Curtis v. Child
| Decision Date | 05 October 1972 |
| Docket Number | 10862,Nos. 10861,s. 10861 |
| Citation | 501 P.2d 1374,95 Idaho 63 |
| Parties | Bessie CURTIS, Plaintiff-Respondent, v. Bill CHILD, and Commissioner of the Idaho Department of Public Assistance, Defendant-Appellant. Minnie M. LINTHICUM, Plaintiff-Respondent, v. Bill CHILD, as Commissioner of the Idaho Department of Public Assistance, Defendant-Appellant. |
| Court | Idaho Supreme Court |
W. Anthony Park, Atty. Gen., Richard C. Russell, Asst. Atty. Gen., Boise, for appellants.
Michael C. Moore, Lewiston, for respondents.
The two cases involved in this appeal present common issues, and were consolidated for consideration of such issues by this Court. Both of the plaintiffs-respondents are elderly ladies and have been patients in the Lewiston Orchards Nursing Home for a number of years. Both of them are bedridden and unable physically or mentally to care for themselves; neither of them have any relatives upon whom they can call for assistance. The record discloses that nursing home care is essential to their subsistence. Each of the respondents has income of slightly over $200 per month derived from benefits from the Veterans Administration and from payments under the Social Security Law. It is undisputed that privately arranged nursing home care would cost far in excess of each of the respondent's monthly income.
Nursing home care in the Lewiston Orchards Nursing Home was provided for After their assistance was terminated, each of the respondents applied for and had a hearing before a department hearing officer. Following these hearings, decisions were entered affirming the termination of each of the respondent's public assistance grant. Appeals were taken to the district court pursuant to I.C. § 67-5215. The district court ruled that the respondents were 'medically needy individuals' within the meaning of I.C. § 56-209b and that the department's regulations denying them aid were arbitrary, capricious, and unreasonable, and therefore unenforceable. The trial court in its judgments reversed the determinations of the hearing officer and ordered medical assistance to each of the respondents reinstated.
each of the respondents, with payment for such care coming from each respondent's Veterans Administration payments and Social Security payment, plus additional payments being made by the Department of Public Assistance (hereinafter referred to as the depatment or as the DPA). Social Security payments were increased by Congress, and because of such increase, each of the respondents was then receiving income in excess of that specified by the department for eligibility to receive assistance, and on April 1, 1970, the respondents' old age assistance was terminated.
The appeals in these cases were taken following the trial court's entry of findings of fact, conclusions of law, and judgment in favor of the individual respondents. We affirm these judgments for the reasons set out below.
The welfare program in issue is the nursing home care benefits segment of Medicaid, a medical assistance program for the poor, established by Title XIX of the Social Security Act, 42 U.S.C.A. § 1396 et seq. The program is financed through contributions from both the federal and state governments, and is administered by the states, guided by federal statutory regulations. 42 U.S.C.A. § 1396a. When a state (at its option) decides to participate in Medicaid, the state is required by § 1396a(a)(10) to provide medical assistance to those persons receiving benefits under one of the state's federally-aided public assistance programs established for the blind, aged, totally and permanently disabled, and families with dependent children. Recipients under one of these federally assisted welfare programs are denoted 'categorically needy' for purposes of eligibility for Medicaid. 45 CFR 248.10.
The federal legislation also provides for assistance programs for persons who do not qualify as 'categorically needy' but can, nonetheless, be deemed 'medically needy.' 42 U.S.C.A. § 1396a(a)(10), (17). Whether the federal legislation makes this phase of the program mandatory or optional with each participating state is the initial issue to be resolved in this appeal.
In addition, appellant in its assignments of error, raises two pertinent issues which must be considered in the disposition of this appeal. First, appellant contends the district court erred in concluding I.C. § 56-209b, which defines the general scope of Idaho's medical assistance plan, makes mandatory the inclusion of 'medically needy' (in addition to 'categorically needy') persons as eligible recipients of Medicaid benefits. Second, appellant rejects the district court determination that the DPA regulation discriminates against a class of needy persons, in violation of the equal protection guarantees of the United States and Idaho Constitutions.
Respondents urge that the Social Security Act does not make optional but rather mandates that states provide Medicaid assistance to those who qualify as 'medically needy.' The district court found that the import of the federal legislation was to make this aid optional. The district court properly construed the Act.
The pertinent portions of the Act are 42 U.S.C.A. § 1396a(a) subsections (10) and (17). Subsection (17) appears to support respondents' contention. That subsection It is undeniable that this subsection, considered by itself, lends strong support to respondents' contention that the federal legislation precludes the DPA from declaring their ineligibility. Subsection (17) must, however, be read in light of the other subsections of the Act, specifically subsection (10). Subsection (10) plainly explains that a state plan must extend aid to the recipients of aid under the four specified categories of assistance programs. The second part details what the plan must include 'if medical or remedial care and services are included for any group of individuals who are not receiving aid * * * under any such State plan (of the four specified categories) and who do not meet the income and resources requirements of (such a plan).'
requires the state to adopt reasonable standards of eligibility for Medicaid, comparable for all groups. The subsection also contains a 'flexible income' or 'spend-down' provision which requires the state plan to 'provide for flexibility in the application of such standards with respect to income by taking into account * * * the costs * * * incurred for medical care or for any other type of remedial care recognized under State law.' 42 U.S.C.A. § 1396a(a)(17). The inference is that since the language of subsecton (17) is mandatory, its provisions require a state to consider medical needs in defining eligibility. If respondents' necessary medical expenses were subtracted from their gross incomes, each would fall within the $152.80 cut-off.
Thus, a reading of subsection (10) indicates that coverage of the 'medically needy' is optional with the states. Wilczynski v. Harder, 323 F.Supp. 509, 515 (D.Conn.1971); Fullington v. Shea, 320 F.Supp. 500, 505 (D.Colo.1970), aff'd mem., 404 U.S. 963, 92 S.Ct. 345, 30 L.Ed.2d 282 (1971). But when a state has adopted the optional 'medically needy' phase, the 'spend-down' provision contained in subsection (17) is applicable. As the court in Fullington v. Shea stated, in discussing claims under the Colorado medical assistance program:
The federal regulations in 45 CFR 248.21 specifically provide that if the medically needy are included in the state medical assistance plan, the 'available income' of a medically needy person must be determined in a 'flexible' manner:
' § 248.21 Financial eligibility-medical assistance programs.
(a) State plan requirements. A State plan under title XIX of the Social Security Act must:
* * *
* * *
(2) With respect to both the categorically needy and, if they are included in the plan, the medically needy:
(i) Provide that only such income and recources as are actually available will be considered and that income and resources will be reasonably evaluated;
* * *
* * *
(3) With respect to the medically needy, if they are included in the plan:
* * *
* * *
(ii) Provide that there will be a flexible measurement of available income which will be applied in the following order of priority:
(a) Frist, for maintenance, so that any income in an amount at or below the established level will be protected for maintenance;
(b) Next, income in excess of that needed for maintenance will be applied to costs incurred for medical insurance premiums and for necessary medical or remedial care recognized under State law and not encompassed within the (c) All of the remaining excess income will be applied to costs of medical assistance included in the State plan.'
State plan for medical assistance. States may set reasonable limits on such medical services for which excess income may be applied.
As indicated above, states have the option, upon deciding to participate in Medicaid programs, to extend benefits to 'medically needy' persons-those who, but for income in excess of the eligibility limits, could qualify as categorically needy. The district court found that the Idaho legislature, by amendment of I.C. § 56-209b in 1966, enacted this option:
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