Turner v. Heckler, C-3-83-207.

CourtUnited States District Courts. 6th Circuit. United States District Courts. 6th Circuit. Southern District of Ohio
Citation573 F. Supp. 867
Docket NumberNo. C-3-83-207.,C-3-83-207.
PartiesLucinda TURNER, et al., Plaintiffs, v. Margaret M. HECKLER, Secretary of Health and Human Services, et al., Defendants.
Decision Date25 August 1983

Jeri Simmons, Dayton, Ohio, for plaintiffs.

Gerald F. Kaminski, Asst. U.S. Atty., Dayton, Ohio, Cory Crognale, Asst. Atty. Gen., Columbus, Ohio, David Smith, Asst. Pros. Atty., Springfield, Ohio, William H. Wolff, Asst. Pros. Atty., Dayton, Ohio, for defendants.


WALTER H. RICE, District Judge.

This case came on to be heard, on April 8, 1983, on Plaintiffs' motion for a preliminary injunction, which seeks to enjoin the enforcement of certain federal and state regulations implementing aspects of the Medicaid program, established under Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq. In response, the federal Defendants in the case have moved to dismiss or for summary judgment in their favor (Doc. # 12), and the State Defendants have filed a memorandum (Doc. # 21) in opposition to the motion for a preliminary injunction.

For the reasons outlined below, Plaintiffs' motion is sustained, and Defendants' motion for summary judgment is overruled in part, and not ruled upon in part. Further procedures are established to determine the scope of the preliminary relief due the Plaintiffs.

Recently, the Supreme Court summarized the scope and purposes of the Medicaid program.

The Medicaid program was established in 1965 in Title XIX of the Act "for the purpose of providing 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. Section 1902(a)(10) of the Act, 42 U.S.C. § 1396a(a)(1), sets forth the basic scope of the program, which has not changed significantly from its enactment in 1965. See 79 Stat. 345. Participating States are required to provide Medicaid coverage to certain individuals—now described as the "categorically needy"; at their option States also may provide coverage (and receive partial federal reimbursement) to other individuals—described as the "medically needy." See, Schweiker v. Gray Panthers, 453 U.S. 34, 37, 101 S.Ct. 2633, 2636, 69 L.Ed.2d 460. These classes are defined by reference to other federal assistance programs.

Schweiker v. Hogan, 457 U.S. 569, 571-72, 102 S.Ct. 2597, 2600-01, 73 L.Ed.2d 227 (1982) (footnote omitted). For purposes of this case, the "other federal assistance programs" are found in the Supplemental Security Income for the Aged, Blind, and Disabled (SSI) program, 42 U.S.C. § 1381 et seq., established in 1972.

While the SSI program is funded only by the federal government, "the expansion of general welfare accomplished by the SSI program increased Medicaid obligations for some states." Hogan, supra, 457 U.S. at 581-82 n. 18, 102 S.Ct. at 2604-05 n. 18. To encourage States to remain in the Medicaid program despite the higher costs, Congress enacted 42 U.S.C. § 1396a(f) ("§ 209(b) option"), which enabled states to "elect to provide Medicaid assistance only to those individuals who would have been eligible under the state Medicaid plan in effect on January 1, 1972." Id. Ohio is a "§ 209(b)" state. Ohio Rev.Code Ann. § 5111.02 (Page 1982).

The state regulation under attack herein is found at Ohio Adm.Code § 5101:1-39-22, which became effective on June 1, 1982. That regulation (hereinafter referred to as the "new" or "Ohio" regulation) concerns the treatment of an institutionalized Medicaid recipient's income, and provides that a certain amount may be deducted from that income to support the needs of a noninstitutionalized spouse or child. Under the regulation, some $222.00 may be set aside each month for a noninstitutionalized spouse.1 The federal regulation which governs the "maintenance needs" of a noninstitutionalized spouse is found at 42 C.F.R. § 435.733(b)-(c) (1982).

Plaintiffs are four married couples (each composed of an institutionalized husband receiving Medicaid payments and a noninstitutionalized wife). Defendants are Margaret M. Heckler, Secretary of the Department of Health and Human Services (HHS); the Department of HHS; John Cuddy, Director of the Ohio Department of Public Welfare (ODPW); the ODPW, Mary Harris, Director of the Montgomery County Welfare Department (MCWD); the MCWD, Ronald E. Rockwell, Director of the Clarke County Welfare Department (CCWD); and the CCWD.2

In their complaint, and in support of their motion for a preliminary injunction, Plaintiffs advance eight separate causes of action (or rationales supporting the motion) in asserting that the above-mentioned state and federal regulations are invalid. Their arguments are as follows:

(1) the regulations violate 42 U.S.C. § 1396a(a)(17)(c), in that same do not provide for a "reasonable evaluation" of available income and resources of the institutionalized spouse;
(2) the state regulation imposes a more restrictive eligibility standard than is permitted under 42 C.F.R. § 435.733(c) (1982) and 42 U.S.C. § 1396a(a)(17);
(3) the regulations, in determining the property of a spouse, create irrebuttable presumptions which violate the Due Process Clause of the Fifth Amendment to the Constitution;
(4) the regulations impermissibly invade and burden the constitutional "associational, privacy, and marital" rights of the plaintiffs;
(5) in promulgating the state regulation, Defendants violated 42 C.F.R. § 431.12(e) (1982), by failing to secure the participation of the State Medical Care Advisory Committee (MCAC);
(6) the failure to uniformly implement the state regulation throughout Ohio violated 42 U.S.C. § 1396a(a)(1) and 42 C.F.R. § 431.50(b) (1982);
(7) the Secretary of HHS made no actual comparison of the new state regulation to Ohio's Medicaid plan as it existed in 1972, as required by 42 U.S.C. § 1316(a)(1); and
(8) relief should be forthcoming under the Mandamus Act, 28 U.S.C. § 1361.

Jurisdiction of these causes of action is predicated on 5 U.S.C. §§ 702-704, 28 U.S.C. §§ 1331, 1343(3)-(4), and is not contested by the Defendants.

In conformity with Fed.R.Civ.P. 65(d), the Court sets out its findings of fact and conclusions of law.


Based upon the record, and upon evidence introduced at the April 8, 1983, hearing, the Court makes the following findings of fact.

1. Plaintiffs are four married couples, consisting of a husband institutionalized in a nursing care facility, and a noninstitutionalized wife. They are all over 50 years of age. (Complaint, ¶¶ 7-18, 23-26).

2. Under Ohio Adm.Code § 5101:1-39-22, the institutionalized spouses are permitted to contribute $222.00 toward their spouse's support for each month. The monthly expenses of the noninstitutionalized spouses were and are in excess, by at least $100.00 or more, of this amount. (Complaint, ¶¶ 1, 7-18, 23-26; Plaintiffs' affidavits attached to complaint; testimony of Dorothy Willoweit and Gladys Tharp).

3. The institutionalized spouses have relatively severe physical and/or mental impairments, and are expected to be confined to their respective institutions for the remainder of their lives. (Complaint, ¶¶ 7-18, 23-26; testimony of Dorothy Willoweit, Robert Beason, Gladys Tharp and James Lauricella).

4. At least one of the institutionalized Plaintiffs, Herbert Willoweit, is in default in payments to his institution. Others may default in the near future. This default is due, at least in part, to the unwillingness of the institutionalized Plaintiffs to adhere to limits on support for the noninstitutionalized spouse found in the new Ohio regulation. If such payments are not made up in two or three months, the nursing home administrator would have no choice but to eventually discharge the resident. (Testimony of James Lauricella and Robert Beason; Complaint, ¶ 1).

5. None of the institutionalized patients has been served with a notice of discharge, as required by Ohio Rev.Code Ann. § 3721.16 (Page 1982). (Testimony of James Lauricella and Robert Beason).

6. While officially promulgated in June of 1982, Ohio Adm.Code § 5101:1-39-22 was not implemented until early in 1983. (Testimony of Rose Ann Benson, James Lauricella and Robert Beason).

7. The Ohio regulation was not promulgated in a uniform manner throughout the state, in that the welfare departments of Montgomery, Greene and Lake counties informed recipients that the regulation would be implemented in June, July and August of 1982, respectively. (Complaint, ¶ 64; Doc. # 5, exs. C-J).

8. The Ohio regulation was not reviewed by the Ohio Medical Care Advisory Committee (MCAC) prior to promulgation. (Complaint, ¶¶ 61-62; exs. L-M attached to the complaint).

9. At the time that the Ohio regulation was approved by the Department of HHS, the Department of HHS did not have a written copy of Ohio's 1972 Medicaid plan and did not compare the Ohio regulation with the specific provisions of Ohio's 1972 written Medicaid plan. (Stipulation of the Plaintiffs and the federal Defendants, Doc. # 16).

10. In January of 1972, Ohio had three cash assistance programs which formed the basis for Medicaid eligibility for the aged, blind, and disabled in Ohio. These programs did not have "flat" cash payments but were based upon flexible standards which depended upon the particular needs of the individual recipients (using disregards, deductions, exclusions, and allowable expenses). (Testimony of Rose Ann Benson; Plaintiffs' Further Memorandum, Doc. # 17, ex. 1).

11. Should an injunction not issue in this case, the Plaintiffs will be injured in that: (1) some or all of the institutionalized spouses may eventually be evicted if their payments to the nursing home continue to be in arrears,...

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