West v. ColeWest v. Cole
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- Before:
- Ready
MEMORANDUM OPINION
In this class action plaintiffs seek injunctive and declaratory relief, under
Plaintiffs and the subclasses which they represent consist of all children under the age of 18 residing in Mississippi who are presently receiving Supplemental Security Income (SSI) disability payments and who, except for the fact that they are receiving SSI payments, would be eligible for Aid to Families with Dependent Children (AFDC) benefits under the AFDC standards in effect in Mississippi on January 1, 1972; all recipients of SSI disability payments under the age of 18 who would be eligible for' Medicaid assistance except for the fact that they are less than 18 years old; and all caretaker relatives of these child-plaintiff subclasses. 1
Defendants, who are sued individually and in their official capacities, are Max M. Cole, Commissioner of the Mississippi State Department of Public Welfare, Thomas O. Metcalfe, Jr., Director of the Mississippi Medicaid Commission, and Raymond G. Messer, Sr. and Roy E. Povall, Directors respectively of the Washington County and Hinds County Departments of Public Welfare. 2 Defendants Messer and Povall are also sued as representatives of the class consisting of all directors of county departments of public welfare.
The named plaintiffs include three families whose personal circumstances are typical of the conditions shared by the plaintiff class.
*94 Emma West lives with her seven children at Hollandale in Washington County. Six of her children are without disability, and they receive a total of $96 per month in AFDC benefits. The seventh child, 10 year old Larry, suffered severe brain damage when he was 5 and is now receiving federal SSI disability benefits. Soon after Larry’s SSI benefits began, however, the county department of public welfare, pursuant to a Mississippi Welfare Department directive, terminated his Medicaid benefits, which he had been receiving continuously since before January 1, 1972.
Christine Williams also resides in Hollandale with her two children and disabled mother. She currently receives $28 per month in AFDC benefits for one of the children. The other, 13 year old Sandra, is severely retarded and recently began receiving SSI disability benefit payments. When SSI benefits began for Sandra, the county department of public welfare, as it had done in the case of Larry West, terminated the Medicaid benefits which Sandra had been receiving, together with AFDC payments, continuously since before January 1, 1972.
Finally among the named plaintiffs, Cynthia Ann Lofton is an 8 year old victim of cerebral palsy, living with her mother and seven brothers and sisters. The Loftons’ total monthly income consists of $108 in AFDC benefits and Cynthia Ann’s $146 SSI check. Prior to SSI, Cynthia Ann had received Medicaid and had been included in her family’s AFDC budget, although the family, because of its size, was already receiving maximum AFDC benefits. Thus, if Cynthia Ann foregoes SSI to qualify for Medicaid and AFDC, her family will receive no additional AFDC benefits; as matters now stand, her SSI qualification deprives her of Medicaid benefits.
Although this case involves a statutory maze of extraordinary complexity, the essential controversy between the parties may be simply stated. As disabled individuals of low income status, plaintiffs qualify for cash assistance under the federally-run SSI program. Many also qualify for the less lucrative cash benefits of the federally-assisted but state-operated AFDC plan. 3 Further, since they are physically disabled, the plaintiff children have pressing medical needs which, owing to their poverty, may be met only through the federally-assisted but state-administered Medicaid program. Plaintiffs claim entitlement to both the higher cash benefits of the SSI program and the medical care provided by the Medicaid assistance plan. Defendants contend that federal law does not require that both SSI and Medicaid benefits be made available to plaintiffs. Defendants’ position is that because of the interaction of federal and state law, plaintiffs must elect to receive benefits either under the SSI plan or under both the AFDC and Medicaid programs; under the defendants’ interpretation, plaintiffs cannot forego the lesser AFDC payment and reap the benefits of both SSI and Medicaid.
I.
Before addressing the merits of this controversy, we must first deal with defendants’ contention that the case involves restraint of the enforcement of state statutes, thus requiring the convening of a three-judge court pursuant to
*95
With respect to the first two causes of action, it is well settled that allegations of Supremacy Clause violations do not require three-judge court treatment. Shea v. Vialpando,
These familiar principles, when considered in light of the narrow construction judicially accorded the three-judge court statute, require us to conclude that a three-judge court is not required in this case. With jurisdiction properly invoked under
II.
In attempting to unravel the complicated questions presented in the case sub judice, it is essential that the basic structure of the pertinent welfare programs be understood.
Prior to January 1, 1974, there were four categorical assistance welfare programs, consisting of Old Age Assistance (Title I), Aid to Families with Dependent Children (Title IV), Aid to the Blind (Title X), and Aid to the Permanently and Totally Disabled (Title XIV). Each program provided cash assistance and was administered by the states, pursuant to the provisions of the Social Security Act,
Even though designed to supplant three of the four categorical assistance plans, the SSI program did effect several changes in the scope of aid to the aged, blind and disabled. Prior to SSI, disabled persons under 18 years of age were ineligible for disability benefits under the old Aid to the Permanently and Totally Disabled program. Under the former plan, disabled individuals under 18 could qualify only for AFDC benefits. Under SSI, disability benefits are extended to otherwise eligible disabled persons of all ages.
In addition to the SSI and AFDC cash assistance programs, Congress has enacted the federally-assisted but state-administered Medicaid Assistance Program, through which medical assistance is furnished to the aged, blind, disabled and families with dependent children whose income and financial resources fall below stated mínimums.
Among the federal Medicaid restrictions binding on participating states are the requirements of
“(a) A State plan for medical assistance must— . . . provide— (A) for making medical assistance available to all individuals receiving aid or assistance under any plan of the State approved under subehapter I, X, XIV, or XVI, or part A of sub-chapter IV of this chapter, or with respect to whom supplementary security income benefits are being paid under subchapter XVI of this chapter
“Notwithstanding any other provision of this subchapter, ... no State . . . shall be required to provide medical assistance to any aged, blind, or disabled individual (within the meaning of subchapter XVI of this chapter) for any month unless such State would be (or would have been) required to provide medical assistance to such individual ■ for such month had its plan for medical assistance approved under this sub-chapter and in effect on January 1, 1972, been in effect in such month, except that for this purpose any such individual shall be deemed eligible for medical assistance under such State plan if (in addition to meeting such other requirements as are or may be imposed under the State plan) the income of any such individual as determined in accordance with section 1396b(f) of this title (after deducting any supplemental security income payment and State supplementary payment made with respect to such individual, and incurred expenses for medical care as recognized under State law) is not in excess of the standard for medical assistance established under the State plan as in effect on January 1, 1972.” (Our emphasis. The first italized portion constitutes the exception to Medicaid eligibility; the second portion relates to computation of income for Medicaid-eligible recipients.)
On October 10, 1969, Mississippi elected to enter into the Medicaid program and submitted, and had approved, a plan for medical assistance. The state’s enabling legislation, codified as
“Recipients of medical assistance shall be the following persons only: (1) Who are qualified for public assistance grants under provisions of Titles I [Old Age Assistance], IV [Aid to Families with Dependent Children], X [Aid to the Blind] or XIV [Aid to the Permanently and Totally Disabled] of the Social Security Act, as administered by the State of Mississippi, as same existed in law, on the effective date of the Mississippi Medicaid Law [October 10, 1969];”
The Mississippi Medicaid Law thus apparently limits Medicaid recipients to persons eligible for assistance under one or more of the four categorical assistance welfare programs, as those programs existed on October 10,1969.
*97 III.
Plaintiffs contend that defendants’ refusal to certify for Medicaid children receiving SSI disability payments is contrary to the letter and spirit of the foregoing federal statutes and, when tested by the Supremacy and Equal Protection Clauses, cannot stand.
We hold that Congress intended to require, and did require, that Mississippi make available Medicaid benefits to all recipients of SSI disability payments under the age of 18 who, except for the fact that they are receiving SSI payments, would qualify for AFDC benefits under the AFDC standards in effect in Mississippi on January 1, 1972. We cannot agree, however, that all SSI disability recipients under the age of 18 are entitled, ipso facto, to Medicaid benefits.
As all parties concede, although state participation in the federal Medicaid program is voluntary, once a state opts for the Medicaid program, as Mississippi has done, it becomes bound by all federal regulations and standards, including federal eligibility requirements. Triplett v. Cobb,
Our Supremacy Clause inquiry thus resolves itself into a determination of whether applicable federal provisions concerning Medicaid eligibility —
Defendants’ interpretation of the pertinent state and federal statutes is an hyperbole of literalism. Conceding that
L5-7] Our rejection of defendants’ version of the effect of
*98
The congressional intent here pertinent is more easily understood when it is remembered that SSI abolished three of the former categorical'assistance programs. In states such as Mississippi, where Medicaid eligibility was restricted to those persons participating in one or more of the categorical assistance programs, the SSI abolition would deprive many of their Medicaid benefits. To ensure that all who had been receiving Medicaid benefits prior to enactment of SSI would continue to receive them, Congress amended the Medicaid Act at
But although this amendment solved one problem, it created another. As previously noted, the SSI program not only transferred welfare plans for the aged, blind and disabled from state to federal control but also expanded the welfare rolls by liberalizing income eligibility requirements, and for the first time including within the disability program disabled persons under the age of 18. Further, amended
The congressional aim is therefore plain: to permit the states to maintain their Medicaid obligations as if SSI had never been enacted, while simultaneously ensuring that all persons eligible for Medicaid benefits prior to SSI’s enactment would continue to receive them. In other words, the Medicaid eligibility rolls were frozen' unless a state might choose to liberalize its own eligibility standard. That Congress intended this result is further manifested by the second significant provision of
Even more specifically, it is evident that, in enacting SSI, Congress was acutely sensitive to the needs of disabled children, who had theretofore been excluded from coverage under the former disability plan. The House Report noted that:
“ . . . disabled children who live in low-income households are certainly among the'most disadvantaged of all Americans and that they are deserving of special assistance in order to help them become self-supporting members of our society. Making it possible for disabled children to get benefits under this program, if it is to their advantage, rather than under the programs for families with children, would be appropriate because their needs are often greater than those of non-disabled children. The bill, accordingly, would include disabled children under the new program.” H.R.Rep.No.92-231, supra, at 147-148.
This brief exegesis establishes beyond serious question that Congress did intend that disabled children under eighteen years of age who could have qualified for Medicaid had SSI not been adopted should continue to receive Medicaid assistance. It is equally clear that the congressional purpose was, emphatically, not to expand Medicaid benefits to all disabled children now qualifying for SSI, irrespective of their eligibility status under pre-SSI state law. Congressional concern for state fiscal problems permitted states to exclude from Medicaid those children who could not have qualified for Medicaid benefits as of January 1,1972.
Those child-plaintiffs who do meet AFDC eligibility standards once their SSI payments are not considered are not among those made newly eligible for cash assistance by virtue of SSI; for in the absence of SSI, these children would qualify for Medicaid under Mississippi’s 1972 plan. Their receipt of Medicaid assistance therefore does not swell Mississippi’s Medicaid rolls in the way that
In view of these well-expressed congressional concerns, it would be anomalous to construe the applicable federal statutes so as to force plaintiffs to elect either to enjoy Medicaid assistance at the expense of obtaining the SSI payments for which they have dire need, or to participate in the SSI program with the sacrifice of medical assistance. We think this would indeed be a “Hobson’s choice,” a result which we are unwilling to impute to congressional intent. For, as Congress has recognized, disabled children generally have medical needs far more pressing than those possessed *100 by other children, in addition to sharing the requirements for subsistence which are common to all. Congress surely did not intend to play shell games with these child assistance programs. Rather, the aim was to enhance, not diminish benefits.
Fortunately, we need not engage in any legerdemain to effectuate the evident purpose of Congress, for by the plain terms of the statute, as those words receive meaning from their legislative origins, plaintiffs are not deprived of Medicaid benefits by their receipt of SSI funds. 7
We read the federal enactment as making
all
SSI recipients eligible for Medicaid benefits, save only those excluded by
With the prohibition of
Scant discussion is needed with respect to the plaintiff subclass which consists of all SSI recipients under the age of 18. These plaintiffs, to the extent that they do not qualify for Medicaid under the state’s January 1, 1972, plan, even after SSI payments are disregarded, are precisely those to whom the exclusion of
IV.
Plaintiffs mount an additional constitutional attack in an effort to win declaratory relief for all SSI disability recipients under 18 years of age. 8 Plaintiffs assert that a denial of medical as *101 sistance to children who are SSI disability beneficiaries involves two types of invidious discrimination anathematic to the Equal Protection Clause. First, it is claimed that otherwise eligible adult SSI disability recipients are Medicaid-eligible, while child SSI disability recipients are denied Medicaid solely on account of their age, thus resulting in arbitrary discrimination on the basis of age. Second, plaintiffs contend that otherwise eligible children now obtaining SSI aid to the blind may receive Medicaid assistance although children benefitting from SSI disability payments may not, thus yielding an irrational distinction between blind and disabled children.
It is worthy of note that the distinctions of which plaintiffs complain predate the SSI program and, at least in some states, have existed since enactment of the four former categorical assistance programs. SSI did not create these distinctions; it merely perpetuated them. It is also significant that the equal protection aspects of the welfare plan, albeit commanded by defendants’ interpretation of state law, are nonetheless allowed by federal statute. If plaintiffs’ equal protection claims warrant approval, then federal law too must fall, at least to the extent it acquiesces in unconstitutional state treatment.
Since plaintiffs’ constitutional challenge implicates no “fundamental right” nor is founded on any “suspect criteria”, as those terms have gained constitutional significance, our equal protection inquiry is governed by the traditional test of whether the legislative classifications here challenged are rationally related to the promotion of a legitimate state interest. U. S. Department of Agriculture v. Moreno,
In the area of social and economic legislation generally, and more particularly in cases involving the allocation of welfare funds inadequate to meet fully the needs of all impoverished and disabled citizens, the Supreme Court has recognized that primary responsibility for making difficult value choices must rest with the legislative branch, which in turn must be permitted considerable latitude in devising programs and allocating the public fisc.
Dandridge,
supra;
Jefferson,
supra. See also Ward v. Winstead,
“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 [377]. ‘The problems of government are practical ones and may justify, if they do not require, rough accommodations —illogical, it may be, and unscientif *102 ic.’ Metropolis Theatre Co. v. City of Chicago,228 U.S. 61 , 69-70,33 S.Ct. 441 , 443,57 L.Ed. 730 [734].”397 U.S. at 485 ,90 S.Ct. at 1161 ,25 L. Ed.2d at 501-02 .
The Court went on to say:
“[T]he intractable economic, social, and even philosophical problems presented by public welfare assistance programs are not the business of this Court. The Constitution may impose certain procedural safeguards upon systems of welfare administration, Goldberg v. Kelly,397 U.S. 254 ,90 S.Ct. 1011 ,25 L.Ed.2d 287 . But the Constitution does not empower this Court to second-guess state officials charged with the difficult responsibility of allocating limited public welfare funds among the myriad of potential recipients.”397 U.S. at 487 ,90 S.Ct. at 1163 ,25 L.Ed.2d at 503 .
Our constitutional assessment of this legislative structure, then, is keyed only to a search for rationality in its purpose and effect. Both the state plan and the federal imprimatur of it withstand such scrutiny.
First, in alleging that Medicaid benefits are denied to SSI disability recipients under the age of 18 solely on the basis of their age, plaintiffs are at least technically incorrect. Under the state plan, defendants now provide Medicaid assistance only to adult SSI beneficiaries who can meet the state Medicaid standards in effect on January 1, 1972.
Assuming, however, that age is the basis for distinction between the disabled who receive Medicaid and those who do not, several legally defensible justifications for that distinction may be posited. As Congress and the Supreme Court have recognized, state welfare funds are finite. The total number of disabled persons within the state may far exceed the state’s capacity to provide for each of them. Eliminating some disabled persons of tender years from the Medicaid rolls would be a rational means of stretching available funds. Disabled persons of this age are more likely to be under parental custody and care and thus in less need of medical assistance than disabled persons without family support. Too, medical needs of the young may well be less severe than those of persons of more advanced age. Given a limited welfare purse, and acknowledging that no state need participate in the Medicaid program except to the extent that it desires, 9 this statutory distinction is constitutionally defensible.
With respect to plaintiffs’ equal protection claims based on differing treatment accorded to recipients of SSI and to the blind and SSI disability recipients, it is again the case that only those SSI blind beneficiaries who satisfy the state Medicaid standards in effect on January 1, 1972, may qualify for medical assistance.
Assuming that the assistance distinction is strictly drawn along blind-disabled lines, such a distinction nevertheless would be supported by legitimate state goals. Again considering the limited available state resources, the legislature could well conclude that the blind have more need for medical assistance than do the disabled. The legislature might also legitimately be influenced by numerical considerations, if it appeared that there were considerably more disabled children than blind children.
*103 The dearth of state legislative history does not allow us to point with any specificity to a particular motive or motives which engendered these statutory distinctions. It is constitutionally sufficient, though, that there exist sufficient bases upon which these distinctions could have been validly drawn. We conclude that plaintiffs’ equal protection claims lack merit and must be denied.
Let an order be entered accordingly.
Notes
. The court on October 31, 1974, entered an order under Rule 23(c) certifying the suit as a class action both for the plaintiff classes as above noted and also for the defendant class of directors of county departments of public welfare.
. By order of January 21, 1975, the court determined that additional parties necessary for just adjudication under Rule 19 had not been made parties to the action and directed their joinder. Subsequently, those parties— S. E. Kossman, Jesse O. Adcock, D. W. Williamson, William G. Burgin, Jr., Edgar J. Stephens, Jr., Milton Case, and Robert M. Logan, Chairman and members, respectively, of the Mississippi Medicaid Commission; and Glen H. Davidson, Thomas P. Waits, Wayne Dowdy, H. A. Scott, and E. U. Parker, Chairman and members, respectively, of the State Board of Public Welfare — waived service of process, entered appearances as defendants, and adopted all the pleadings and briefs filed by the other named defendants.
. An amendment to the AFDC program adopted concurrently with the passage of SSI effectively prohibits beneficiaries of SSI funds from qualifying for AFDC benefits.
. Although our holding is based on the effect of federal law, we note here that even the applicable state statute appears to command a result contrary to the defendants’ position.
*98 We choose not to rely on our construction of the state statute because the point was never squarely addressed by the parties.
This controversy had its genesis in an opinion issued by the state’s Attorney General advising the Mississippi State Department of Public Welfare that the Mississippi Medicaid Law — specifically
It is first clear that this court, empowered to construe state as well as federal statutes, is not bound by the interpretation given the state statute by the Attorney General of Mississippi. In the absence of any state court decision on point, our task is rather to construe the statute as we believe the Supreme Court of Mississippi would construe it. See e. g., Trail Builders Supply Co. v. Reagan,
A fair reading of § 43-13-115 reveals that the only relevant AFDC eligibility standards were those existing on October 10, 1969, the effective date of the Mississippi Medicaid Law. The phrase, “as the same existed in law”, can only refer to the welfare program under which the Medicaid applicant seeks to qualify, and the time limitation contained in the statute must mean that later amendments, if any, to the AFDC program are not to be considered.
Since
. “Under present law, States are required to cover under medicaid all people eligible for cash assistance payments. If this provision were carried over into the new assistance programs, many thousands of additional people, the great majority of whom would be people made newly eligible for assistance to the aged, blind, and disabled, would be required to be covered under medicaid. In view of the serious financial and other problems of many State medicaid programs, your committee decided not to require the States to cover the newly eligible but rather leave the decision up to each individual State. Your committee’s bill would, therefore, pro- • vide that despite any other requirements of Title XIX, no State shall be required to provide medicaid coverage to any individual or family member in any month where such *99 person would not have been eligible for such assistance under the State plan in effect on January 1, 1971.” H.R.Rep.No.92-231, 92d Cong., 1st Sess. (1971) at 147. The 1971 date was later changed to 1972 as a result of legislative delay on the bill.
. “The SSI payment levels are higher than present payments in a number of states ; in order not to impose a substantial fiscal burden on these states, a provision was written into the Medicaid law allowing the State the option of either covering all SSI recipients or not covering the newly éligible SSI recipients who would not have met the State’s January 1, 1972 standard for determining Medicaid eligibility.” S.Rep., No. 93-553, 93rd Cong., 2d Sess. (1973) at 57.
. In construing the terms of these federal welfare acts, we are particulary guided by the standard of liberal interpretation elucidated in Townsend v. Swank,
. Although plaintiffs complain of equal protection violations toward both subclasses of *101 child-plaintiffs, we have already found that the first subclass is entitled to injunctive relief under the Supremacy Clause. It is therefore unnecessary to consider that class here, and our equal protection remarks are confined to the second child-subclass, which consists of those SSI recipients under the age of 18 who cannot qualify for AFDC aid and hence for Medicaid under the January 1,-1972, state plan.
.
Jefferson,
supra,