Clark v. Commissioner of Income Maintenance

• Decision Date: 20 December 1988
• Docket Number: No. 13468,13468
• Citation: 209 Conn. 390,551 A.2d 729
• Court: Connecticut Supreme Court
• Parties: , 24 Soc.Sec.Rep.Ser. 457, Medicare & Medicaid Guide P 37,643 Louise CLARK, Conservatrix (ESTATE OF Wilbur CLARK) v. COMMISSIONER OF INCOME MAINTENANCE.

Page 729

551 A.2d 729

209 Conn. 390, 24 Soc.Sec.Rep.Ser. 457,

Medicare & Medicaid Guide P 37,643

Louise CLARK, Conservatrix (ESTATE OF Wilbur CLARK) v. COMMISSIONER OF INCOME MAINTENANCE.

No. 13468.

Supreme Court of Connecticut.

Argued Nov. 1, 1988.

Decided Dec. 20, 1988.

Hugh Barber, Asst. Atty. Gen., with whom were Martin Rosenfeld, Asst. Atty. Gen., and, on the brief, Joseph I. Lieberman, Atty. Gen., for appellant (defendant).

Timothy J. Johnston, with whom was Patricia A. Thompson, Vernon, for appellee (plaintiff).

Patty Jenkins Pittman, New Haven, filed a brief for the Connecticut Women's Educational and Legal Fund, Inc., as amicus curiae.

George B. Bickford, Bloomfield, filed a brief for the Connecticut Probate Assembly as amicus curiae.

Before PETERS, C.J., and ARTHUR H. HEALEY, SHEA, CALLAHAN, GLASS, COVELLO and HULL, JJ.

PETERS, Chief Justice.

The dispositive issue in this appeal is whether income "available" to an institutionalized incompetent for medicaid eligibility purposes includes an amount a Probate Court has ordered the incompetent to pay his at-home spouse. The plaintiff, Louise Clark, conservatrix for her husband Wilbur Clark, brought an administrative appeal pursuant to General Statutes § 17-2a ¹ claiming that the defendant, the commissioner of income maintenance, had awarded Wilbur Clark insufficient medicaid support by not excluding from his "available" income the amount that the Probate Court had ordered him to pay her in spousal support. The Fair Hearing Officer (FHO) upheld the defendant's ruling. The trial court, however, sustained the plaintiff's appeal holding that the defendant should have excluded the amount of the spousal support award from Wilbur Clark's "available" income. The defendant appealed to the Appellate Court and we transferred the case to ourselves pursuant to Practice Book § 4023. We find error.

The parties do not dispute the relevant facts. Wilbur Clark is an elderly, incompetent, nursing home resident for whom his wife, the plaintiff, serves as conservatrix. On May 29, 1984, the plaintiff, as spouse, applied to the Probate Court for a $340 per month allowance from her husband's estate. The plaintiff, as conservatrix, did not object to her own application and the Probate Court, on June 22, 1984, granted her a $460 per month allowance from the estate principal, an amount $120 more per month than she had requested.

On October 4, 1984, the plaintiff, on her husband's behalf, applied to the defendant for Title XIX medicaid assistance, which the defendant granted effective retroactively to July 1, 1984. In determining the applicant's eligibility, the defendant found that he received $629.60 per month from social security and $698 per month from a Teamster's pension, for a monthly income of $1327.60, a figure that neither party disputes. See 42 U.S.C. § 1382a(a)(2)(B); 20 C.F.R. § 416.1121(a). The defendant wrote to the plaintiff several times asking for her own asset information to determine whether any of Wilbur Clark's income should be diverted to her to meet her maintenance needs. See 42 C.F.R § 435.832(c). The plaintiff never responded, believing she had no such obligation as she had not applied for medicaid herself. The defendant therefore awarded benefits to Wilbur Clark based on $1327.60 per month of "available" income.

The plaintiff disputed the defendant's award to the incompetent and requested a fair hearing pursuant to General Statutes § 17-2a. The FHO upheld the defendant's award, also finding $1327.60 per month "available" to Wilbur Clark and ruling that the defendant need not consider the Probate Court award in determining his "available" income. ²

The trial court then sustained the plaintiff's appeal from the FHO's decision. It held that no state statute or regulation mandated that the defendant, in calculating an applicant's "available" income, must disregard court orders requiring the applicant to pay sums to a third party and that the defendant had, therefore, acted illegally in calculating Wilbur Clark's "available" income. The court remanded the case to the defendant to redetermine the applicant's eligibility. The defendant appeals from the trial court's judgment.

The federal medicaid program, established by Congress in 1965, "provid[es] federal financial assistance to States that choose to reimburse certain costs of medical treatment for needy persons." Harris v. McRae, 448 U.S. 297, 301, 100 S.Ct. 2671, 2680, 65 L.Ed.2d 784, reh. denied, 448 U.S. 917, 101 S.Ct. 39, 65 L.Ed.2d 1180 (1980); 42 U.S.C. § 1396 et seq. Although states participate voluntarily, a state electing to participate must develop a plan, approved by the secretary of health and human services, containing "reasonable standards ... for determining eligibility for and the extent of medical assistance...." 42 U.S.C. § 1396a(a)(17). ³ All participating states must provide coverage to "the categorically needy": dependent children, the aged, the blind and the disabled who qualify for welfare assistance under the Supplemental Security Income (SSI) program; 42 U.S.C. §§ 1381 through 1383; or, upon the election of the state, under a more restrictive standard in place before 1972. 42 U.S.C. § 1396a(f). ⁴ States are also afforded the option of covering the "optionally categorically needy": individuals who are financially ineligible for SSI, but eligible for, or a recipient of, optional state supplementation to SSI. 42 U.S.C. § 1396a(a)(10)(A). Finally, states may also, at their option, provide assistance to the "medically needy": those whose resources are sufficient to cover their ordinary living expenses, but not their medical care. 42 U.S.C. § 1396a(a)(10)(C); 42 C.F.R. §§ 435.300 through 435.340.

Connecticut has elected to cover the "optionally categorically needy" and the "medically needy," as well as the "categorically needy." The plaintiff has applied for benefits on her husband's behalf under the "medically needy" option. Applicants qualify for assistance as "medically needy" if they incur medical expenses to an extent that reduces their income to the established eligibility level. These persons must first "spenddown" their "available" income on their medical care expenses to the eligibility level, with the medicaid program covering the unpaid balance. Thus, the lower the amount of income an applicant is deemed to have "available," the less he must "spenddown" to qualify for assistance. 42 C.F.R. § 435.301; see Atkins v. Rivera, 477 U.S. 154, 158, 106 S.Ct. 2456, 2459, 91 L.Ed.2d 131 (1986). ⁵

The legislature, by General Statutes § 17-134a, ⁶ has authorized the commissioner of income maintenance to administer Connecticut's medicaid program. Our statutes further provide that "[a]ll of the provisions of this chapter are extended to the medical assistance program except such provisions as are inconsistent with federal law and regulations governing Title XIX of the Social Security Amendments of 1965 and this part." General Statutes § 17-134e. "Thus, the legislature recognized the primacy of the applicable federal provisions and this court must be guided by those provisions. Stated in another way, the federal statutes and regulations set a limit upon the authority of the commissioner as well as furnishing a guide to his administration of the program." Morgan v. White, 168 Conn. 336, 343-44, 362 A.2d 505 (1975).

In determining an individual's eligibility for medicaid benefits, the commissioner may take "into account only such income and resources as are, as determined in accordance with standards prescribed by the Secretary [of health and human services], available to the applicant or recipient...." (Emphasis added.) 42 U.S.C. § 1396a(a)(17)(B). The plaintiff contends that the Probate Court order for her to pay herself $460 of Wilbur Clark's monthly income compels the defendant to exclude that amount from Wilbur Clark's total income in determining his medicaid eligibility. She suggests that such an exclusion is required in order to give proper legal effect to a valid Probate Court order.

In our view, the plaintiff misconstrues the issue in this case. The Probate Court undoubtedly has the authority to enter an enforceable spousal support order. General Statutes § 45-75(b). ⁷ This case, however, concerns whether the defendant must consider that court order in determining an applicant's eligibility for the federally funded medicaid program. We hold that he need not, indeed that he cannot. ⁸

"Congress explicitly delegated to the Secretary broad authority to promulgate regulations defining eligibility requirements for Medicaid." Schweiker v. Gray Panthers, 453 U.S. 34, 43, 101 S.Ct. 2633, 2640, 69 L.Ed.2d 460 (1981). "In view of this explicit delegation of substantive authority, the Secretary's definition of the term 'available' is 'entitled to more than mere deference or weight.' ... Rather, the Secretary's definition is entitled to 'legislative effect' because, '[i]n a situation of this kind, Congress entrusts to the Secretary, rather than to the courts, the primary responsibility for interpreting the statutory term.' " Id., at 44, 101 S.Ct. at 2640, quoting Batterton v. Francis, 432 U.S. 416, 425-26, 97 S.Ct. 2399, 2405-06, 53 L.Ed.2d 448 (1977); see also Herweg v. Ray, 455 U.S. 265, 274-75, 102 S.Ct. 1059, 1066, 71 L.Ed.2d 137 (1982); Marcus' Appeal from Probate, 199 Conn. 524, 532 n. 3, 509 A.2d 1 (1986).

The Secretary's regulations require that an "agency must reduce its payment to an institution, for services provided to an individual ... by the amount that remains after deducting the amounts specified in paragraph (c) of this section, from the individual's income." (Emphasis added.) 42 C.F.R. § 435.832(a). Paragraph (c) specifically lists only four amounts an agency may deduct from a "medically needy" applicant's total income: (1) a personal needs allowance; (2) an at-home spousal allowance; (3) an at-home family allowance; and (4) medical or remedial...