Emerson v. Wynia
| Decision Date | 10 January 1991 |
| Docket Number | No. Civ. 4-89-1034.,Civ. 4-89-1034. |
| Citation | 754 F. Supp. 705 |
| Parties | James EMERSON, individually, and on behalf of all others similarly situated, Plaintiff, v. Ann WYNIA, in her official capacity as Commissioner of the Minnesota Department of Human Services, and Louis Sullivan, in his official capacity as Secretary of the United States Department of Health and Human Services, Defendants. |
| Court | U.S. District Court — District of Minnesota |
Patricia Marie Siebert, Laurie N. Davison, Minneapolis Legal Aid, Minneapolis, Minn., for plaintiff.
Hubert H. Humphrey, III, Minnesota Atty. Gen., and Patricia A. Sonnenberg, Sp. Asst. Atty. Gen., St. Paul, Minn., for defendant Wynia.
Sheila Lieber, Dept. of Justice, Civil Div., Federal Programs Branch, Margot E. de Ferranti, Dept. of Justice, Civ. Rights Div., Washington, D.C., for defendant Sullivan.
This matter is before the Court on the parties' cross motions for summary judgment. Plaintiff's motion will be granted and defendants' motions will be denied.
The facts in this case are not in dispute. The plaintiff class in this action is composed of individuals who have been or will be denied or terminated from medical assistance because of defendant Wynia's policy of refusing to exclude court-ordered child support payments from countable income under the Minnesota Medical Assistance program. The named plaintiff James B. Emerson is 51 years of age and has multiple sclerosis; consequently he is unable to walk and uses an electric wheelchair. Plaintiff requires substantial medical care and a trained attendant to meet his basic daily needs. Plaintiff was divorced in July 1987 and both parties were represented by counsel. In the divorce decree, plaintiff was ordered to pay $200 per month in child support.
Plaintiff qualifies for medical assistance by "spending down" his income to the qualifying level set by the state.1 Plaintiff's sole source of income is $863 per month in social security benefits. Until October 1, 1989, plaintiff's child support was deducted by the state in the calculation of plaintiff's monthly income. This deduction (along with other allowable deductions) would leave plaintiff with a countable monthly income of $611. The income level to qualify for Medicaid is $420 per month, so the plaintiff would be required to pay the first $191 in income for his medical care.
On September 23, 1989, plaintiff received notice that the state would no longer exclude court-ordered child support payments from determination of plaintiff's monthly income. This meant that plaintiff's monthly spend down to qualify for medical assistance would be $391. This would leave plaintiff with a monthly available income (after child support and medical assistance spend down) of $220, as compared to $420 before the state's policy was introduced. Plaintiff alleges that he is being placed in the position of choosing between defaulting on his court-ordered child support or forgoing his medical care.
Plaintiff began an administrative appeal which has been stayed pending the outcome of this action. There are no questions of material fact in conflict between the parties. The only issue for the Court to resolve is whether the state and federal defendants are appropriately fulfilling their statutory mandate to the medically needy.2
This case centers on the question of how to determine the "income" of recipients of medical assistance. The medical assistance program is designed to provide health care to persons whose income and resources are insufficient to pay for it themselves. Atkins v. Rivera, 477 U.S. 154, 106 S.Ct. 2456, 2458, 91 L.Ed.2d 131 (1986). A state is not required to participate in Medicaid, but once it chooses to do so, it must create a state plan that conforms to the requirements of the Medicaid statute and federal regulations. Schweiker v. Gray Panthers, 453 U.S. 34, 36-37, 101 S.Ct. 2633, 2636-37, 69 L.Ed.2d 460 (1981). The participating state is required to provide Medicaid to "categorically needy" persons (i.e., those receiving aid to families with dependent children (AFDC) or supplemental security income (SSI)). 42 U.S.C. § 1396a(a)(10)(A)(i). A state has the option of providing Medicaid coverage to, among others, aged, blind or disabled individuals whose income is too great to enable them to qualify for the "categorically needy" program. 42 U.S.C. § 1396a(a)(10)(C). This is the "medically needy" program.
The state must establish reasonable income standards for participation and permit recipients whose income exceeds the income standard to receive Medicaid after "spending down" to the income guideline. 42 U.S.C. § 1396a(a)(17). The "spend down" is the amount of medical expenses an individual must pay out of pocket before becoming eligible for Medicaid. See footnote 1 and 42 C.F.R. § 435.831.
The State of Minnesota provides Medicaid (known in Minnesota as "medical assistance") to medically needy aged, blind and disabled individuals and families. Minn.Stat. § 256B.055, subd. 7. The state requires that the income of the medically needy aged, blind and disabled be no more than 120 percent of the income for comparably sized AFDC families. Minn.Stat. § 256B.056, subd. 4.
Income eligibility in the medical assistance program is controlled by federal statute which requires:
A State plan for medical assistance must ... include reasonable standards ... to provide for taking into account only such income and resources as are, as determined in accordance with standards prescribed by the Secretary, available to the applicant or recipient and ... as would not be disregarded under SSI and AFDC....
42 U.S.C. § 1396a(a)(17)(B).
The Secretary has not developed regulations on how income should be calculated for the medically needy program. The Secretary has taken the position that income is defined under the AFDC and SSI programs. Memorandum of Secretary Sullivan in Support of Motion for Summary Judgment at 5.
Congress amended the Medicaid statute in 1982 to require states to use "the same methodology" for the medically needy as for the categorically needy. The Secretary interpreted this to require states to use the same disregards and deductions to determine financial eligibility as those utilized in the AFDC and SSI cash assistance programs. In response, in 1984, Congress instituted a moratorium against disapproving state plans more flexible (i.e., less restrictive) than the AFDC and SSI methodologies. Deficit Reduction Act of 1984, Pub.L. No. 98-369, § 2373(c)(1), 98 Stat. 494, 1112 (1984).
In response to the Secretary's restrictive interpretation of the 1984 statutory amendments, Congress passed additional legislation in 1987. Medicare and Medicaid Patient and Program Protection Act, Pub.L. No. 100-93, § 9, 101 Stat. 680, 695 (1987). The Medicare Catastrophic Coverage Act of 1988 made this moratorium permanent by allowing states to be less restrictive, but not more restrictive than the AFDC and SSI methodologies. 42 U.S.C. § 1396a(r)(2).
In Minnesota, court-ordered child support payments had been excluded from consideration as "income" of the payor under the medically needy program since at least January 1, 1972. This policy changed when the State of Minnesota was directed by the Secretary to alter its medical assistance income formula so that it was the same as the AFDC and SSI formulas. The state defendant initiated a policy review which resulted in a change of policy requiring that court-ordered child support payments be counted as income.
In reviewing a statute the Court has final authority on all issues of statutory construction. The Supreme Court has noted:
The judiciary is the final authority on issues of statutory construction and must reject administrative constructions which are contrary to clear congressional intent.
I.N.S. v. Cardoza-Fonseca, 480 U.S. 421, 447, 107 S.Ct. 1207, 1221, 94 L.Ed.2d 434 (1987) (citations omitted). If the Court finds that Congress has not directly addressed the question at issue, then the Court must determine whether the agency's regulation is based on a permissible construction of the statute. Cardoza-Fonseca, 480 U.S. at 445 n. 29, 107 S.Ct. at 1220 n. 29. The Court should give deference to the Secretary's interpretation of the Act, but deference is inappropriate if the Secretary's view conflicts with the Medicaid statute. Washington v. Bowen, 815 F.2d 549, 554 (9th Cir.1987).
In construing a statute the words should be interpreted through their ordinary meaning. Consumer Product Safety Commission v. GTE Sylvania, Inc., 447 U.S. 102, 100 S.Ct. 2051, 64 L.Ed.2d 766 (1980). A court should also decline to adopt a strained reading of a statute which renders one part a mere redundancy. Beef Nebraska, Inc. v. United States, 807 F.2d 712 (8th Cir.1986).
Plaintiff argues that 42 U.S.C. § 1396a(a)(17)(B) requires the exclusion of court-ordered child support from the calculation of "income." Plaintiff notes that the statute has two parts. The statute permits only the counting of (1) "income and resources ... available to the applicant or recipient," and (2) "as would not be disregarded under SSI and AFDC." Plaintiff contends that the state should look at the income available and exclude any income disregarded under the SSI and AFDC programs.
The plaintiff argues that the relevant legislative history indicates only income which is actually available should be considered as income.
The Senate report states:
(d) Determination of need for medical assistance.... Another provision is included that requires States to take into account only such income and resources as (determined in accordance with standards prescribed by the Secretary), are actually available to the applicant or recipient and as would not be disregarded ... in determining the eligibility for and the amount of...
To continue reading
Request your trial
-
Himes v. Sullivan, Civ. No. 91-6172L.
...failure to pass the amendment stemmed from its belief that such income was already excluded by statute. See Emerson v. Wynia, 754 F.Supp. 705, 709 n. 4 (D.Minn.1991), appeal In my opinion, there is no basis for plaintiffs' assertion that Congress failed to pass this amendment because it bel......
-
Estate of G.E. v. Division of Medical Assistance and Health Services
...but rather on the Director's view of the requirements of the federal Medicaid act, as derived from federal cases such as Emerson v. Wynia, 754 F.Supp. 705 (D.Minn.1991), Whaley v. Schweiker, 663 F.2d 871 (9th Cir.1981) and Tsosie v. Califano, 651 F.2d 719 (10th Cir.1981). See J.G. v. Divisi......
-
Ussery v. Kansas Dept. of Social and Rehabilitation Services
...considered in calculating the amount of patient liability. The trial court's reasoning consists primarily of quotes from Emerson v. Wynia, 754 F.Supp. 705 (D. Minn.1991). That case was reversed by the Eighth Circuit Court of Appeals in Emerson v. Steffen, 959 F.2d 119 (8th Cir.1992). The tr......
-
Indiana Dept. of Public Welfare v. Payne
...resource and income methodologies than those used in SSI states. See Mowbray v. Kozlowski (4th Cir.1990), 914 F.2d 593; Emerson v. Wynia (D.Minn.1991), 754 F.Supp. 705.9 This provision was amended in 1989, but the changes are not relevant to Payne's circumstances or our decision. After the ......