, 464 (1st Cir. 1975), cert. denied, 425 U.S. 904, 96 S.Ct. 1495, 47 L.Ed.2d 54 (1976).

I. Class Certification

Under Fed.R.Civ.P. 23, determination of whether an action is to be maintained as a class action should be made "as soon as practicable" after commencement of the suit. We certify the class because we find it is numerous, its members pose common questions of law and fact, the named parties' claims are typical of those of the class, and the named parties will provide fair and adequate representation. Fed.R.Civ.P. 23(a). We also find, pursuant to Fed.R.Civ.P. 23(b)(2), that the defendants have refused to act on grounds generally applicable to the class as a whole.³

II. Interpretation of the Pickle Amendment

The parties agree generally as to the purpose of the Pickle Amendment. Although it is an amendment to the Medicaid legislation, the Pickle Amendment involves the convergence of three different programs under the Social Security Act:

1. The Old Age, Survivors and Disability Insurance program (OASDI), 42 U.S.C. § 401 et seq. (Title II of the Act), often known as "Social Security," provides cash benefits to workers and their families in illness or old age. Section 215(i) of the Act, 42 U.S.C. § 415(i), provides for annual cost-of-living increases in monthly OASDI benefits.

2. The Supplemental Security Income program (SSI), 42 U.S.C. § 1381 et seq. (Title XVI of the Act), provides cash benefits to aged, blind, or disabled persons whose income (including any OASDI benefits they may receive) falls below a prescribed level.

3. The Medicaid program, 42 U.S.C. § 1396 et seq. (Title XIX of the Act), provides medical assistance to needy families and individuals.

Under the Medicaid program, persons who receive both OASDI and SSI automatically qualify for medicaid benefits. 42 U.S.C. § 1396a(a)(10).⁴ Persons who receive OASDI, but whose income and resources are too great to permit them to qualify for SSI, may be conditionally eligible for Medicaid. In Massachusetts, these conditionally eligible persons receive Medicaid benefits, but only after they have incurred medical expenses ("spent down") in specified amounts. See 42 U.S.C. § 1396a(a)(10).⁵

In some cases, individuals who were once receiving both OASDI and SSI either (1) lose their eligibility for SSI, or (2) are unable to regain their eligibility for SSI, because of cost-of-living increases in their OASDI benefits. Because they are not eligible for SSI, such persons are also not automatically eligible for Medicaid. The Pickle Amendment attempts to remedy this negative effect of cost-of-living increases by granting automatic Medicaid eligibility to certain of these persons. The dispute before us concerns exactly which persons must be given automatic Medicaid benefits pursuant to the amendment. The defendants claim that only persons falling into category (1) above are covered by the Pickle Amendment;⁶ the plaintiffs claim that the amendment also covers certain persons in category (2).⁷

The statute itself sheds a great deal of light on this dispute. The full text of the Pickle Amendment, Pub.L. No. 94-566, § 503, 90 Stat. 2685 (1976), codified at 42 U.S.C. § 1396a (note), is as follows:

PRESERVATION OF MEDICAID ELIGIBILITY FOR INDIVIDUALS WHO CEASE TO BE ELIGIBLE FOR SUPPLEMENTAL SECURITY INCOME BENEFITS ON ACCOUNT OF COST-OF-LIVING INCREASES IN SOCIAL SECURITY BENEFITS.

In addition to other requirements imposed by law as a condition for the approval of any State plan under title XIX of the Social Security Act Medicaid, there is hereby imposed the requirement (and each such State plan shall be deemed to require) that medical assistance under such plan shall be provided to any individual, for any month after June 1977 for which such individual is entitled to a monthly insurance benefit under OASDI but is not eligible for benefits under SSI, in like manner and subject to the same terms and conditions as are applicable under such State plan in the case of individuals who are eligible for and receiving benefits under SSI for such month, if for such month such individual would be (or could become) eligible for benefits under SSI except for amounts of income received by such individual and his spouse (if any) which are attributable to increases in the level of monthly insurance benefits payable under OASDI which have occurred pursuant to section 215(i) of such Act OASDI cost-of-living increases, in the case of such individual, since the last month after April 1977 for which such individual was both eligible for (and received) benefits under SSI and was entitled to a monthly insurance benefit under OASDI, and, in the case of such individual's spouse (if any), since the last such month for which such spouse was both eligible for (and received) benefits under SSI and was entitled to a monthly insurance benefit under OASDI. Solely for purposes of this section, payments of the type described in section 1616(a) of the Social Security Act or of the type described in section 212(a) of Public Law 93-66 shall be deemed to be benefits under SSI.⁸

Except for the title, the Pickle Amendment contains no language that could be construed to limit its applicability to persons who become ineligible for SSI benefits as a result of an OASDI cost-of-living increase.⁹ Rather, the statute sets out a detailed formula to be applied each month to determine whether an individual not receiving SSI is nevertheless entitled to automatic Medicaid eligibility.

First, the individual must have been eligible for both OASDI and SSI (and receiving SSI) in some month after April 1977. In other words, in some month since April 1977 the individual must have enjoyed automatic eligibility for Medicaid.

Second, the individual must be currently ineligible for SSI, but eligible for OASDI.

Third, the individual's monthly income must be such that, but for cost-of-living increases in this OASDI benefit levels that have occurred since the last month after April 1977 when he was eligible for both OASDI and SSI (and received SSI), the individual would be eligible for SSI.¹⁰

The Pickle Amendment, therefore, tolerates a "gap" in automatic Medicaid eligibility. If an individual received OASDI and SSI in any month after April 1977 and lost eligibility for SSI because of an increase in income or resources not related to OASDI cost-of-living increases, the individual would be ineligible for automatic Medicaid benefits for that month and for any subsequent months in which his income, disregarding cost-of-living increases since his last month of SSI eligibility, remained above maximum SSI levels. This "gap" in eligibility, however, does not bar the individual from regaining eligibility for automatic Medicaid benefits. If the individual suffers a decrease in income, or if the maximum income levels for SSI are raised, the individual may regain eligibility under the Pickle Amendment if his monthly income, decreased by the OASDI cost-of-living increases since his last month of SSI eligibility, falls below the maximum SSI level.

In no event may a person receive automatic Medicaid under the amendment if his income from sources other than Social Security (OASDI) exceeds the SSI level. Nor may outside income ever be disregarded in calculating Medicaid eligibility. The only portions of a person's income that are disregarded are the cost-of-living increases in Social Security.

The defendants, despite the precise formula set forth in the Pickle Amendment, insist that its title and legislative history demonstrate that Congress intended to preserve automatic Medicaid eligibility only where SSI benefits are lost because of an OASDI cost-of-living increase, so that no "gap" or break in Medicaid eligibility occurs.

We note first that, as the defendants have pointed out, the starting point in statutory...