Bessie CURTIS, Plaintiff-Respondent, v. Bill CHILD, as 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.
Nos. 10861, 10862
Supreme Court of Idaho
Oct. 5, 1972
Rehearing Denied Nov. 3, 1972
501 P.2d 1374
Michael C. Moore, Lewiston, for respondents.
DONALDSON, Justice.
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
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,
The federal legislation also provides for assistance programs for persons who do not qualify as “categorically needy” but can, nonetheless, be deemed “medically needy.”
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
OPTIONAL NATURE OF THE MEDICALLY NEEDY CLASSIFICATION
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
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].”
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 (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:
“It is thus clear that coverage of the ‘medically needy’ is optional with the states. Colorado has not chosen to cover this group of people and the statute [
1396a ] does not demand that they do so. If there were such a plan, the plaintiffs’ argument that the cut-off point could only be established after medical expenses had been deducted from net income would have merit.” 320 F.Supp. at 505.
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) First, 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.”
CONSTRUCTION OF THE STATUTE
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
“56-209b. Medical assistance.—Medical assistance shall be awarded to persons who are recipients of old-age assistance, aid to dependent children, aid to the blind, aid to the permanently and totally disabled and to such other persons as may be defined under the authority of this act to be medically needy individuals.” (Emphasis added.)
The court then determined that one who requires nursing home care and cannot pay $255.00 per month, or whatever the reasonable minimum for such care might be, is a “medically needy” person within the purview of
To decide this issue, this Court must indulge in an exercise of statutory construction. Since there is no legislative history to give us insight into the Idaho legislature‘s collective minds, the literal, but logical, wording of the entire statutory scheme of medical assistance (
Appellant contends that the legislature did not intend to extend medical assistance to medically needy persons. In support of this contention appellant notes that when
“The term ‘medically needy’ refers to an individual whose income and resources equal or exceed the State‘s standards under the appropriate financial assistance plan but are insufficient to meet his costs for medical insurance premiums and for necessary medical and remedial care and services recognized under State law but not encompassed in the State plan for medical assistance, plus his costs for medical and remedial care and services included in the State plan.” 45 CFR 248.10(a) (2).
According to this definition, the respondents are “medically needy” individuals. One of the requirements of federal financial participation is that a state, in determining the financial eligibility of medically needy individuals, must use a “flexible measurement of available income,” as delineated in 45 CFR 248.21(a) (3) (ii) (set forth above). The DPA has failed to use such a flexible measurement in determining the financial eligibility of the respondents; the DPA has, therefore, failed to follow legislative direction and failed to meet one of the requirements of federal financial participation. The DPA has defined the eligibility conditions for medically needy individuals in such terms as do not meet the requirements for federal financial participation in medical assistance payments to medically needy individuals, contrary to the legislative intent expressed in
The applicable DPA regulations provide that nursing home services are available as medical assistance to individuals who would, upon application, be eligible for inclusion in one of the categorical programs (i.e., by being old, or disabled, or blind, or having dependent children) and whose income is less than $152.80. DPA Operating Policies and Procedures ¶¶ 3161(2) and 3162.1(h). When a flexible measurement of available income is added to the existing regulations, both of the respondents qualify for medical assistance because they are elderly with insufficient available income (after it is applied to maintenance and necessary medical services) to afford the costs of nursing home services included in the state plan. Therefore, after the respondents’ available income has been applied to the costs of nursing home services in an approved nursing home (i.e., one which charges no more than $255 per month), each of them is entitled to medical assistance in an amount equal to the difference between $255 and the amount of income
Because of our conclusion on the statutory interpretation question, it is unnecessary to reach the constitutional issue of whether the department‘s denial of medical assistance to the respondents denied them equal protection of the laws. In general, this Court will not pass on questions of constitutionality unless it is absolutely necessary to do so in order to determine the merits of the case. Swensen v. Buildings, Inc., 93 Idaho 466, 463 P.2d 932 (1970); Hill v. Schultz, 71 Idaho 145, 227 P.2d 586 (1951); Twin Falls Canal Co. v. Huff, 58 Idaho 587, 76 P.2d 923 (1938).
Judgments affirmed. Costs to respondents.
McQUADE, C. J., and COGSWELL, D. J., concur.
McFADDEN, Justice (dissenting).
It is my conclusion that the majority opinion erred in concluding
This Court on several occasions has considered the administrative interpretation given statutes as a guideline in arriving at what the legislature intended in enacting a particular statute. In Application of Idaho Hospital Ass‘n, 73 Idaho 320, 251 P.2d 538 (1952), this Court stated:
“Administrative interpretation over a period of years has, and is entitled to, great weight, United Pacific Ins. Co. v. Bakes, 57 Idaho 537, at page 545, 67 P. 2d 1024, and will be followed unless there are urgent or cogent reasons to the contrary. McCall v. Potlatch Forests, Inc., 69 Idaho 410, at page 413, 208 P.2d 799.” 73 Idaho at 324, 251 P.2d at 540.
More recently this Court stated in Messinger v. Burns, 86 Idaho 26, 382 P.2d 913 (1963):
“In construing a statute, it is the duty of this court to ascertain the legislative intent, and give effect thereto. In ascertaining this intent, not only must the literal wording of the statute be examined, but also account must be taken of other matters, ‘such as the context, the object in view, the evils to be remedied, the history of the times and of the legislation upon the same subject, public policy, contemporaneous construction, and the like,’ In re Gem State Academy Bakery, 70 Idaho 531, 541, 224 P.2d 529, 535.” 86 Idaho at 29-30, 382 P.2d at 915.
In Idaho Public Utilities Commission v. V-1 Oil Company, 90 Idaho 415, 412 P.2d 581 (1966), it is stated:
“A construction given a statute by executive or administrative officers of the state is entitled to great weight and will be followed by the court unless there are cogent reasons for holding otherwise. (Citing cases.)” 90 Idaho at 420, 412 P.2d at 583.
In this instance the Department of Public Assistance (now Department of Social and Rehabilitation Services, S.L.1972, Ch. 196, p. 483) has clearly demonstrated that since the 1966 amendment of
After enactment at the special legislative session the Department of Public Assistance adopted numerous rules and operating policies and procedures, including Section 3161, Manual of Operating Policies and Procedures. This particular section pertains to the matter of eligibility for medical assistance and limits the eligibility to
“(1) Recipients of money payments for Old Age Assistance, Aid to the Blind,
Aid to Dependent Children (including all children and adults included in the Aid to Dependent Children payment) and Aid to the Permanently and Totally Disabled; (7-1-66).
(2) Individuals, who upon application would be eligible for money payments under any of the above categories. * * * (9-15-69).
(3) Children under 21 in foster homes or private institutions for whom the Department is assuming financial responsibility in whole or in part (4-1-70).”
Section 3163.2, Manual of Operating Policies and Procedures, provides:
“The test of eligibility for Medical Assistance is the test of eligibility under one of the four assistance categories. * * *”
The foregoing quoted provisions from the department‘s Manual of Operating Policies and Procedures is a clear indication of the interpretation the department has made of
That the legislature itself has accepted the department‘s interpretation of
Further proof of the legislature‘s acceptance of the department‘s statutory inter-
“The following items are not included in the budget as presented but should be considered:
1. The following programs would be beneficial to the health and wellbeing of Idahoans:
a. Unemployment parent program under the Aid to Dependent Children program.
b. Medically needy program for all Idahoans.
c. General Assistance program. * * *”
The legislature in making the appropriation to the Department of Social and Rehabilitation Services, did not expand the department‘s request. S.L.1972, Ch. 363, p. 1069.
It is my conclusion that the majority opinion has failed to consider the legislative and departmental interpretation of the statute and is imposing upon the department demands beyond its fiscal capacity to fulfill, and further that the trial court was in error in its interpretation of
While the majority opinion by reason of its conclusion did not reach another issue presented by the appellant in this case, under my view that the trial court erred in its determination, I am obligated to consider it.
This additional issue is the contention by the appellant that the district court erred in its ruling that sections 3161 and 3150.1 of the department‘s regulations, arbitrarily, capriciously and unreasonably excluded from medical assistance persons who did not qualify under one of the four categories for public assistance. This same argument attacks the district court‘s ruling that the exclusion of medical needy who do not otherwise qualify for assistance is likewise arbitrary, capricious, unreasonable, and violative of
The Supreme Court of the United States in Dandridge v. Williams, 397 U.S. 471, 90 S.Ct. 1153, 25 L.Ed.2d 491 (1970), involving the question of whether a Maryland statute providing for aid to dependent children was unconstitutional in fixing a maximum amount to be paid to any family regardless of the number of children in the family, stated:
“In the area of economics and social welfare, a State does not violate the Equal Protection Clause merely because the classifications made by its laws are imperfect. If the classification has some ‘reasonable basis,’ it does not offend the Constitution simply because the classification ‘is not made with mathematical nicety or because in practice it results in some inequality.’ Lindsley v. Natural Carbonic Gas Co., 220 U.S. 61, 78, 31 S. Ct. 337, 340, 55 L.Ed. 369. ‘The problems of government are practical ones and may justify, if they do not require, rough accommodations—illogical, it may
be, and unscientific.’ Metropolis Theatre Co. v. City of Chicago, 228 U.S. 61, 69-70, 33 S.Ct. 441, 443, 57 L.Ed. 730. ‘A statutory discrimination will not be set aside if any state of facts reasonably may be conceived to justify it.’ McGowan v. Maryland, 366 U.S. 420, 426, 81 S.Ct. 1101, 1105, 6 L.Ed.2d 393.
To be sure, the cases cited, and many others enunciating this fundamental standard under the Equal Protection Clause, have in the main involved state regulation of business and industry. The administration of public welfare assistance, by contrast, involves the most basic economic needs of impoverished human beings. We recognize the dramatically real factual difference between the cited cases and this one, but we can find no basis for applying a different constitutional standard. See Snell v. Wyman, D.C., 281 F.Supp. 853, aff‘d, 393 U.S. 323, 89 S.Ct. 553, 21 L.Ed.2d 511. It is a standard that has consistently been applied to state legislation restricting the availability of employment opportunities. Goesaert v. Cleary, 335 U.S. 464, 69 S.Ct. 198, 93 L.Ed. 163; Kotch v. Board of River Port Pilot Com‘rs, 330 U.S. 552, 67 S.Ct. 910, 91 L. Ed. 1093. See also Flemming v. Nestor, 363 U.S. 603, 80 S.Ct. 1367, 4 L.Ed.2d 1435. And it is a standard that is true to the principle that the Fourteenth Amendment gives the federal courts no power to impose upon the States their views of what constitutes wise economic or social policy.” 396 U.S. 485-486, 90 S.Ct. 1161-1162.
See also, Jefferson v. Hackney, 406 U.S. 535, 92 S.Ct. 1724, 32 L.Ed.2d 285 (1972).
Respondents, however, take exception to reliance upon Dandridge v. Williams, supra, as authority that the department‘s rules are not constitutionally discriminatory. They claim the instant case is distinguishable from Dandridge on the basis that in Dandridge the case was dealing with a maximum limitation on aid to families with dependent children while in this case the question is whether the individual respondents are going to receive anything at all.
A similar contention to that of respondents was presented in the case of Fullington v. Shea, 320 F.Supp. 500 (D.C.1970), Rehearing Denied, 404 U.S. 963 (1971). In that case the opinion pointed to the following statement contained in McGowan v. Maryland, 366 U.S. 420 (1961),
“A statutory discrimination will not be set aside if any state of facts reasonably may be conceived to justify it.” 320 F.Supp. at 506.
and also the statement in Dandridge,
“* * * [I]t does not offend the Constitution simply because the classification ‘is not made with mathematical nicety or because in practice it results in some inequality.’ * * *.” 320 F.Supp. at 506.
The Court in Fullington v. Shea found a rational basis on which discrimination was acceptable, i.e. “superimposition” of a program whereby needy recipients would be selected by an income formula which accounts for necessary monthly medical expenses—a “spenddown” formula6—could conceivably create significant administrative difficulties and uncertainties and also could encourage excessive medical expenses and resultant waste, factors affecting the state‘s ever present need for preserving revenue. 320 F.Supp. at 506, 507.
What was said in Fullington v. Shea is applicable to the present case. At oral argument and in its brief, appellant alludes to the very complex problem facing the legislature when it considered the implementation of the Title XIX program of the Social Security Act in Idaho. It was pointed out that the cost of fully implementing it by bringing into its sphere of coverage persons other than those presently receiving payments under one of the
It is my conclusion that under Title XIX of the Social Security Act, it was optional with the states as to whether medical assistance would be furnished to other than those categories receiving public assistance; that the department rules and regulations were enacted pursuant to legislative authority and that the classification brought about by the application of such rules and regulations is founded upon a rational basis, and the state‘s decision not to exercise the option is constitutionally permissible.
In conclusion, it is appropriate to repeat the language of the Court in Fullington v. Shea, statements I deem applicable to the instant appeals:
“The plaintiffs have presented a case in which gross inequity is apparent, especially in the extreme cases used to demonstrate the problem presented to this Court, but this fact cannot serve as a basis for our overturning a program on constitutional grounds.” 320 F.Supp. at 507.
The judgments of the district court should be reversed and the causes remanded for the district court to enter judgments in conformity with this opinion.
SHEPARD, J., concurs.