Document: 477 U.S. 154 106 S.Ct. 2456 91 L.Ed.2d 131 Charles ATKINS, Commissioner, Massachusetts Department of Public Welfare, Petitionerv.Santos RIVERA et al. No. 85-632. Argued April 21, 1986. Decided June 23, Syllabus The Medicaid program the Social Security Act (Act) provides medical assistance to persons whose income and resources are insufficient meet costs necessary care services. States participating in must provide coverage "categorically needy," that is, eligible for cash under either Supplemental Income Aged, Blind, Disabled (SSI) or Aid Families with Dependent Children (AFDC) program. A State also may elect benefits "medically who nonfinancial eligibility requirements AFDC SSI, but exceed financial standards those programs. Under 42 U.S.C. § 1396a(a)(17), medically needy qualify if they incur expenses, i.e., "spend down," an amount reduces their level. That section a is take into account, "except extent prescribed by Secretary [of Health Human Services], . incurred care," determine "reasonable" "comparable all groups." Pursuant issued regulation permitting employ maximum spenddown period six months compute needy. 1396a(a)(10)(C)(i)(III), state plan prescribe "the single standard be employed determining resource such groups, methodology which shall same would [AFDC SSI]." plan, lack sufficient measured on monthly basis basic needs automatically Medicaid. earn enough needs, expenses within 6-month consume earnings what required needs. Welfare denied respondents because exceeded limit, period. After denial was upheld administrative review, sought injunctive relief from Superior Court against use court held invalid, Supreme Judicial agreed, holding providing "same methodology" used both categorically needy, requires 1-month applied calculations Held: Massachusetts' calculating does not violate Act's requirement. Pp. 161-167. (a) Secretary's plainly permits has done. Because supported plain language adopted pursuant explicit grant rulemaking authority, it entitled "legislative effect" controlling unless arbitrary, capricious, manifestly contrary Act. 161-162. (b) history requirement demonstrates never intended control length spenddown, rather simply instruct treat components similarly persons. 162-166. 395 Mass. 189, 479 N.E.2d 639 (1985), reversed. BLACKMUN, J., delivered opinion unanimous Court. H. Reed Witherby, Boston, Mass., petitioner. Jerrold J. Ganzfried, Washington, D.C., U.S., as amicus curiae, special leave Rene Reixach, Jr., Rochester, N.Y., respondents. Justice BLACKMUN 1 This case concerns means calculate medical-assistance (Medicaid) Title XIX 2 In Massachusetts, income, basis, Commonwealth, however, persons, like respondents, Construing two groups calculated using methodology," invalid Commonwealth's measuring expenses. ruled inasmuch measure means, identical this conflicts rulings Federal Courts Appeals,1 we granted certiorari. 474 1018, 566, 88 551 (1985). 3 * Medicaid, enacted 1965 Act, 79 Stat. 343, amended, 1396 seq. (1982 ed. Supp. II), designed See Schweiker v. Hogan, 457 569, 571, 102 2597, 2600, 73 227 (1982). Government shares participate return, comply imposed Services. 1396a II); Gray Panthers, 453 34, 36-37, 101 2633, 2636-2637, 69 460 (1981). 4 needy." 1396a(a)(10)(A) II). These programs: (SSI), 1381 (AFDC), 601 II).2 Congress considered these "especially deserving public assistance" see at 37, S.Ct., 2637, one SSI only if, given month, he she earns less than been determined necessities life. cover necessities, Thus, person category incurs during payment funds necessities. 5 programs.3 581-582, 2605-2606. effectively Only when down" exceeds level, roughly position SSI: any further expenditures then have come 6 creating mechanism 1396a(a)(17) provided Secretary, care." statute, Services instructed agencies "use prospective more income" CFR 435.831 7 electing assist 1396a(a)(17). addition, significantly present purposes, plans describe 8 1396a(a)(10)(C)(i)(III) (emphasis added). II 9 Respondent Rivera outside her home mother children. She receives no job, slightly excess permit AFDC. 1983, chosen program, Mass.Gen.Laws, 118E:1 (1984), 10 To Rivera's first gross income. Code Mass.Regs. §§ 505.200, 505.210, 505.320 Next, certain deductions disregards arrive "countable $535.30.4 CMR 505.200 506.100-506.200 435.831(a) countable limit $100.30. 506.400 1382(c)(1) 602(a)(13) As result, did time. able later date, subject being consumed spent down 11 over calculated. 118E:10 (1984); 506.510 permitted federal regulations. Accordingly, multiplied $100.30 six; thus could receive beginning date service after $601.80 expenses.5 Department's decision denying Appeals Referee. App. Pet. Cert. A46. 12 argued applicants violates mandates determinations earned shorter incurring expenses.6 13 certified class been, being, will subjected On motion summary judgment, found violated statutory A28. 14 appealed It there that, since determination involve all, match. regulations explicitly allow 15 Court, panel vote, invalid. Commissioner relied part, id., 197, N.E.2d, 644-645, ruling United District sustaining challenge regulation. Hogan Heckler, 597 F.Supp. 1106, 1110-1113 subsequently reversed, 769 F.2d 886 (CA1 1985), cert. pending sub nom. Bowen, 85-6386. Although noting do spenddowns, observed require computation Therefore, concluded, employed, III 16 created provision eliminate perceived weakness effect. Amendments 1960, 601(a), 74 987. Senate Report explained existing law some absolute-income cutoff point. An individual just specified obtain aid while unable assistance, even small compared cost needed. S.Rep. 404, 89th Cong., 1st Sess., pt. 1, p. 78 (1965), U.S.Code Cong. & Admin.News 1965, 1943. 17 cure problem, statute amended terms State's allowance maintenance required. instruction stating account care, Secretary." 18 provided, inception until time, months. 45 248.21(a)(4) (1970), originally promulgated HEW Handbook Assistance Administration, Supplement D, Medical Programs, D-4220(A)(4) (June 17, 1966). We long recognized perhaps due intricacy "Congress conferred exceptionally broad authority applying sections Act." 43, 2640. Batterton Francis, 432 416, 425, 97 2399, 2405, 53 448 (1977). delegation includes appears " 'entitled mere deference weight.' 44, 2640, quoting 426, 2406. Indeed, effect," "unless [it is] statute," Chevron U.S.A. Inc. Natural Resources Defense Council, Inc., 467 837, 844, 104 2778, 2782, 81 694 (1984). IV A. 19 Respondents contend regulation, thereto, "manifestly statute." point another 1396a(a)(10)(C) (i)(III),that eligibility, express congressional mandate methodology, here budget period, requirement, argument goes, operates limitation regulate administration spenddowns. Similarly, direct restriction States, requiring them spend down, B 20 proviso, appeared 1981, spenddown. Rather, instructs income—e.g., interest court-ordered support payments—similarly 21 proviso Congress' attempt relationship between treatment understand precise purpose brief foray earlier efforts address relationship, reflects desire overrule particular interpretation had advanced Secretary. 22 When enacted, individuals. Instead, "comparable" groups.7 several interpreted original "comparability" virtually treatment. See, e.g., 38 Fed.Reg. 32216 (1973), codified 248.2; Caldwell Blum, 621 491, 495 (CA2 1980), denied, 452 909, 3039, 412 (1981); Greklek Toia, 565 1259, 1261 1977), Blum Toomey, 436 962, 98 3081, 57 1128 (1978); Fabula Buck, 598 869, 872-873 (CA4 1979). Notably, claim prevented up months.8 23 concluded judicial flexibility set adjust scope services fit varying H.R.Rep. 97-208, 971 (1981), 396. part Omnibus Budget Reconciliation 1981 (OBRA), 95 357, deleting amendment, include its "a description criteria individuals assistance." OBRA 2171(a)(3)(C)(i), 807. 24 authorize different individuals: 25 "States longer apply uniform treating matters deemed interest, payments, infrequent irregular specify used, reasonable." 46 47980 26 accordingly left free were unrelated "reasonable."9 calculation Despite various changes followed OBRA's passage, many continued conformity still-existing choice. 27 disagreed interpretation. 127 Cong.Rec. 23363 (1981) (remarks Rep. Waxman). disagreement led enactment Tax Equity Fiscal Responsibility 1982 (TEFRA), 137(a)(8), 96 378. House TEFRA "makes clear Services] alter rules before September 30, respect levels, standards, resources." 97-757, reaffirmed previously effect Ibid. 28 correct problem wholly remained force operated solely invalidate post-OBRA deviate programs "such income." Treatment spenddowns untouched proviso.10 V 29 itself silent how months' family contribute begins. consistent intent, choose judgment 30 so ordered. 85-6386 (construing provision); DeJesus Perales, 770 316 pending, 85-6337 New York provision). 1972, 86 1465, replace three categorical programs—Old Age Assistance, 301 (1970 ed.); 1201 Permanently Totally Disabled, 1351 ed.). programs, together AFDC, administered state-eligibility standards. n. 18, 2605-2606, level comparable most, instances corresponding need. limits are, families (one persons), higher coverage. 506.410 304.410 results qualifying without state-court proceedings, raised manner portions disregarded. issue, presently satisfied submission paid unpaid bills. 506.540 Madeline McKenna intervene proceedings. McKenna, Rivera, McKenna's $531.66, $106.66 $425 two. $639.96 legislation choosing extend "for making remedial available would, [cash program] (as accordance standards) services." 345. current version contains rely arriving note very having incomes allowed cash-assistance still Medicaid; therefore, cannot read fundamental way, comparability provisions "did treated comparably respects." 587, 2608, F.2d, 323-324; 891-897. explained: "Before Amendments, depended individual's specific For example, deeming aged, blind, disabled taken [T]he revised linkage explicit. need adopt related develop own. However, 1902(a)(17)(C) amended. Consequently, final Subsequent legislative makes Deficit Reduction 1984, 2373(c)(1), 1112, impose moratorium disapproving might inconsistent doing so, sole intent enacting 98-861, pp. 1366-1367 (1984) 697.

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