Document: 534 U.S. 473122 S.Ct. 962151 L.Ed.2d 935 NOTICE: This opinion is subject to formal revision before publication in the preliminary print of United States Reports. Readers are requested notify Reporter Decisions, Supreme Court States, Washington, D. C. 20543, any typographical or other errors, order that corrections may be made goes press.WISCONSIN DEPARTMENT OF HEALTH AND FAMILY SERVICES, PETITIONERv.IRENE BLUMER No. 00-952. SUPREME COURT THE UNITED STATES Argued December 3, 2001Decided February 20, 2002 Syllabus In developing standards for determining Medicaid eligibility, participating must "tak[e] into account only such income and resources as are, determined accordance with prescribed by Secretary [of Health Human Services (Secretary)], available applicant." 42 §1396a(a)(17)(B) (emphasis added). Because spouses typically possess assets jointly bear financial responsibility each other, eligibility determinations married applicants have resisted simple solutions. Until Medicare Catastrophic Coverage Act 1988 (MCCA Act), state often left a spouse living at home (called "community spouse") destitute, couple's drained qualify his her mate (the "institutionalized Medicaid, posteligibility diminished reduce amount payable institutional care. The MCCA's "spousal impoverishment" provisions responded this problem including statute requirements which comply allocating resources. Act's allocation rules direct that, month one institutionalized, "no community shall deemed institutionalized spouse," §1396r-5(b)(1); require set "minimum monthly maintenance needs allowance" (MMMNA), §1396r-5(d)(3); prescribe if spouse's insufficient yield equal above MMMNA, shortfall called (CSMIA) deducted from paid spouse, §1396r-5(d)(1)(B). resource provide, inter alia, portion (CSRA) reserved benefit §1396r-5(c)(2). To calculate CSRA, separately owned added together time institutionalization commenced; half total, certain limits, then allocated §§1396r-5(c)(1)(A), (2)(B), (f)(2)(A), (g). CSRA unavailable determination, but all (excluding $2,000 personal allowance under federal regulations) spent can achieved, Section 1396r-5(e)(2)(C) provides "fair hearing" mechanism through couple obtain higher establishing standard (in relation it generates) inadequate raise "the income" MMMNA. employed two methods making determination; differ their construction subsection (e)(2)(C) term income." Under "income-first" method used most includes not actual hearing, also an anticipated CSMIA authorized income-first method, because takes potential CSMIA, makes less likely will increased; therefore tends couples expend additional becomes eligible. contrast, "resources-first" remaining excludes consideration. has circulated comment proposed rule allowing threshold choice using either resources-first method. After entering Wisconsin nursing home, respondent Irene Blumer applied husband Burnett. Green County Department (County) Blumers could retain $74,822 $72,822 Burnett's Irene's allowance. next found date application, possessed exceeding limit $14,513. accordingly concluded would eligible until spending reduced $14,531 amount. sought hearing arguing ($1,639) fell below applicable MMMNA ($1,727), examiner was obliged increase CSRA. adopts rule, he lacked authority CSRA: difference between erased if, after achieving transferred Burnett, income. sufficient allow transfer, no reason reserve Burnett and, consequently, cause advancing eligibility. Circuit affirmed, Appeals reversed, concluding State's conflicts MCCA, which, appeals court held, unambiguously mandates Held: qualifies permissible interpretation MCCA. Pp. 13-21. (a) Neither §1396r-5(e)(2)(C)'s text nor structure forbids Wisconsin's approach. case turns on whether words §1396r-5(e)(2)(C) interpreted include potential, transfers permitted According Blumer, plain meaning precludes inclusion; choosing possessive modifier spouse's," maintains, Congress clearly expressed its intent actually count calculation. rejects argument. Use does demand quoted phrase mean by, rather than attributable to, spouse; contrary, use indeterminate. Cf., e.g., Smiley v. Citibank (South Dakota), N. A., 517 735 , 739. finds similarly unpersuasive Blumer's argument design whole regard, contends enhanced occurs assessment conducted, while been reverses priority ordered disagrees conclusion: properly comprehended preeligibility projection situation; unreasonable State estimation period transfer law permits time. same misunderstanding underlies contention renders meaningless §1396r-5(b)(1)'s key prohibition against deeming spouse. confuses inclusion calculation provision. Far precluding approach, offers affirmative support Subsection (b)(1) counterpart prohibiting attribution Indeed, §1396r-5(d)(1)(B) specifically CSMIA. Mindful expected see, Schweiker Gray Panthers, 453 34 45, satisfied reasonably interprets MCCA anticipating hearing. conclusion bolstered further consideration: A fair limited redetermination, adjust itself, §1396r-5(e)(2)(A)(i); therefore, cannot barred taking 13-18. (b) parties disputed permissibility definitively resolve matter. notes, however, leeway choices urged characteristic statute, designed advance cooperative federalism. See Harris McRae, 448 297 308. When interpreting statutes so structured, range least where superintending agency latitude consistent statute's aims. See, Batterton Francis, 432 416 429-431. Secretary, who possesses relevant here, §1396a(a)(17), explicitly recognizing both methods. That position statement warrants respectful U.S., 43-44. affords large discretion regarding related variables: level §1396r-5(d)(3), retain, §1396r-5(f)(2)(A). Nothing indicates similar inappropriate respect application §1396r-5(e)(2)(C). Eliminating choose hinder efforts strike own balance implementing Act. Lukhard Reed, 481 368 383. currently allocate funds little offset greater expense reducing relatively few applicant significant resources, offering nothing perhaps disadvantaging, lack substantial assets. contradicts Secretary's result unnecessary unwarranted. 18-21.2000 WI App. 150, 237 Wis. 2d 810, 615 W. 647, reversed remanded. ON WRIT CERTIORARI TO APPEALS WISCONSIN, DISTRICT IV Ginsburg, J., delivered Court, Rehnquist, Kennedy, Souter, Thomas, Breyer, JJ., joined. Opinion Justice Ginsburg Court. 1 requires 102 Stat. 754, U.S.C. § 1396r -5 (1994 ed. Supp. V), complex instructions part statute. spousal impoverishment permit meet minimum she when usually Medicaid. 2 shelters diminution allowance," "CSRA," "resource allowance"). allows shows, state-administered able maintain statutorily defined live gains 3 entitled i.e., shelter excess allowance, Wisconsin, like majority uses considers first expressly permits, suffice enable once 4 Respondent whose delayed petitioner Family Services' challenges inconsistent provision governing upward ed.). upheld challenge. We reverse court's judgment. we conclude, chosen Consistent adopted Services, hold represents 5 * 6 program funding reimburse needy persons cost medical Social Security Act, tit. XIX, added, 79 343, amended, 1396 et seq. "Each develops plan containing reasonable extent assistance" within boundaries Services. 36-37 (1981) (internal quotation marks omitted); §1396a(a)(17).1 formulating those standards, "provide 7 id., 44-48. 1989, year took effect, generally considered "available" other. approach observing "from beginning program, presume support." Id., 44; see 45 (quoting passage S. Rep. 404, 89th Cong., 1st Sess., pt. 1, p. 78 (1965), "it proper expect other"). Similarly, held were commonly full 8 At time, did treat individually Accordingly, titled solely name escaped consideration H. R. 100-105, 2, pp. 66-67 (1987). 9 As later enacted 1988, these existing practices applicant's produced unintended consequences. Many destitute drain necessary 66-68. Conversely, ample means assistance name. 10 protect "pauperization" preventing financially secure obtaining assistance. 65 (bill seeks "end th[e] pauperization" "by assuring excessive available"). achieve aim, installed intricate interlocking 11 Income governed §§1396r-5(b) (d). Covering "an institution," §1396r-5(b)(1) spouse." thus preserved affect determination general, disregarded calculating pay care established. 12 Other address 1396r-5(b)(2)(A) prescribes, main payment treated named "name-on-the-check" rule). 1396r-5(d) number exceptions ensure dependents basic needs. Among exceptions, §§1396r-5(d)(3) establishes calculated multiplying poverty percentage State. Since 1992, 150%, §§1396r-5(d)(3)(A)-(B), resulting exceed $1,500 per dollars ($2,175 2001 dollars), §§1396r-5(d)(3)(C), (g).2 13 If §1396r-5(b)(2), states comes play. provision, "deducted" otherwise long reallocated ensures latter's former's result, expenses absent 14 Resource controlled §§1396r-5(c) (f).3 For purposes eligibility,4 determine CSRA), total (whether separately) share"). §1396r-5(c)(1)(A). share ceiling $60,000 indexed inflation 2001, $87,000) floor, State, $12,000 (also inflation; amounts $17,400 $87,000). §§1396r-5(c)(2)(B), (g).5 small sum aside $2,000, 20 CFR 416.1205 (2001)) achieved. 15 challenge elements for, provided §§1396r-5(e). dispute centers §1396r-5(e)(2)(C), request section part: 16 "If [CSRA] generated allowance) [MMMNA], there substituted, (f)(2) section, adequate provide [the MMMNA]." 17 succeeds deems expenses; accordingly, become sooner. 18 divergent methods: States; preferred others. (e)(2)(C). §1396r-5(e) §1396(d)(1)(B), supra, 5-6. Thus, plus fall 19 "Community received pursuant raised generate meeting shortfall, accomplish task. sum, 21 issued several statements supporting Initially, requiring officers HCFA, Chicago Regional Letter 51-93 (Dec. 1993), Pet. Cert. 78a-83a. More recently, "some law." 22-94, (July 1994), 89a. 22 "allow[ing] needs." 66 Fed. Reg. 46763, 46765 (2001). details reasons "clearly requir[e] [method] exclusion other." 46767. "in view federalism considerations embodied program," 46765, appropriate "leave decision alternative use," 46767.6 B 23 facts illustrate operation different consequences approaches. admitted 1994 1996 accord §1396r-5(c), 1994, amounted $145,644. Dividing evenly Blumers, attributed CSRA,7 Combining sums, 24 Blumers' had $145,644 $89,335. exceeded $14,513 threshold. down limit. 25 Seeking $1,639, consisting $1,015 benefits, $309 annuity, $315 protected CSRA.8 argued $1,727, thereby protecting capable covering shortfall. 26 Excluding just noted, $14,513, generating roughly $63 Attributing $1,702, still $25 short officer addressing reserving increased encompass immediately deficit covered (or CSMIA) Irene, $927 $336 pension. 27 statute: 28 sub. (6)(b) without enough [MMMNA] department establish (6)(b)3. results generates . Except exceptional cases duress unless maximum (4)(b)." Ann. §49.455(8)(d) (West 1997) 29 Applying $88 This, concluded, do; need acceleration 30 following table illustrates differences Blumers: 31 _______________________________________________________________________ | Analysis |Income Resources Financial Situation First |________________________________________________|__________|___________| Initial Allocation: Total Share Standard Amount Protected: Personal Allowance Assessment Income: Pension $1,324 $1,639 $1,727 Compared -$1,639 Shortfall Satisfying Shortfall: Enhanced $0 n/a Required Transfer End Result: Protected $89,335 32 examiner's affirmed County. Appeals, reversed. Concluding appellate declared impermissibly law. 2000 647. denied discretionary review. 33 holding impermissible required, accords Ohio intermediate courts. Kimnach Dept. Servs., 96 3d 640, 645 E. 825, 829-830 (1994), appeal allowed, 71 St. 1447, 644 409 (1995). Most courts consider issue, highest New York Massachusetts, well Federal Courts Cleary ex rel. Waldman, 167 F.3d 801, 805 (CA3), cert. denied, 528 870 (1999); Chambers 145 793, 801 (CA6), 525 964 (1998); Golf Div. Soc. 91 Y. 656, 662, 697 555, 558 Thomas Commissioner Medical Assistance, 425 Mass. 738, 746, 682 874, 879 (1997). granted certiorari conflict, 533 927 (2001), now judgment Appeals. II question presented prescription necessary, answer question, agree, 35 line ¶20, conflict weight lower authority, Cleary, F.3d, 807; Chambers, 802, argues She regularly "income" definition, instead focuses contending "[b]y spouse" measure. Brief 16. disagree. Congress' J. Taylor, Possessives English: An Exploration Cognitive Grammar (1996) ("[T]he entity denoted possessor nominal necessarily everyday, legalistic sense term) possessee."); 739 (questioning characterization statutory unambiguous division courts). 36 maintains "design whole" K mart Corp. Cartier, Inc., 486 281 291 (1988). relies heavily, ¶¶21-23, distinction initial apply extent-of-assistance 17-18. notes sequence, contends, shows intended enhancement operate discrete stages: former remedies prior latter relief previous proves inadequate. 18. imputation reserved, concludes, established 37 do agree circumscribed manner urges. Although conducted preeligibility,9 purpose anticipate situation couple. procedure project what Tr. Oral Arg. (officer conducting "concerns post period"; at-home period, jacked up income"). measure projected operative posteligibility. §§1396r-5(b)(2), (d)(3). 38 short, situation, think is, occur.10 39 skewed contention, advanced oral argument, 6-10, one. §1396r-5(b)(1). effectively converts some And continues, expenses. §1396a(a)(10)(A); 435.120 (2000). theory would, logical matter, clear contravention (b)(1). 40 contemplated again, simply affairs exist theoretical incorporation future effect spouses. fact §1396r-5(d)(1)(B), occur "[a]fter [the] eligible." §1396r-5(d)(1). point, income, ibid., longer times honored, simultaneously spouse.11 41 (b)(1), running opposite direction. program's background principle other," 78) omitted), hearing.12 note (e), hearings redetermination It dissatisfied with: 43 "(i) [CSMIA]; 44 "(ii) ; "(iii) computation (c)(1) section; [and] 46 "(iv) (c)(2) section." §1396r-5(e)(2)(A). 47 Given itself adjusted (e)(2)(A)(i), conclude forbidden (e)(2)(A)(v), Accord, 810. III 48 here although 49 implanted, 308 (1980). reluctant leave 429 (1977), example, regulation promulgated Health, Education, Welfare affording implementation Aid Families Dependent Children (AFDC) unemployed parent program. challenged allowed cover exclude coverage unemployment resulted participation labor conduct disqualify them benefits compensation Noting AFDC involved "concept federalism," 431, "recognize local options eligibility," 430. (1987), plurality Virginia's policy treating injury awards law, 377-381. agency, pointed out, many years 378. 50 issue §1396a(a)(17),13 preliminarily 46767 (2001); 89a.14 recently spirit Federalism," Government "should [income-first resources-first] use." 51 Cf. Mead Corp., 218 Jefferson Univ. Shalala, 512 504 (1994) (reliance "significant expertise" particularly context "a highly technical regulatory program" omitted)); 43-44 (Secretary "exceptionally broad authority" statute). acknowledges, 31-32, accorded 5, §1396r-5(f)(2)(A), 6-7. us 52 "strik[e] balance" Lukhard, Such alteration seeking "not lot people" account, not, whom variables primary protection impoverishment. pushed toward altering every person install, spending, affects formula perceive contradicting 53 54 stated, remanded proceedings opinion. 55 ordered. 56 Stevens, O'Connor Scalia join, dissenting. 57 Notes:1 delegated rulemaking power Care Financing Administration (HCFA), Statement Organization, Functions, Delegations Authority Pt. F, 13262-13263 (1981), Centers 35437 nevertheless refer throughout charged interpretive authority. "excess cover, unusually high rent mortgage payments. §§1396r-5(d)(3)(A)(ii), (d)(4). Either seek "exceptional circumstances duress." §1396r-5(e)(2)(B). definition "resources" automobile, belongings, forms property. §§1382b(a), 1396r-5(c)(5). Once eligible, [gained by] §1396r-5(c)(4). points Amicus Curiae 8, n. 4, technically defines §1396r-5(f)(2), denotes share" falls Assets automatically excluded §§1396r-5(f)(1), (2). observe, below, share. Petitioner 7, 6; 5; ¶10, 816, 650, ¶10. employs definition: combined separately-owned Medicaid." 46768 adhere common understanding Comments submitted November 6, 2001. fears comments reached due disruption Nation's postal system October 16-17. remains unclear take action rule. 61625 sets floor $50,000. §49.455(6)(b)1m. federally imposed ceiling, $79,020 ($60,000 1996), became 28a. incorrectly mistakenly attributing him $378 $87,355 yielded 25a; (Apr. 29, 1997). error our decision, correct figures (rounded nearest dollar) illustrative purposes. dictated mechanics process; preserve assets, any, know should Taking dissent emphasizes "unless permitted," post, 5-6 §49.455(8)(d)) supplied dissent). Only omitting essential language construe "requir[ing] (4)(b) substantially identical §1396r-5(d)(1), very §49.455(8)(d). Like directs "after §49.455(4)(b). "permit" pre-eligibility terms either. drawing contrary inference based incomplete reading, dissent, "neglects issue," 5. (a)(3) leaves place Supplemental (SSI) constitutes determinations. 19-22. particular, imposes SSI requirement, codified §1396a(r)(2)(B), adopt income-assessment people SSI. 21. carved out §1396r-5(a)(3) implicated case. Reply 14. entirely money indisputably "mandates optional," 6. presumably post-eligibility lest receive guaranteed illustrates, situation. regard fallen 12. "mandatory" understands term, dissent's friction guarantee failure mandate realize guarantee. faulting possibility projections prove inaccurate, attacks inherent itself. pre-eligibility, 15, 9, inevitably make predictions, predictions "may ultimately come fruition," income-first, decide enhance speculation about period. diminishes unexpectedly, "predicted" basis enhancement. §1396r-5(a)(1) divests §1396a(a)(17) 39. (a)(1) "supersede subchapter (including sections 1396a(a)(17) 1396a(f) title) them," says §1396a(a)(17). noted delegation extremely area, (1981); implicitly withdrew here. Contrary suggestion, never wavered 78a-83a; 89a; dissenting 58 (MCCA), important protections home. Eligibility paying costs pre-1988 required deplete benefits. prevent spouse"), gives rights right joint (CSRA).1 second 59 designed, part, assure maintained (MMMNA).2 safeguard subsistence hearing," calculations -5(e)(2) challenged. §1396r-5(e)(2)(A)(v). 60 During income-producing case, applicable. By terms, remain counted purposes, enables ineligible 61 straightforward. caption indicates, deals "[r]evision made. provides: 62 allowance." 63 §1396r-5(c)(1)(A) level, "shall substituted" new produce 64 With sole authorizes applies needs, help family members But states, redetermined assistance."3 passed prohibits spouse.4 Unless plainly invalid created There possible bases §1396r-(e)(2)(C): first, despite express limitation §1396r-5(d) deductions eligible," really meant "before after"; second, deduction him." clear, arguments 67 Rather admitting reading strains engages analytical sleight hand: conceives commanded condition prediction things come. Ante, ("In 'community income' occur"). Court's temporal manipulation innovative; wrong three reasons. 68 First, speculating predicts neglects issue. permissible, states: "The [Community Spouse Monthly Allowance] '[a]fter eligible.' §1396r-5(d)(1)." 16-17 statement, replaces "made to" "transferred to," exposes precisely why "theoretical" requires: "[T]he [substitute CSRA] permitted." Wisc. (1993-1994) "make available" words, -5(d)(1) established, statue MCCA.5 69 Second, so.6 increasing optional. Furthermore, prediction, mandatory plausible "prediction" fruition. might contribute Alternatively, fluctuate over given augment Finally, finding ineligibility fictional (as case) occurring.7 events occurs, ensuring security undermined. thought experiment 70 Third, expresses 1396r-5(b)(2)(A)(i) "[Posteligibility,] respective mandating treats violates §1396r-5(b)(2)(A)(i). final pays "respectful consideration" letter memoranda " 'in Federalism' 20. document depends 'upon thoroughness evident consideration, validity reasoning, consistency earlier pronouncements, factors give persuade.' 228 taken positions 78a-90a, current analysis potentially conflicting statutes. devoid 'power 72 concludes explanation represent better resource-first mentioning least, identifies congressional preference former. 73 ambiguous. adjustment conditioned predicted imposing invalid. I affirm respectfully dissent. Notes: -5(C)(1)(A) ed). amount, 1396r-5(d)(3) grants flexibility setting 150% two. $1,406.25 $2,175 month. $1,935. Allowances "After assistance, institution, order: "(A) (described 1396a(q)(1) title), specified 1396a(q)(2) title. "(B) paragraph (2)), of) "(C) member ." Wis "Except or, (4)(b), asserts response fails "permit[ed]" (4)(b). 16, 10. describes posteligibility, whereas (8)(d) overlooking permissive character continues ignore Counsel conceded required. ("It doesn't transfer"). waffles describing something "potential" occur, ante, 13, "will occur," Nevertheless, -5(e)(2)(C) contemplates transfer. ruling ironic, say predicate so-called "income first" hypothetical precluded preclude reallocation (c) place.

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