Medicare&Medicaid Gu 35,478
Marjorie VANCE, on her own behalf and as Next Friend of
Linda Barteau, her minor child, and Susan Turner, on her own
behalf and as Next Friend of Shane Turner, her minor child,
and All Others Similarly Situated; Appellees,
v.
Leo HEGSTROM, Individually and in his Official Capacity as
Director of the Department of Human Resources of the State
of Oregon; and Keith Putman, Individually and in his
Official Capacity as Director of the Adult and Family
Services Division of Department of Human Resources of the
State of Oregon; and Otis R. Bowen,*
Individually and in his Official Capacity as Secretary of
the Department of Health and Human Services of the United
States of America; Appellants.
Nos. 85-4050, 85-4065.
United States Court of Appeals,
Ninth Circuit.
Argued and Submitted May 8, 1986.
Decided July 1, 1986.
As corrected July 2, 1986.
Roger A. Schwartz, National Health Law Review, Washington, D.C., for appellees.
Philip Schradle, Salem, Or., for Hegstrom.
William J. McIntyre, Seattle, Wash., for Heckler.
Appeal from the United States District Court for the District of Oregon.
Before ALARCON, REINHARDT and THOMPSON, Circuit Judges.
THOMPSON, Circuit Judge:
State appellants Hegstrom and Putnam (No. 85-4050) and federal appellant Secretary of Health and Human Services Bowen (No. 85-4065) appeal the district court's order granting summary judgment in favor of appellees.
* FACTS
This case involves an interpretation of Title XIX of the Social Security Act, as amended, 42 U.S.C. Sec. 1396 et seq. (Medicaid) and its relation to Title IV-A of the Social Security Act, as amended, 42 U.S.C. Sec. 601 et seq. Title IV-A is more commonly known as Aid to Families with Dependent Children (AFDC). Both programs are cooperative federal-state efforts that enable states to provide assistance to needy families and individuals. See Lynch v. Rank,
1. Medicaid
States electing to provide Medicaid benefits must cover "categorically needy" individuals. Cubanski,
Standards for determining Medicaid eligibility are set forth in 42 U.S.C. Sec. 1396a(a)(17). Schweiker v. Hogan,
[I]nclude 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 of 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, ...
42 U.S.C. Sec. 1396a(a)(17).
Subsection (17)(B) grants the Secretary broad powers to set standards to determine what income is available to a Medicaid recipient. Herweg v. Ray,
2. AFDC
Aid to Families with Dependent Children was enacted to "encourag[e] the care of dependent children in their own homes or in the homes of relatives...." 42 U.S.C. Sec. 601. Medberry v. Hegstrom,
The Secretary's regulations require that states provide Medicaid to individuals receiving AFDC. 42 C.F.R. Sec. 435.110(a). For purposes of section 435.110, "an individual is reсeiving AFDC if his needs are included in determining the amount of the AFDC payment" to be received by a family with dependent children. 42 C.F.R. Sec. 435.110(b). To qualify for AFDC benefits, individuals must meet certain standards of financial need, as defined by their income and resources. 42 U.S.C. Sec. 602(a).
Applicants for AFDC are called family filing units. Prior to 1984, a family applying for AFDC benefits could exclude from the filing unit those family members whose income and/or resources, if counted in the overall family income and resources, would makе the family ineligible for AFDC benefits. For example, prior to 1984, if one child in a family received $300 per month in social security benefits, that child and his income could have been excluded from the family filing unit, thus enabling the remainder of the family to qualify for and receive AFDC benefits.
This procedure changed in 1984 when Congress passed the Deficit Reduction Act of 1984, P.Law No. 98-369, 98 Stat. 1145 (DEFRA). Section 2640(a) of the Act, codified at 42 U.S.C. Sec. 602(a)(38), no longer allows an applicant for AFDC to exclude children from thе filing unit. Specifically, in determining the eligibility of a dependent child for AFDC benefits a state must include:
(A) any parent of such child, and
(B) any brother or sister of such child, ... if such parent, brother, or sister is living in the same home as the dependent child, and any income of or available for such parent, brother, or sister shall be included in making such determination and applying such paragraph with respect to the family ...;
42 U.S.C. Sec. 602(a)(38).
Thus, siblings who were previously excluded from the family filing unit are now members of the unit and their income is considered availаble to all members of the filing unit.
Appellees Marjorie Vance and Susan Turner are two mothers who, with their children, received AFDC and Medicaid benefits prior to 1984.2 Each had one child who was excluded from the AFDC and Medicaid filing units prior to 1984 because they received social security benefits. Following the enactment of DEFRA, those children were made members of the family filing unit. The social security benefits received by those children made their families ineligible for AFDC benefits and consequently those benefits were terminated by Oregon. In addition to the termination of these AFDC benefits, which is not at issue in this case, Oregon also terminated appellees' Medicaid benefits. It was Oregon's position that because Medicaid eligibility of families and children not receiving AFDC is determined by the financial eligibility requirements of the states' AFDC plan, 42 C.F.R. Sec. 435.711, when a family became ineligible for AFDC because of the sibling income provisions of DEFRA,3 the family was also ineligible for Medicaid.
In response to an inquiry from the state, the Health Cаre Financing Administration (HCFA) of the Department of Health and Human Services informed Oregon that this position fully complied with the Medicaid statutes and regulations. HCFA administers the Medicaid program at the federal level and is responsible for assuring that states operate their programs in accordance with their approved plans and in compliance with all applicable requirements. HCFA also assured Oregon that its position did not conflict with 42 C.F.R. Sec. 435.602(a)4 because each sibling was now a member of the filing unit receiving assistance and thus the state was not deeming income. HCFA further informed Oregon that it could lose matching federal Medicaid funds if it provided Medicaid to a family ineligible for AFDC because of the sibling income provisions of DEFRA.
When Oregon terminated the appellees' Medicaid benefits appellees filed the present action. They claimed that the termination of their Medicaid benefits violated Medicaid statutes prohibiting deeming of sibling income. The district court granted appellees' motion for summary judgment and enjoined Oregon "from enforcing any rule or policy that includes as income for purposes of determining Medicaid eligibility, income of an individual, other than applicants or recipients, who is not the parent of a child that is under twenty-one, blind or disabled, or a spouse." The district court expressly adopted the reasoning of Olson v. Reagen, No. 85-101-A (S.D.Iowa Apr. 11, 1985) and Gibson v. Puett, No. 83-84-1232 (M.D.Tenn. Dec. 5, 1984) both оf which held that subsection (17)(D) and the Secretary's regulations precluded inclusion of sibling income for purposes of determining Medicaid eligibility.5
II
DISCUSSION
A. Standard of Review
We review the district court's order granting summary judgment de novo. Regents of the University of California v. Heckler,
1. The Directive
Appellee's Medicaid benefits were terminated because of a directive issued to the states by the Secretary. The parties disagree as to thе amount of deference we are to accord the directive because it was not a regulation promulgated under the Administrative Procedure Act (APA, 5 U.S.C. Sec. 551, et seq.)
The directive is a rule within the meaning of 5 U.S.C. Sec. 551(4). K. Davis, Administrative Law Treatise Sec. 7:7 at 171 (Supp.1982) ("agency's statement that asserts or changes the agency's law by affecting rights or obligations is a rule"). An agency's rule that is legislative will be given the force and effect of law by a reviewing court. Batterton v. Francis,
Substantive rules create law. They "usually implement existing law, imposing general, extrastatutory obligations pursuant to authority properly delegated by Congress." Southern California Edison Co. v. Federal Energy Regulatory Commission,
Interpretive rules clarify and explain existing law or regulations. Southern Cаlifornia Edison Co.,
We recognize that not all agency pronouncements "can be considered regulations enforceable in federal court." Cubanski,
Our conclusion that the Secretary's directive is a substantive rule entitled to the force and effeсt of law limits our review to "determining whether the Secretary has exceeded his statutory authority or whether the regulation is arbitrary and capricious." Herweg,
2. Statutory Construction
In cases involving statutory construction, we begin with the language employed by Congress. American Tobacco Co. v. Patterson,
B. Merits
Appellants contend the Secretary's definition of a Medicaid filing unit, which includes siblings and their income, is a proper exercise of his authority under subsection (17)(B). They argue that the Secretary has not "deemed" income to a filing unit in violation of subsection (17)(D) and the relevant regulations. Rather, he has exercised his authority under subsection (17)(B) to determine what income is available to a filing unit by defining the filing unit, which under DEFRA and 42 C.F.R. Sec. 435.711 must include siblings. The Secretary distinguishes his definition of a filing unit from deeming of income by arguing that deeming cases involve attribution of income to the Medicaid applicant in the filing unit from someone outside the unit, whereas here it is the income of individuals within the filing unit that is being included in the total income of the family unit. Thus, according to the Secretary, subsection (17)(D) would be relevant only after the filing unit was defined; it would not be relevant to the definition of the filing unit.
Although the Secretary has been granted broad authority under subsection (17)(B) to prescribe standards setting eligibility requirements for state Medicaid plans, Herweg,
The Secretary relies heavily on the legislative history of subsection (17)(D) and DEFRA to support his interpretation of subsection (17)(B). However, "where the language of a statute is unambiguous, it is cоnclusive as to its meaning '[a]bsent a clearly expressed legislative intention to the contrary.' " Lynch,
The Secretary attempts to avoid the plаin language of subsection (17)(D) by arguing that Congress clearly expressed an intent that the subsection apply only to relatives outside the nuclear family household and that it fully intended for the nuclear family to remain responsible for a Medicaid applicant. However, the legislative history relied on by the Secretary does not support such a conclusion. The term "nuclear family" does not appear in the legislative history. The legislative history refers only to a spouse, or the parent of a minor child, or the parent of children over twenty-one who are blind or permanently and totally disabled. See, e.g., S.Rep. No. 404, 89th Cong., 1st Sess. 78, reprinted in 1965 U.S.Code Cong. & Ad.News 1943, 2018; H.Rep. No. 213, 89th Cong. 1st Sess. 1, 68 (1965). Moreover, the Secretary's own regulations do not include the term "nuclear family." Title 42 C.F.R. Sec. 435.602, entitled "Limitation on the financial responsibility of relatives," refers only to the spouse of an individual or a parent of a child who is under twenty-one or blind or disabled.
The Secretary also contends that his definition of a Medicaid filing unit is consistent with Congress's reason for passing DEFRA, which was to reduce spending in light of a huge federal deficit. See, e.g., 130 Cong.Rec. S4097-98 (daily ed. Apr. 9, 1984) (statement of Senator Dole). The Secretary relies on statements made by members of Congress, and statements made in Congressional staff reports, that changes in the AFDC filing unit would result in decreases in the number of children receiving Medicaid, thus suggesting Congress recognized a change in the AFDC filing unit would also affect Medicaid eligibility. See e.g., id. at S.4099 (statement of Senator Dole); Senate Committee on Finance, 98th Cong., 2d Sess., Deficit Reduction Act of 1984, Explanation of Provisions Approved by the Committee on March 21, 1984, at 980, 1006-110 (Comm. Print 1984); Staff of Senate Committee on Finance, 98th Cong., 2d Sess., Data and Materials for the Fiscal Year 1985 Finance Committee Report Under the Congressional Budget Act 61 (Comm.Print 1984); Staff of Senate Committee on Finance, 98th Cong. 1st Sess., Data and Materials for the Fiscal Year 1984 Finance Committee Report Under the Congressional Budget Act 76 (Comm.Print 1983); Staff of House Committee on Ways and Means, 97th Cong., 2d Sess., Description of the Administration's Legislative Recommendations under the Jurisdiction of the Committee on Ways and Means 33 (Comm.Print 1982). It does not follow, however, that Congress intended to deny persons such as appellees Medicaid benefits when it enacted the AFDC amendments. The only express statements referring to the impact of the AFDC amendments on Medicaid are contained in reports prepared by staff personnel of members of Congress. These reports merely reflect the administration's view that changes in AFDC would also affect Medicaid eligibility. They are not statements of what Congress intended when it passed DEFRA. The statute finally enacted by Congress which required states to include sibling income when determining AFDC eligibility is directed solely to the provisions of 42 U.S.C. Sec. 602, which is a component of the AFDC statute, and not to subsection (17)(D). We must assume that Congress was aware of subsection (17)(D) when it enacted the AFDC amendments, could have amended subsection (17)(D), and chose not to do so. See Cannon v. University of Chicago,
The Secretary's own regulations are also significant and he may not disregard them when interpreting section 602 and subsections (17)(B) and (D). Flores v. Bowen,
Finally, we note that the Secretary's current position appears to be directly opposite to that taken in an analogous situation in early 1984. At that time, a recent amendment to AFDC allowed the deeming of stepparent income in determining AFDC eligibility. See 42 U.S.C. Sec. 602(a)(31). However, the Secretary concluded that states were prohibited by 42 C.F.R. Sec. 435.113 from considering the stepparent's income for purposes of determining Medicaid eligibility. See Malloy,
The Secretary's 1984 position is consistent with Massachusetts Ass'n. of Older Americans v. Sharp,
III
CONCLUSION
We conclude that 42 U.S.C. Sec. 1396a(a)(17)(D) precludes the Secretary from requiring statеs to include sibling income in computing income available to a family filing unit for the purpose of establishing Medicaid eligibility, and thus the Secretary may not define a filing unit under 42 U.S.C. Sec. 1396a(a)(17)(B) so as to require inclusion of a sibling and his or her income in the Medicaid family filing unit.
AFFIRMED.
Notes
Otis R. Bowen is substituted for his predecessor, Margaret M. Heckler, Secretary of Health and Human Services, pursuant to Fed.R.App. 43(c)(1)
Deeming income allows the state to assume that income is available to an appliсant, regardless of whether the income is actually available. Herweg,
Appellee Vance is the mother of two children, Linda, age 17, and Guisseppe, age 8. From 1980 until 1984, Vance and Linda received AFDC in the amount of $368 per month. Guisseppe did not receive AFDC as he received social security survivor benefits in the amount of $472 per month. Following the enactment of DEFRA, Vance and Linda's AFDC and Medicaid benefits were terminated when Guisseppe's income was included as part of the family's income. Appellee Turner was 9 months pregnant at the time this lawsuit was filed. Turner lost her AFDC and Medicaid benefits in 1984 because one of her children received $542 per month in social security benefits
Sibling income is income which is received by siblings who have no duty to support the other members of the housеhold. It can be from social security benefits, child support, or other sources
42 C.F.R. Sec. 435.602 provides:
(a) Except for a spouse of an individual or a parent for a child who is under age 21 or blind or disabled, the agency must not--
1) Consider income and resources of any relative available to an individual; nor
2) Collect reimbursement from any relative for amounts paid by the agency for services provided to an individual.
(b) The income and resources of spouses and parents must be considerеd in determining financial eligibility as provided for the categorically needy ... and medically needy....
Four other district courts have reached similar conclusions. See Reed v. Blinzinger,
The parties have not addressed whether the directive was ever published in accordance with the Freedom of Information Act, 5 U.S.C. Sec. 552(a)(1)(D). See Cubanski,
