Nelson v. Betit

• Decision Date: 08 May 1997
• Docket Number: No. 960489-CA,960489-CA
• Citation: 937 P.2d 1298
• Parties: 316 Utah Adv. Rep. 31 Joie D. NELSON, Plaintiff and Appellant, v. Rod BETIT, in his Capacity as Executive Director of the Utah Department of Human Services, Defendant and Appellee.
• Court: Utah Court of Appeals

Page 1298

937 P.2d 1298

316 Utah Adv. Rep. 31

Joie D. NELSON, Plaintiff and Appellant, v. Rod BETIT, in his Capacity as Executive Director of the Utah Department of Human Services, Defendant and Appellee.

No. 960489-CA.

Court of Appeals of Utah.

May 8, 1997.

Michael E. Bulson, Ogden, for Plaintiff and Appellant.

Jan Graham and Linda Luinstra, Salt Lake City, for Defendant and Appellee.

Before WILKINS, BENCH and GREENWOOD, JJ..

WILKINS, Associate Presiding Judge:

Appellant Joie D. Nelson seeks reversal of the trial court's order of summary judgment by which she was included in her son's "family" for purposes of determining her son's eligibility for Aid to Families with Dependent Children (AFDC) benefits pursuant to 42 U.S.C.A. § 602(a)(24) (West 1991). We affirm.

BACKGROUND

In July 1992, appellant and her minor son were living together. Because of physical and financial circumstances, both appellant and her son were eligible for and receiving support under the AFDC program for a family of two. On July 28, 1992, appellant applied to the Social Security Administration (SSA) for benefits under two different programs: the Social Security Disability Insurance (SSDI) program, and the Supplemental Security Income (SSI) program. In October 1992, the SSA notified appellant that she was eligible for the SSDI program. Later that month, appellant received a lump-sum payment of $4918, representing SSDI benefits calculated from August 1992. As required, appellant notified the Department of Human Services (DHS), which administers the AFDC program, that she had received the SSDI lump-sum payment.

When DHS received notice of appellant's receipt of SSDI benefits, DHS re-evaluated the family's eligibility for AFDC benefits. DHS applied the lump-sum rule, codified at 42 U.S.C.A. § 602(a)(17) (West 1991), which requires a family receiving AFDC benefits to use a lump-sum payment until exhausted in place of the family's monthly AFDC benefits. As a result, in October 1992, DHS concluded that appellant and her son had become ineligible for AFDC and Medicaid benefits for twelve months beginning November 1992 through October 1993.

In November 1992, the SSA notified appellant that she also qualified for benefits under the SSI program. Later in December 1992, she received an SSI lump-sum payment, representing benefits relating back to July 1992, the SSI application date. Appellant immediately notified DHS and requested it reconsider its decision to deny her son AFDC and Medicaid benefits. Appellant asserted that because she had been deemed eligible for and received SSI benefits relating back to July 1992, she was an SSI recipient when she received the SSDI lump sum in October. Therefore, she argued that under the exception in 42 U.S.C.A. § 602(a)(24), which excludes an SSI recipient's income from consideration in determining the family's AFDC eligibility, her SSDI lump-sum payment should not have been included as part of the family's available income, and her son should not have been found ineligible for AFDC and Medicaid benefits. DHS, however, upheld its decision to terminate benefits to appellant's son based on its policy regarding the application of section 602(a)(24). Under DHS's policy, which is based on the Secretary of the United States Department of Health and Human Services's (the Secretary) interpretation of section 602(a)(24) in a 1993 AFDC Action Transmittal, appellant did not become an SSI recipient until December 1992, when she actually received the SSI benefit check.

Both DHS and appellant agree that had she received the SSI check before the SSDI benefit check, her income and resources would have been excluded under section 602(a)(24) from the family's available income for AFDC eligibility purposes. As a result, appellant argues that DHS and the Secretary's interpretation of section 602(a)(24) is both unjust and leads to unreasonable results. Appellant asserts that the SSA's administrative processing delays caused the SSDI lump-sum payment to be calculated as part of the family's available income and resources, leaving her son ineligible for benefits.

Appellant challenged DHS's decision both administratively and by suit in the district court. On cross-motions for summary judgment, the district court, giving substantial deference to the Secretary's interpretation of section 602(a)(24), determined that appellant was not an SSI recipient in October 1992 when she received the SSDI lump-sum payment because she had neither been notified of her SSI eligibility nor received any SSI benefits. Therefore, the SSDI lump sum was appropriately included in the family income for purposes of determining AFDC eligibility. Appellant now challenges the district court's order affirming DHS's decision to terminate AFDC and Medicaid benefits to her son.

STANDARD OF REVIEW

Summary judgment is appropriate when there are no disputed issues of material fact and the moving party is entitled to judgment as a matter of law. See Utah R. Civ. P. 56(c). Because the parties agree the facts are undisputed, we examine only issues of law. We review the district court's conclusions of law for correctness, giving them no deference. See Harline v. Barker, 912 P.2d 433, 438 (Utah 1996). In addition, "we may affirm a grant of summary judgment on any ground available to the trial court, even if it is not one relied on below." Higgins v. Salt Lake County, 855 P.2d 231, 233 (Utah 1993).

ANALYSIS

AFDC/SSI/SSDI Benefits and the Lump-sum Rule

The AFDC program provides financial assistance to needy dependent children and their parents or relatives who live with and care for them. See 42 U.S.C.A. § 601 (West 1991); Shea v. Vialpando, 416 U.S. 251, 253, 94 S.Ct. 1746, 1750, 40 L.Ed.2d 120 (1974). The program's principal purpose is to help such parents and relatives "attain or retain capability for the maximum self-support and personal independence consistent with the maintenance of continuing parental care and protection." 42 U.S.C.A. § 601. In addition, children and their caretakers found eligible for AFDC benefits are automatically eligible for health care benefits under Medicaid. See 42 U.S.C.A. § 1396a(a)(10)(A) (West 1992).

The AFDC program " 'is based on a scheme of cooperative federalism,' " as it is jointly funded by federal and state governments on a matching fund basis. Shea, 416 U.S. at 253, 94 S.Ct. at 1750 (quoting King v. Smith, 392 U.S. 309, 316, 88 S.Ct. 2128, 2132-33, 20 L.Ed.2d 1118 (1968)). States participate in the program voluntarily, but in electing to do so are obligated to administer the program in accordance with federal statutes and regulations. See 42 U.S.C.A. § 602 (West 1991); Shea, 416 U.S. at 253, 94 S.Ct. at 1750. However, within these confines, states are given broad discretion in disbursing program resources, i.e., determining the standard of need and the level of benefits. See Lukhard v. Reed, 481 U.S. 368, 371, 107 S.Ct. 1807, 1810, 95 L.Ed.2d 328 (1987); cf. 15,844 Welfare Recipients v. King, 474 F.Supp. 1374, 1382 (D.Mass.1979) (recognizing states' strong interest in allocating limited welfare resources).

In addition, pursuant to the Social Security Act, the federal government provides benefits to disabled persons under two programs administered by the SSA. The SSI program, codified at 42 U.S.C.A. § 1381-83 (West 1991-1992), is a federally funded and federally administered program designed to assist low-income individuals who are aged, blind, and disabled. See id. § 1381(a) (West 1991); Sullivan v. Zebley, 493 U.S. 521, 524, 110 S.Ct. 885, 888, 107 L.Ed.2d 967 (1990); Pennsylvania v. United States, 752 F.2d 795, 797 (3d Cir.1984). After an individual applies for SSI benefits, the SSA, which administers the SSI program, generally takes a period of time to both determine the applicant's eligibility and then to begin making payments. See Moore v. Colautti, 483 F.Supp. 357, 362 (E.D.Pa.1979), aff'd, 633 F.2d 210 (3d Cir.1980). This period of time between the application date and the date the individual receives the first SSI payment is typically referred to as the "determination period." It is not unusual for the determination period to last six months or more. See id. However, once the individual is deemed to have met SSI requirements, the SSA considers the individual eligible for benefits as of the application date, see 42 U.S.C.A. § 1382(c)(6) (West 1992), ¹ and the individual receives a retroactive lump-sum payment for all benefits accrued during the determination period.

The SSDI program, codified at 42 U.S.C.A. § 401-33 (West 1991), is also federally funded and federally administered and provides disability benefits similar to the SSI program. Although both the SSI and SSDI programs share a common definition of disability, see 42 U.S.C.A. §§ 423(d)(1)(A) (West 1991), 1382c(a)(3)(A) (West 1992); 20 C.F.R. §§ 404.1505, 404.1520, 416.905, 416.920 (1996), SSDI benefits are provided through an insurance program and are only available to disabled persons who have the requisite work history and have contributed to the Social Security program. See 42 U.S.C.A. §§ 423(a)(1)(A), 423(a)(1)(D), 423(c)(1) (West 1991); Bowen v. Yuckert, 482 U.S. 137, 140, 107 S.Ct. 2287, 2290, 96 L.Ed.2d 119 (1987). SSI benefits, however, are available to any blind, disabled, or elderly individual, regardless of work history. Because the two programs are administered separately by the SSA, a recipient could be notified of and begin receiving payments under one program before he or she is notified of his or her eligibility for the other.

Because the AFDC program is based on financial need, all the family's available income ² and resources must be considered in determining whether the family is eligible for the program. Eligibility for the AFDC program is limited by the lump-sum rule, codified at 42 U.S.C.A. § 602(a)(17) (West 1991). This rule requires a family that receives a nonrecurring lump-sum payment ³ to apply the lump sum...