Olson v. NormanOlson v. Norman
The Secretary of the United States Department of Health and Human Services (the Secretary) and the Commissioner of the Iowa Department of Human Services (the Commissioner) appeal from orders of the district court granting summary judgment and a permanent injunction to the plaintiff class.
In December 1984, before the challenged terminations of benefits, plaintiff Diane Olson lived with her four children in Coon Rapids, Iowa. Olson’s son, Jamie Jackson, received Social Security benefits on the account of his late father. Olson and her other three children received AFDC and Medicaid. Plaintiff Lorrie Greene was a sixteen year-old mother who lived with her one year-old daughter, Kira, and her legal guardians, Michael and Jacquolyn Wright, in Shenandoah, Iowa. The Wrights had unspecified resources; Greene and her daughter received AFDC and Medicaid. Plaintiff Jennifer Kay Bechen was an eighteen year-old mother who lived with her son, Jesse Sharkey, and her parents in Dubuque, Iowa. Bechen’s parents had unspecified resources; Bechen and her son received AFDC and Medicaid. In late 1984, the commissioner informed the plaintiffs that they and their children were no longer eligible for AFDC or Medicaid because changes in federal law required the inclusion of Jamie Jackson, the Wrights, and Bechen’s parents in plaintiffs’ respective filing units. Plaintiffs appealed and, after their appeals were dismissed, brought this action.
Plaintiffs Olson and Greene brought this action for declaratory and injunctive relief against the Commissioner; the court subsequently permitted Bechen to intervene as a plaintiff. On April 11, 1985, the district court issued a preliminary injunction, temporarily protecting the plaintiffs’ Medicaid eligibility. On May 7, 1985, the Commissioner filed a “third-party cross-complaint” against the Secretary. On March 14, 1986, after two amendments to the complaint, the district court granted class certification and entered judgment in favor of the plaintiff class. On June 11, 1986, after considering various motions, the court amended the class definition and entered final judgment. The court also held that the plaintiffs had prevailed against the Commissioner and that both plaintiffs and the Commissioner had prevailed against the Secretary. Finally, on January 22, 1987, the court entered a final order directing the Secretary to pay costs and attorneys’ fees to the other parties.
II.
Title XIX of the Social Security Act establishes a cooperative state-federal program, commonly known as Medicaid, which provides medical assistance to needy persons “whose income and resources are insufficient to meet the costs of necessary medical services.”
Central to the instant dispute is the requirement that participating states provide Medicaid benefits to “categorically needy” individuals.
A state participating in Medicaid must develop a state plan consistent with the requirements of
include reasonable standards ... for determining eligibility for and the extent of medical assistance under the plan which
(B) 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 ...
(D) do not take into account the financial responsibility of any individual for any applicant or recipient or assistance under the plan unless such applicant or recipient is such individual’s spouse or such individual’s child who is under age 21 or ..., is blind or permanently and totally disabled,____
“[S]ubsection (17)(B) delegates to the Secretary broad authority to prescribe standards setting eligibility requirements for state medicaid plans.” Herweg v. Ray,
Until 1984, the named plaintiffs in this action were all AFDC recipients categorically entitled to Medicaid benefits under
In 1984, however, Congress limited the ability of families to control the composition of the filing unit. The Deficit Reduction Act of 1984, P. Law No. 98-369, 98 Stat. 1145 (DEFRA), amended numerous federal laws, including both the AFDC statute and the Medicaid statute.
(A) any parent of such child, and
(B) any brother or sister of such child, if such brother or sister meets the conditions [for a “dependent child”] described in clauses (1) and (2) of section 606(a) of this title or in section 607(a) of this title (if such section is applicable to the State), if such parent, brother, or sister is living in the same home as the dependent child, and any income available for such parent, brother, or sister shall be included in making such determination and applying such paragraph with respect to the family....
The Secretary read
III.
A. Standard of Review
The parties dispute the appropriate standard for judicial review of the challenged actions. The trial court found its “task ... limited to ensuring that the Secretary did not exceed his statutory authority and that the regulation was not arbitrary or capricious.” Olson,
B. Siblings
Subsection (17)(D) is quite clear: the determination of Medicaid eligibility may take into account the financial responsibility of the applicant’s spouse and of the minor applicant’s parents; it may not take into account the financial responsibility of others such as siblings and grandparents. The Secretary may deem the income of a spouse or a minor applicant’s parents available to that applicant; he may not deem the income of siblings or grandparents available to the applicant. The Secretary concedes this, but contends that the termination of the Olson family’s benefits was
The Secretary’s threshold argument is that subsection (17)(D) was never intended to prohibit consideration of sibling income. This argument borders on the frivolous. The Secretary stresses the Congressional intent to relieve the burden some states placed on the adult children of elderly parents. See, e.g., Ill Cong.Rec. 16149 (1965) (Sen. Saltonstall) (amendment adding subsection (17)(D) “removes the financial responsibility of children of the aged for meeting their parents’ medical expenses before [medical assistance to the elderly] can become operative.”) It is clear, however, that Congress was concerned about the burdens that might be placed on other family members:
Your committee believes it is proper to expect spouses to support each other and parents to be held accountable for the support of their minor children and their blind or permanently and totally disabled children even though 21 years of age or older. Such requirements for support may reasonably include the payment by such relative, if able, for medical care. Beyond such degree of relationship, however, requirements imposed are often destructive and harmful to the relationships among members of the family group. Thus, States may not include in their plan provisions for requiring contributions from relatives other than a spouse or the parent of a minor child or children over 21 who are blind or permanently and totally disabled. Any contributions actually made by relatives or friends, or from other sources, will be taken into account by the State in determining whether the individual applying for medical assistance is, in fact, in need of such assistance.
H.Rep. No. 213, 89th Cong., 1st Sess. 68 (1965) (emphasis added). The legislative history is wholly consistent with the clear language of subsection (17)(D). The Secretary cannot now rewrite the statute to deny Medicaid benefits to applicants whose siblings have their own resources.
The Secretary next argues that consideration of sibling income is not “deeming” prohibited by subsection (17)(D). Rather, it is merely the inclusion of income of all members of the filing unit, as required by
The instant dispute has nothing to do with those who voluntarily include otherwise excludable persons in their filing units. The issue here is whether the Secretary can deny Medicaid benefits to children based on the income of siblings who are involuntarily included in the filing unit. We find that he cannot. The Secretary’s assertion that
The Secretary’s related suggestion that sibling income is “actually available” con
Finally, the Secretary contends that the legislative history of DEFRA indicates that Congress intended the amendments to
We join the other courts that have unanimously rejected the Secretary’s efforts to rewrite or ignore the clear language of the statute and regulations. See Vance v. Hegstrom,
It is uncontested that, in enacting DEFRA, Congress sought to reduce spending, but it is not clear that it intended to do so by excluding plaintiffs and similarly situated persons from Medicaid eligibility. Although DEFRA amended some sections of the Medicaid statute, DEFRA § 2640 refers only to AFDC. The legislative history indicates that members of the administration and perhaps some Congressional staff members generally anticipated that changes in AFDC would provide Medicaid savings. However, these statements are insufficient to support the Secretary’s case. The cited statements speak very generally about Medicaid savings; they do not specif
C. Grandparents
Under subsection (17)(D), the Secretary may deem the income of a minor applicant’s parents available to that Medicaid applicant, even if the minor has children of his or her own. It is not clear from the record whether plaintiffs ever disputed this, but they now concede that plaintiff Bechen, and others like her, were permissibly removed from the Medicaid rolls:
The parties’ remaining dispute has thus narrowed to a question about precisely how the Secretary may assess the needs and resources of Medicaid applicants whose parents are minors. Disposition of this issue requires some understanding of the technical procedure for determining AFDC and Medicaid eligibility.
To determine whether applicants are eligible for AFDC, the state agency compares their incomes and resources, less certain reserves, allowances, and disregards, with a state “need standard.” 45 C.F.R. 233.-20(a)(3)(ii). The need standard is based on the number of persons in a family filing unit, and assumes economies of scale. Thus, in Iowa, a single person filing unit has a need standard of $213 per month, while a two person filing unit has a need standard of $421 per month, or $210.50 per person. A three person filing unit has a need standard of $497, or only $165.67 per person. The per capita need standard continues to decrease as the filing unit size increases.
A state need not provide this full need standard, but may make a “ratable reduction” consistent with
The Secretary contends that minor parents and their children should be considered a single filing unit. Thus, a hypothetical teenaged mother and her two children would qualify for no more than $381 in AFDC payments. To the extent that the minor mother’s own parents have sufficient resources to support her, this sum could be reduced by up to $163, or the maximum AFDC payment for a single-person filing unit. Thus the children would be independently entitled to no more than $218. If the minor mother had additional resources of her own, this $218 could be reduced accordingly. Thus, if she earned $250 per month, her children would not be eligible for AFDC or for Medicaid under the Secretary’s approach.
The plaintiffs contend that the Secretary’s scheme violates subsection (17)(D) by taking into account the financial responsibility of the applicants’ grandparents. They assert that, at least for Medicaid purposes, the Secretary must characterize the minor’s children as a separate filing unit. Thus the two child filing unit in our hypothetical is entitled to $322 per month in AFDC benefits; their mother’s own income of $250 reduces this, but still leaves them eligible for Medicaid.
The court must agree with the plaintiffs. The children’s eligibility turns on whether their grandparents’ resources are taken into account as income available to their family unit. The Secretary’s description of his procedure clearly “take[s] into account the financial responsibility” of the children’s grandparents, albeit indirectly. This “double-deeming” violates subsection (17)(D). Cf. Malloy v. Eichler,
IV.
The district court awarded plaintiffs costs and attorneys’ fees against both the Commissioner and the Secretary, and awarded the Commissioner costs and attorneys’ fees against the Secretary. The Commissioner does not appeal from the order of attorneys’ fees against her, but the Secretary appeals from the awards against him.
The court awarded fees to the plaintiffs pursuant to two alternate subsections of
Federal officials who violate federal rights protected by
The record here does not support a finding that there was a conspiracy to violate plaintiffs’ rights. The intergovernmental nature of a joint state-federal program does not by itself make out a conspiracy. There are no findings of special pressures brought to bear by federal actors here, cf. Savage v. Toan,
Under
shall, within thirty days of final judgment in the action, submit to the court an application for fees and other expenses which shows that the party is a prevailing party and is eligible to receive an award under this subsection, and the amount sought, including an itemized statement____ The party shall also allege that the position of the United States was not substantially justified. Whether or not the position of the United States was substantially justified shall be determined on the basis of the record (including the record with respect to the action or failure to act by the agency upon which the civil action is based) which is made in the civil action for which fees and other expenses are sought.
The requirement that plaintiff submit an application within thirty days of final judgment is “a mandatory, jurisdictional condition.” Monark Boat Co. v. NLRB,
The trial court found the plaintiffs entitled to attorneys' fees without waiting for a formal fees application and without specifying which of the other parties would be obligated to pay the fees. The court directed plaintiffs to file a statement of
The trial court also found the Secretary liable under
Waivers of sovereign immunity must be strictly construed. E.g., United States v. Mitchell,
The parties agree that the scope of the
“Under present law in the United States, each party is responsible for the payment of his own attorney fees and other expenses incurred during litigation. The ‘American rule,’ however, has both common law and statutory exceptions.” H.R. Rep. No. 96-1418, at 8, U.S.Code Cong. & Admin.News 1980, at 4986. The Committee went on to identify the “two well-recognized [common law] exceptions to the American rule,” and to note that “Congress has authorized the recovery fees in a variety of contexts, usually to effectuate a specific and compelling public interest.” H.R. Rep. No. 96-1418, at 8, U.S.Code Cong. & Admin.News 1980, at 4986. The laws cited as exceptions are all federal: both common law and statutes. Id. Indeed, the committee specifically noted that the federal government would “be liable under the same standards which govern awards against other parties under Federal statutory exceptions.” H.R.Rep. No. 96-1418, at 17, U.S.Code Cong. & Admin.News 1980, at 4996 (emphasis added).
We do not read
V.
The judgment on the merits in No. 86-2027/2079 is affirmed. The award of attorneys’ fees in No. 87-1176 is reversed and
Notes
. The two appeals have been consolidated. The Secretary's appeal was docketed as No. 86-2027, and the Commissioner’s was docketed as No. 86-2079. The Commissioner did not file a brief in support of her appeal and, at oral argument, stated that she had appealed only to ensure a consistent result.
. Under Title XIX of the Social Security Act,
. The Commissioner does not appeal from an order directing her to pay attorneys' fees to the plaintiffs.
. States may also choose to provide medicaid to the "medically needy” whose resources and income are too large to permit categorical assistanee but who lack the ability to pay medical expenses.
. DEFRA is a lengthy piece of legislation; it fills over 700 pages of the statutes at large.
. See Bowen v. Gilliard, —U.S.-,
. This section specifically restricts deeming income to Medicaid applicants. See supra at pp. 815.
. The Secretary has changed his position on the plaintiffs’ Medicaid eligibility in the course of this litigation. In the district court, he asserted that the termination of plaintiffs' benefits was consistent with federal law. See Answer of Third Party Defendant (Record (R.) 83, 84) (admitting that the Commissioner and Iowa Department of Human Services were “acting in a manner consistent with the directives of the [Secretary] in denying medical assistance to the named plaintiffs and putative class members in this action.”) He now concedes that Greene’s benefits should not have been terminated. He also suggests that Bechen’s situation is more complex than originally recognized.
. The Secretary does not defend the termination of the Greene family’s benefits or those of Bechen’s son. The plaintiffs concede that the termination of Bechen's own benefits was consistent with the statute.
. The trial court’s injunction prohibits the Secretary and Commissioner from terminating or denying Medicaid benefits "to persons who have lost their eligibility for Aid to Families With Dependent children due to consideration of sibling or nonparental caretaker income.” Olson, At 283 (1986). It is undisputed in this case that the same analysis applies to both terminations and denials.
. The Secretary concedes that at the time of the amendment, siblings with independent resources could be excluded from determinations of Medicaid eligibility.
. The Secretary’s position is also inconsistent with his own binding regulations, see
. “[W]hen Ms. Bechen was cancelled from AFDC benefits her own Medicaid benefits were also properly cancelled because both the AFDC and Medicaid programs allow for consideration of parental income to a child under the age of 21." Brief of Plaintiffs-Appellees at 32.
. The Secretary’s position has not always been clear. The Commissioner understood the Secretary’s instructions to require “a minor mother and her children to be treated as on eligibility unit for both A[F]DC and Medicaid purposes. If the minor mother lives with her parents, the income of the parents must be considered as available to the assistance unit composed of the minor mother and her children.” Commissioner’s Response to Plaintiffs Motion for Summary Judgment at 4 (R. 354). The Commissioner . therefore terminated Jesse Sharkey and others in the same situation from the Medicaid program. In his answer, the Secretary admitted that the Commissioner acted consistently with his requirements. Answer (R. 83, 84). His current position to the contrary was first clearly stated in his reply brief on appeal.
. Although the Secretary has conceded that the deeming of a grandparent’s income violates subsection (17)(D), he continues to argue that the deeming of a sibling’s income is not contrary to that provision. His basis for the distinction is not clear.
. The Secretary does not expressly concede Jesse Sharkey’s case, but this conclusion follows from the Secretary's more generally described position.
. Judge Friendly observed that the Byzantine construction of the Social Security Act makes it “almost unintelligible to the uninitiated,” Friedman v. Berger,
. It appears that the Iowa payments standards have increased since late 1984, when the Commissioner attempted to terminate plaintiffs’ benefits. For example, it appears that the single member filing unit payment has increased from 1154 to $163, and the four member filing unit payment has been increased from $419 to $443.
. The trial court awarded costs pursuant to
. Plaintiffs are essentially nominal parties in the fees appeal. Since they are entitled to recover against the Commissioner, and the award against the Secretary makes no real difference to them. The Commissioner, of course, would prefer to share liability for plaintiffs’ attorneys’ fees with the Secretary. Thus it is the Commissioner who has most vigorously defended both awards against the Secretary.
. Although the Commissioner styled her pleading as a "Third-Party Cross-Complaint,” the parties agree that the Secretary has been treated as a defendant in this litigation.
. The Secretary notes that the Commissioner may be entitled to some reimbursement for his defense of this action under