Ross v. Giardi

• Decision Date: 02 July 1996
• Docket Number: No. 15342,15342
• Citation: 237 Conn. 550,680 A.2d 113
• Court: Connecticut Supreme Court
• Parties: , 51 Soc.Sec.Rep.Ser. 658, Medicare & Medicaid Guide P 44,695 Mina ROSS, Administratrix (Estate of Mary Guttman) v. Patricia A. GIARDI, Acting Commissioner of Social Services.

Page 113

680 A.2d 113

237 Conn. 550, 51 Soc.Sec.Rep.Ser. 658,

Medicare & Medicaid Guide P 44,695

Mina ROSS, Administratrix (Estate of Mary Guttman) v. Patricia A. GIARDI, Acting Commissioner of Social Services.

No. 15342.

Supreme Court of Connecticut.

Argued March 22, 1996.

Decided July 2, 1996.

Hugh Barber, Assistant Attorney General, with whom, on the brief, were Richard Blumenthal, Attorney General, and Richard J. Lynch, Assistant Attorney General, for appellant (defendant).

Lea Nordlicht Shedd, Hamden, for appellee (plaintiff).

Before BORDEN, BERDON, NORCOTT, KATZ and PALMER, JJ.

BORDEN, Associate Justice.

The dispositive issue in this administrative appeal is whether the department of social services is required to grant retroactive medicaid benefits to the plaintiff for medical expenses incurred while her resources exceeded the statutory limit if, during the months for which retroactive benefits are sought, her incurred medical expenses exceeded her excess resources. The defendant, Patricia A. Giardi, acting commissioner of the department of social services (department), appeals from the judgment of the trial court, which reversed the decision of the fair hearing officer of the department. The hearing officer had concluded that the plaintiff, Mary Guttman, ¹ was not entitled to medicaid benefits for medical expenses incurred during months in which her resources exceeded the standards established by the state. The trial court reversed the decision of the hearing officer, in reliance upon the decision of this court in Matarazzo v. Rowe, 225 Conn. 314, 326-27, 623 A.2d 470 (1993), in which we held that if the state's medicaid plan in effect on January 1, 1972 (1972 plan), provided for "resource spend down," the state is required to continue to apply that methodology in its medicaid eligibility determinations. We reverse the judgment of the trial court.

The following facts are undisputed. In September, 1993, the plaintiff applied to the department for medicaid benefits. She sought financial assistance for medical expenses incurred while she was a nursing home resident. At the time of the plaintiff's application, she possessed resources in excess of the state's limit of $1600. See General Statutes §§ 17b-80 and 17b-264. By the end of September, the plaintiff had applied the excess resources to her incurred medical expenses. The defendant granted benefits to the plaintiff commencing September, 1993. The defendant denied retroactive eligibility for the three months prior to September, 1993, ² however, because the plaintiff's resources during those months exceeded the applicable limit. ³

The plaintiff contested the defendant's denial of retroactive eligibility in an administrative hearing. The plaintiff argued that the state's 1972 plan required the use of a "resource spend down" methodology, which would allow an applicant whose incurred medical expenses exceeded her excess resources to establish retroactive eligibility for benefits by spending excess resources down to the applicable limit. Consequently, the plaintiff argued, this court's decision in Matarazzo required the defendant to continue to employ that methodology and, specifically, to apply it to the plaintiff's application for benefits. As a result, the plaintiff argued, she should be granted retroactive benefits because she had applied her excess resources to her outstanding medical expenses as permitted by resource spend down.

The fair hearing officer upheld the denial of retroactive benefits. The plaintiff appealed to the Superior Court pursuant to the Uniform Administrative Procedure Act, General Statutes § 4-166 et seq. The trial court reversed the decision of the hearing officer, holding that this court's decision in Matarazzo required the defendant to award retroactive benefits if application of resource spend down would render the plaintiff eligible. The trial court remanded the case to the hearing officer for factfinding concerning the amount of the medical expenses incurred in the three months prior to the application for benefits. The defendant appealed from the judgment of the trial court to the Appellate Court, and we transferred the appeal to this court pursuant to Practice Book § 4023 and General Statutes § 51-199(c).

I

The plaintiff claims that the defendant improperly refused to apply resource spend down to her application for benefits and thereby improperly denied her medicaid benefits for the three months preceding her application. The plaintiff argues that federal law requires the defendant to apply resource spend down because that methodology was required by the state's 1972 plan. The plaintiff relies upon the decision of this court in Matarazzo v. Rowe, supra, 225 Conn. at 326-27, 623 A.2d 470, in which we held that the defendant is required to allow resource spend down if the 1972 plan required its application.

The defendant argues that we erroneously concluded in Matarazzo that federal law requires the defendant to continue to apply resource spend down if it was required by the 1972 plan. The defendant concedes that the 1972 plan did provide for some form of resource spend down, but argues that federal law does not require the defendant to continue to apply this methodology. The defendant asks this court to reconsider our contrary determination in Matarazzo.

To resolve the plaintiff's claim and the defendant's challenge to our prior decision, we are required to wade once again into the virtually impenetrable "Serbonian bog" of federal and state laws governing the medicaid system. ⁴ Id., at 318 and n. 3, 623 A.2d 470.

A

"Stare decisis gives stability and continuity to our case law. This court, however, has recognized many times that there are exceptions to the rule of stare decisis.... A court, when once convinced that it is in error, is not compelled to follow precedent.... If, however, stare decisis is to continue to serve the cause of stability and certainty in the law--a condition indispensable to any well-ordered system of jurisprudence--a court should not overrule its earlier decisions unless the most cogent reasons and inescapable logic require it.... This is especially true when the precedent involved concerns the interpretation or construction of a statute. (Citations omitted.) Herald Publishing Co. v. Bill, 142 Conn. 53, 62, 111 A.2d 4 (1955); see Kluttz v. Howard, 228 Conn. 401, 406, 636 A.2d 816 (1994); White v. Burns, 213 Conn. 307, 335-36, 567 A.2d 1195 (1990)." (Internal quotation marks omitted.) General Electric Employees Federal Credit Union v. Zakrzewski, 235 Conn. 741, 744, 670 A.2d 274 (1996). We now review Matarazzo and the federal medicaid statutory scheme to determine whether cogent reasons and inescapable logic require us to modify or reverse that decision, as urged by the defendant.

In Matarazzo, we provided the following review of the history of the medicaid program. "The medicaid program, established in 1965 as Title XIX of the Social Security Act, and codified at 42 U.S.C. § 1396 et seq., 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). Clark v. Commissioner of Income Maintenance, 209 Conn. 390, 394, 551 A.2d 729 (1988). Connecticut has elected to participate in the medicaid program and has assigned to the department the task of administering the program. General Statutes § 17-134a et seq.

"As originally enacted, [the] Medicaid [Act] required participating States to provide medical assistance to categorically needy individuals who received cash payments under one of four welfare programs established elsewhere in the Act.... The categorically needy were persons whom Congress considered especially deserving of public assistance because of family circumstances, age, or disability. States, if they wished, were permitted to offer assistance also to the medically needy--persons lacking the ability to pay for medical expenses, but with incomes [or resources] too large to qualify for categorical assistance. Schweiker v. Gray Panthers, 453 U.S. 34, 37, 101 S.Ct. 2633 [2636-37], 69 L.Ed.2d 460 (1981).

"Since its enactment, the Social Security Act has undergone substantial revisions. In 1972, Congress replaced three of the four categorical assistance programs with a new program called Supplemental Security Income for the Aged, Blind and Disabled (SSI), 42 U.S.C. § 1381 et seq.... Under SSI, the Federal Government displaced the States by assuming responsibility for both funding payments and setting standards of need. In some States the number of individuals eligible for SSI assistance was significantly larger than the number eligible under the earlier, state-run categorical need programs.

"The expansion of general welfare accomplished by SSI portended increased Medicaid obligations for some States because Congress retained the requirement that all recipients of categorical welfare assistance--now SSI--were entitled to Medicaid. Congress feared that these States would withdraw from the cooperative Medicaid program rather than expand their Medicaid coverage in a manner commensurate with the expansion of categorical assistance. [I]n order not to impose a substantial fiscal burden on these States or discourage them from participating ... Congress offered what has become known as the § 209(b) option. ⁵ Under [§ 209(b) ], States could elect to provide Medicaid assistance only to those individuals who would have been eligible under the state Medicaid plan in effect on ...