Source: https://supreme.justia.com/cases/federal/us/450/221/
Timestamp: 2019-04-24 19:56:13+00:00

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The Supplemental Security Income (SSI) program, which is part of the Social Security Act, provides a subsistence allowance to needy aged, blind, and disabled persons. Inmates of public institutions are generally excluded from this program, except that, under § 1611(e)(1)(B) of the Act, a reduced amount of SSI benefits are provided to otherwise eligible persons in a hospital, extended care facility, nursing home, or intermediate care facility receiving Medicaid funds for their care. Appellees, aged 21 through 64 and residing in public mental institutions that do not receive Medicaid funds for their care, brought a class action in Federal District Court challenging their exclusion from the reduced SSI benefits. The District Court held such exclusion unconstitutional as violative of the equal protection guarantees of the Due Process Clause of the Fifth Amendment on the ground that the "mental health" classification could not withstand judicial scrutiny because it did not have a "substantial relation" to the object of the legislation in light of its "primary purpose."
Held: Appellees' rights to equal protection were not violated by denying them SSI benefits. Pp. 450 U. S. 230-239.
(a) In § 1611(e)(1)(B), Congress made a distinction not between the mentally ill and a group composed of nonmentally ill, but between residents in public institutions receiving Medicaid funds for their care and residents in such institutions not receiving such funds. To the extent that the statute has an indirect impact upon the mentally ill as a subset of publicly institutionalized persons, the record in this case presents no statistical support for a contention that the mentally ill as a class are burdened disproportionately to any other class affected by the classification. The indirect deprivation worked by this legislation upon appellees' class, whether or not the class is considered "suspect," does not, in the absence of any evidence that Congress deliberately intended to discriminate against the mentally ill, move this Court to regard it with a heightened scrutiny. Pp. 450 U. S. 230-234.
substitute its personal notions of good public policy for those of Congress. Under this standard, and based on the legislative history, it was not irrational for Congress to elect, in view of budgetary constraints, to shoulder only part of the burden of supplying a "comfort money" allowance, leaving the States with the primary responsibility for making such an allowance available to those residents in state-run institutions, and to decide that it is the Medicaid recipients in public institutions who are the most needy and deserving of the SSI benefits. Pp. 450 U. S. 234-239.
BLACKMUN, J., delivered the opinion of the Court, in which BURGER, C.J., and STEWART, WHITE, and REHNQUIST, JJ., joined. POWELL, J., filed a dissenting opinion, in which BRENNAN, MARSHALL, and STEVENS, JJ., joined, post, p. 450 U. S. 239.
the Due Process Clause of the Fifth Amendment, that portion of the Social Security Act, as amended, that excludes these otherwise eligible persons from the supplemental benefits. The Secretary of Health and Human Services has taken a direct appeal to this Court under 28 U.S.C. § 1252.
result in death or which has lasted or can be expected to last for a continuous period of not less than twelve months."
§ 1614(a)(3)(A) of the Act, 42 U.S.C. § 1382c(a)(3)(A).
"a hospital, extended care facility, nursing home, or intermediate care facility receiving payments (with respect to such individual or spouse) under a State plan approved under subchapter XIX [Medicaid]. . . ."
generally any person residing in a public institution, explicitly has tied eligibility for a reduced amount of SSI benefits to residence in an institution receiving Medicaid benefits for the care of the eligible individual.
greatly resembles other characteristics that this Court has found inherently "suspect" as a means of legislative classification, special justification should be required for the congressional decision to exclude appellees.
demonstration of their "rational relationship" to "a legitimate state interest." Ibid. Under that standard, these classifications withstood scrutiny. Congress' use, however, of a "mental health" classification was deemed to require a closer examination because "mental health classifications possess the significant indicia of the suspect classifications recognized in other cases." Id. at 1052. Although recognizing that the mentally ill as a group do not demonstrate all the characteristics this Court has considered as denoting inherently suspicious classifications, such as race and national origin, [Footnote 11] the District Court believed that the mentally ill were "a politically impotent, insular minority" that "have been subject to a history of unequal protection.'" Ibid. The court therefore concluded that Congress could legislatively disfavor the mentally ill, as § 1611(e) did, only if the statutory classification passes an "intermediate level of judicial scrutiny," id. at 1053, that is, only if the "classification bears a substantial relation" to the object of the legislation evaluated "in light of the primary purpose" of the scheme of which it is a part. Ibid. The court adjudged that the "primary purpose" of the small monthly stipend was to enable the needy to purchase comfort items not provided by the institution. Rejecting the Secretary's proposed justifications for the exclusion, [Footnote 12] the District Court held that the classification could not withstand scrutiny.
The legislative history, it said, revealed no intent to exclude appellees' class; the court could conceive of no "possible unexpressed purpose for the exclusion"; and the court reasoned that "aged blind and disabled inmates of all public institutions would have similar needs." Ibid. Upon the Secretary's direct appeal from this judgment, we noted probable jurisdiction. Harris v. Wilson, 446 U.S. 964 (1980).
"historically have been subjected to purposeful unequal treatment; they have been relegated to a position of political powerlessness; and prejudice against them curtails their participation in the pluralist political system and strips them of political protection against discriminatory legislation."
(Footnote omitted.) Id. at 41.
We have no occasion to reach this issue because we conclude that this statute does not classify directly on the basis of mental health. [Footnote 13] The SSI program distinguishes among three groups of persons, all of whom meet the basic eligibility requirements: persons not in a "public institution" may receive full benefits; persons in a "public institution" of a certain nature ("hospital, extended care facility, nursing home, or intermediate care facility receiving payments (with respect to such individual or spouse) . . . under [Medicaid])" (emphasis added), § 1611(e)(1)(B), may receive reduced benefits; and persons in any other "public institution" may not receive any benefits. The statute does not isolate the mentally ill or subject them, as a discrete group, to special or subordinate treatment. At the most, this legislation incidentally denies a small monthly comfort benefit to a certain number of persons suffering from mental illness; but in so doing, it imposes equivalent deprivation on other groups who are not mentally ill, while at the same time benefiting substantial numbers of the mentally ill.
funds for their care and residents in such institutions not receiving Medicaid funds.
basis of mental health. Appellees admit that no such evidence exists; indeed, they rely on the absence of explicit intent as proof of Congress' "inattention" to their needs and, therefore, its prejudice against them. Brief for Appellees 39. As in Jefferson v. Hackney, 406 U. S. 535 (1972), the indirect deprivation worked by this legislation upon appellees' class, whether or not the class is considered "suspect," does not, without more, move us to regard it with a heightened scrutiny. Cf. Personnel Administrator of Massachusetts v. Feeney, 442 U. S. 256 (1979).
"In the area of economics and social welfare, a State does not violate the Equal Protection Clause [and correspondingly the Federal Government does not violate the equal protection component of the Fifth Amendment] 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 inequity.' Lindsley v. Natural Carbonic Gas Co., 220 U. S. 61, 220 U. S. 78."
Dandridge v. Williams, 397 U.S. at 397 U. S. 485.
"This inquiry employs a relatively relaxed standard reflecting the Court's awareness that the drawing of lines that create distinctions is peculiarly a legislative task and an unavoidable one. Perfection in making the necessary classifications is neither possible nor necessary."
427 U. S. 314 (1976). See also United States Railroad Retirement Bd. v. Fritz, 449 U. S. 166 (1980). As long as the classificatory scheme chosen by Congress rationally advance a reasonable and identifiable governmental objective, we must disregard the existence of other methods of allocation that we, as individuals, perhaps would have preferred.
"People who are residents of certain public institutions, or hospitals or nursing homes which are getting Medicaid funds, would get benefits of up to $25 a month (reduced by nonexcluded income). For these people, most subsistence needs are met by the institution, and full benefits are not needed. Some payment to these people, though, would be needed to enable them to purchase small comfort items not supplied by the institution. No assistance benefits will be paid to an individual in a penal institution."
H.R.Rep. No. 92-231, p. 150 (1971). The Senate Report followed the House's language almost identically. See S.Rep. No. 92-1230, p. 386 (1972). We find these passages, at the very least, to be a clear expression of Congress' understanding that the stipend grant was to be limited to a group smaller than the total population of otherwise eligible, institutionalized people. That the bill's section-by-section analysis contained in the House Report laid out the terms of the exclusion precisely supports the conclusion that Congress was aware of who was included in that limited group. See H.R.Rep. No. 92-231, at 334.
"is rationally related to the legitimate legislative desire to avoid spending federal resources on behalf of individuals whose care and treatment are being fully provided for by state and local government units"
"may be said to implement a congressional policy choice to provide supplemental financial assistance for only those residents of public institutions who already receive significant federal support in the form of Medicaid coverage."
that it was irrational of Congress, in view of budgetary constraints, [Footnote 24] to decide that it is the Medicaid recipients in public institutions that are the most needy and the most deserving of the small monthly supplement. See, e.g., Califano v. Boles, 443 U. S. 282, 443 U. S. 296 (1979); Califano v. Jobst, 434 U. S. 47, 434 U. S. 53 (1977); Weinberger v. Salfi, 422 U. S. 749, 422 U. S. 768-770 (1975); Richardson v. Belcher, 404 U. S. 78, 404 U. S. 83 84 (1971).
We conclude that Congress did not violate appellees' rights to equal protection by denying them the supplementary benefit. The judgment of the District Court is reversed.
The SSI program, Title XVI of the Social Security Act, largely replaced the prior system of federal grants to state-run assistance programs for the aged, blind, and disabled contained in Titles I, X, XIV, and XVI of the Act, that is, Old Age Assistance, 49 Stat. 620, as amended, 42 U.S.C. § 301 et seq.; Aid to the Blind, 49 Stat. 645, as amended, 42 U.S.C. § 1201 et seq.; Aid to the Permanently and Totally Disabled, 64 Stat. 555, as amended, 42 U.S.C. § 1351 et seq.; and Aid to the Aged, Blind, or Disabled, 76 Stat.197, 42 U.S.C. § 1381 et seq. (1970 ed.). See Califano v. Aznavorian, 439 U. S. 170, 439 U. S. 171 (1978); Califano v. Torres, 435 U. S. 1, 435 U. S. 2 (1978).
To be eligible for SSI benefits, a person must be "aged," that is, 65 or older, or "blind," or "disabled," as those terms are defined in § 1614 of the Act, as amended, 42 U.S.C. § 1382c, and his income and resources must be below the levels specified in § 1611(a), as amended, 42 U.S.C. § 1382(a).
"(e) Limitation on eligibility of certain individuals"
"(1)(A) Except as provided in subparagraph (B) and (C), no person shall be an eligible individual or eligible spouse for purposes of this subchapter with respect to any month if throughout such month he is an inmate of a public institution."
"(B) In any case where an eligible individual or his eligible spouse (if any) is, throughout any month, in a hospital, extended care facility, nursing home, or intermediate care facility receiving payments (with respect to such individual or spouse) under a State plan approved under title XIX, the benefit under this title for such individual for such month shall be payable -- "
"(i) at a rate not in excess of $300 per year (reduced by the amount of any income not excluded pursuant to section 1612(B)) in the case of an individual who does not have an eligible spouse;"
"(ii) in the case of an individual who has an eligible spouse, if only one of them is in such a hospital, home or facility throughout such month, at a rate not in excess of the sum of -- "
"(I) the rate of $300 per year (reduced by the amount of any income, not excluded pursuant to section 1612(B), of the one who is in such hospital, home, or facility), and"
"(II) the applicable rate specified in subsection (B)(1) (reduced by the amount of any income, not excluded pursuant to section 1612(B), of the other); and"
"(iii) at a rate not in excess of $600 per year (reduced by the amount of any income not excluded pursuant to section 1612(B)) in the case of an individual who has an eligible spouse, if both of them are in such a hospital, home, or facility throughout such month."
"(C) As used in subparagraph (A), the term 'public institution' does not include a publicly operated community residence which serves no more than 16 residents."
Added in 1976 by Pub.L. 9566, § 505(a), 90 Stat. 2686, this subsection met objections that § 1611(e) impeded reform efforts to deinstitutionalize certain groups of handicapped individuals, such as the mentally retarded. Congress determined to encourage the establishment of state-run group homes for such people by making residents in these institutions eligible for SSI benefits. See S. Rep No. 94-1265, p. 29 (1976); H.R.Conf.Rep. No. 94-1745, pp. 27-28 (1976).
"payments with respect to care or services for any individual who has not attained 65 years of age and who is a patient in an institution for tuberculosis or mental diseases."
In 1950, when it first enacted federal grants for medical assistance, Congress excluded "any individual . . . who is a patient in an institution for . . . mental diseases" from eligibility. 64 Stat 558. This exclusion was incorporated into the Medicaid statute in 1965, 79 Stat. 352, but exceptions were made for the needy aged in mental institutions, and for the care of mentally ill persons in general medical facilities. Ibid. In 1972, in the bill enacting the SSI program, Congress further broadened Medicaid benefits for the mentally ill to include most children in mental institutions. 86 Stat. 1461. A Senate proposal for demonstration projects to investigate the possibility of extending Medicaid benefits to the mentally ill between the ages of 21 through 64 in mental hospitals was defeated at that time. See S.Rep. No. 92-1230, p. 281 (1972); H.R.Conf.Rep. No. 92-1605, p. 65 (1972).
This Court repeatedly has held that the Fifth Amendment imposes on the Federal Government the same standard required of state legislation by the Equal Protection Clause of the Fourteenth Amendment. See, e.g., Weinberger v. Salfi, 422 U. S. 749, 422 U. S. 768-770 (1975); Richardson v. Belcher, 404 U. S. 78, 404 U. S. 81 (1971).
The three-judge court also found that the state statute classified on the basis of age, not mental health, and that it was rational and constitutional. The Court of Appeals declined to review that constitutional holding on the ground that review from the three-judge court could be had only in this Court. Wilson v. Edelman, 542 F.2d at 1276-1282.
The Court of Appeals also held that only two of the named plaintiffs, Maudie Simmons and John Kiernan Turney, had satisfied the minimum, nonwaivable requirement of 42 U.S.C. § 405(g) that a party may seek review only of a "final decision of the Secretary" denying, terminating, or suspending benefits under the SSI program. The other named plaintiffs, including Charles Wilson, were eligible for, or had sought and been denied, benefits only under the prior cooperative state-federal programs, and therefore they were dismissed as parties. We have retained Wilson as a named party in the caption of this case, however, as did the District Court on remand, for the sake of uniformity.
"all persons residing in HEW Region V who have been terminated from benefits under Title XVI, or who have applied for Supplemental Security Income benefits under Title XVI and have been denied such benefits, on or after January 1, 1974, solely because they are between the ages of 21 and 65 and hospitalized in a public mental institution."
"[t]he detainee status is necessarily temporary in nature, and the [Secretary] could legitimately wish to withhold these extra-subsistence payments while the detainee is housed in a public institution and until his future status is determined."
The District Court noted that a person's mental health problem, especially one that has led to institutionalization, is likely to "bear [a] relation to ability to perform or contribute to society.'" Id. at 1051-1052, quoting Frontiero v. Richardson, 411 U. S. 677, 411 U. S. 686 (1973). The court also acknowledged that "[i]t is debatable whether and to what extent the mental illness is an `immutable characteristic determined solely by the accident of birth.'" 478 F.Supp. at 1052, again quoting Frontiero, 411 U.S. at 411 U. S. 686.
"1) the conservation of federal resources; 2) the concern that federal funds be received on behalf of residents of qualified institutions; and 3) the fact that plaintiffs are not 'similarly situated' with Medicaid patients in terms of federal interest and control."
We therefore intimate no view as to what standard of review applies to legislation expressly classifying the mentally ill as a discrete group.
Social Security Administration statistics show that 30.7% of all blind and disabled adult persons awarded SSI benefits in 1975 (109,509 persons) were deemed disabled by mental disorders, and the Administration has concluded that "[m]ental illness was the most common cause of disability in 1975." Kochhar, Blind and Disabled Persons Awarded Federally Administered SSI Payments, 1975, Social Security Bulletin 13, 15 (June 1979). Half of this number suffered from mental illness, rather than mental retardation, and these statistics did not include any persons with prior entitlement to benefits. Ibid.
Further, as a recent study also indicates, a substantial number of mentally ill people in institutions actually receive SSI benefits. Social Security Administration, Representative Payments under the SSI Program, August, 1977, Research and Statistics Note No. 9 (Sept. 16, 1980). This study established that 15% of the total population receiving SSI benefits (for all reasons, including age, blindness, and disability) had "representative payees" (a person "appointed to manage the benefits of an adult beneficiary" because of "the adult beneficiary's inability to manage his own funds"). Id. at 1. Out of a total of 184,133 institutionalized persons who were receiving SSI benefits in August, 1977, through such "representative payees," 76,494, or approximately 41%, were institutionalized because of mental disorders. Id. at 7 (Table 6) and 2 (Table 1). Thus, even on this incomplete data, a sizable number of SSI recipients were persons institutionalized for mental illness.
Appellees appear to concede the rationality of Congress' general exclusion of publicly institutionalized persons from full SSI benefits.
An otherwise eligible person does not receive SSI benefits if he is receiving long-term treatment in a medical facility that is not certified under Medicaid standards as a provider. See § 1861 of the Act, 42 U.S.C. § 1395x. These strict standards exclude many facilities, but work to the ultimate benefit of those receiving Medicaid. Cf. O'Bannon v. Town Court Nursing Center, 447 U. S. 773 (1980).
The average inpatient stay in public mental hospitals is short. Recently collected data for 1975 reveal a median stay in state and county mental hospitals of only 25.5 days. Witkin, Characteristics of Admissions to Selected Mental Health Facilities, 1975: An Annotated Book of Charts and Tables, National Institute of Mental Health 93, DHHS Publication No. (ADM) 80-1005 (1981). This study also showed that young and elderly patients had longer periods of stay than patients in the middle-age group. Id. at 95. The rapidity with which inpatients are released from public institutions has increased since the 1950's. In 1971, 75% of all patients admitted to state mental hospitals were released within the first three months, while 87% were released within the first six months. Ozarin, Redick, & Taube, A Quarter Century of Psychiatric Care, 1950-1974: A Statistical Review, 27 Hospital & Community Psychiatry 515, 516 (1976). Data from the National Institute of Mental Health show that the proportion of "patient care episodes" (admissions during a year plus residents at the beginning of the year) attributable to inpatient treatment at state and county hospitals declined from 49% in 1955 to 9% in 1977. This dramatic decrease in the percentage of persons admitted to these hospitals was paralleled by a growth in treatment through outpatient and community mental health facilities; that percentage grew from 23% in 1955 to 76% in 1977. Witkin, Trends in Patient Care Episodes in Mental Health Facilities, 1955-1977, National Institute of Mental Health, Mental Health Statistical Note No. 154, p. 3 (Sept.1980). At the same time, the total number of "patient care episodes" increased four-fold, from approximately 1.7 million in 1955 to 6.9 million in 1977. Id. at 1.
"can reasonably be expected to improve the condition, by reason of which such services are necessary, to the extent that eventually such services will no longer be necessary."
§ 1905(h)(1)(B) of the Act, 42 U.S.C. § 1396d(h)(1)(B).
The Medicaid limitation was based on Congress' assumption that the care of persons in public mental institutions was properly a responsibility of the States. See H.R.Rep. No. 1300, 81st Cong., 1st Sess., 42 (1949) (enacting federal funding for services to the needy aged, blind, and disabled provided in public medical institutions, but excluding assistance to those in "public or private institutions for mental illness and tuberculosis, since the States have generally provided for medical care of such cases"); S.Rep. No. 404, 89th Cong., 1st Sess., pt. 1, pp. 144-147 (1965) (enactment of Medicaid providing coverage only to the aged needy in mental or tuberculosis institutions; noting that "[t]he reason for this exclusion was that long-term care in such hospitals had traditionally been accepted as a responsibility of the States," id. at 144). This exclusion was upheld in Legion v. Richardson, 354 F.Supp. 456 (SDNY), summarily aff'd sub nom. Legion v. Weinberger, 414 U.S. 1058 (1973), and Kantrowitz v. Weinberger, 388 F.Supp. 1127 (DC 1974), aff'd, 174 U.S.App.D.C. 182, 530 F.2d 1034, cert. denied, 429 U.S. 819 (1976), and appellees disavow any intention to dispute that holding. Brief for Appellees 26-27; Tr. of Oral Arg.19.
Whether a State chooses to elect or not to elect to provide an equivalent monthly stipend to institutionalized mental patients does not alter the rationality of Congress' decision.
The Secretary has interpreted § 1611(e)(1)(B) to require that at least 50% of the cost of services be reimbursed by Medicaid before the reduction of benefits becomes effective. 20 CFR § 416.231(B)(5)(1980).
Congress continues to investigate other more general solutions and to propose alterations in § 1611(e). See H.R.Rep. No. 96-451, pt. 1, p. 153 (1979); 125 Cong.Rec. 31349-31350, 31354-31355, 31356 (1979) (remarks of Rep. Corman, Rep. Pepper, and Rep. Bingham) (proposing amendment to § 1611(e) to forestall reduction of benefits until after eligible individual has been institutionalized in a Medicaid institution for three months); Staff of the Senate Committee on Finance, The Supplemental Security Income Program, 95th Cong., 1st Sess., 109-115 (Comm.Print 1977) (advocating legislative amendments standardizing the monthly stipend to institutionalized persons).
Louisville Gas Co. v. Coleman, 277 U. S. 32, 277 U. S. 41 (1928) (Holmes, J., dissenting).
The amount of money and the number of people potentially involved are not inconsiderable. Although the appellees do not agree, the Secretary estimates that the annual cost of implementing the District Court's order nationwide would approximate $30 million. Reply Memorandum for Appellant 3. In 1979, a total of almost 2.2 million people were receiving SSI benefits for disabilities, an increase of over 900,000 from January, 1974. See Social Security Bulletin 49 (Table M-24) (June, 1979). Further, of all the disabled adults who applied for benefits between January, 1974, and July, 1975, 1.1% were denied eligibility by reason of their residence in a public institution. See S.Rep. No. 95-1312, p. 7 (table) (1978).
JUSTICE POWELL, with whom JUSTICE BRENNAN, JUSTICE MARSHALL, and JUSTICE STEVENS join, dissenting.
a statutory classification developed to further legitimate goals of one welfare program to another welfare program serving entirely different needs. The result is an exclusion of wholly dependent people from minimal benefits, serving no Government interest. This irrational classification violates the equal protection component of the Due Process Clause of the Fifth Amendment.
"For these people, most subsistence needs are met by the institution, and full benefits are not needed. Some payment to these people, though, would be needed to enable them to purchase small comfort items not supplied by the institution."
H.R.Rep. No. 92-231, p. 150 (1971). See also S.Rep. No. 92-1230, p. 386 (1972). This comfort allowance is provided to institution residents only if the qualified person resides in a public hospital or institution that receives Medicaid funds on his behalf. 42 U.S.C. § 1382(e)(1)(B). Thus, no comfort allowance will be paid to an individual unless the form of institutionalized treatment he receives is compensable under the separate Medicaid program.
treatment in various contexts. The residual exclusion of large state institutions for the mentally ill from federal financial assistance rests on two related principles: States traditionally have assumed the burdens of administering this form of care, and the Federal Government has long distrusted the economic and therapeutic efficiency of large mental institutions. See S.Rep. No. 404, 89th Cong., 1st Sess., 20 (1965). See also 42 U.S.C. § 1396d(h)(1)(B) (persons under 21 receive Medicaid benefits for treatment in mental institutions only when standards of utility are met).
The legislative history of § 1611(e) sheds no light on why Congress made the exclusion from reduced SSI benefits coextensive with the exclusion from Medicaid payments. [Footnote 3/3] The Secretary argues that Congress might rationally have concluded that the States have the primary responsibility for making payments of comfort allowances to appellees because they already bear the responsibility for paying for their treatment. Brief for Appellant 27. In accepting this justification, the Court adds that whether the States do, ever have, or ever will provide this benefit to residents of large mental institutions is irrelevant to the rationality of Congress' supposed judgment. Ante at 450 U. S. 237, n. 20.
School District v. Rodriguez, 411 U. S. 1, 411 U. S. 17 (1973); Dandridge v. Williams, 397 U. S. 471 (1970). This simply stated test holds two firmly established principles in tension. The Court must not substitute its view of wise or fair legislative policy for that of the duly elected representatives of the people, Vance v. Bradley, 440 U. S. 93, 440 U. S. 109 (1979); Dandridge, supra at 397 U. S. 485 486, but the equal protection requirement does place a substantive limit on legislative power. At a minimum, the legislature cannot arbitrarily discriminate among citizens. E.g., Johnson v. Robison, 415 U. S. 361, 415 U. S. 374-375 (1974); James v. Strange, 407 U. S. 128, 407 U. S. 140 (1972); Weber v. Aetna Casualty & Surety Co., 406 U. S. 164, 406 U. S. 175 (1972). Enforcing this prohibition while avoiding unwarranted incursions on the legislative power presents a difficult task. No bright line divides the merely foolish from the arbitrary law. [Footnote 3/4] Given this difficulty, legislation properly enjoys a presumption of rationality, which is particularly strong for welfare legislation where the apportionment of scarce benefits in accordance with complex criteria requires painful but unavoidable line-drawing. Mathews v. De Castro, 429 U. S. 181, 429 U. S. 185 (1976).
purpose appears other than the current position of the Secretary, the Court should require that the classification bear a "fair and substantial relation" to the asserted purpose. See F. S. Royster Guano Co. v. Virginia, 253 U. S. 412, 253 U. S. 415 (1920). This marginally more demanding scrutiny indirectly would test the plausibility of the tendered purpose, and preserve equal protection review as something more than "a mere tautological recognition of the fact that Congress did what it intended to do." Fritz, supra at 449 U. S. 180 (STEVENS, J., concurring in judgment).
Neither the structure of § 1611 nor its legislative history identifies or even suggests any policy plausibly intended to be served by denying appellees the small SSI allowance. As noted above, the only purpose identified in the House and Senate Reports is the irrelevant goal of depriving inmates of penal institutions of all benefits. See n 3, supra. The structure of the statute offers no guidance as to purpose, because § 1611(e) is drawn in reference to the policies of Medicaid, rather than to the policies of SSI. By mechanically applying the criteria developed for Medicaid, Congress appears to have avoided considering what criteria would be appropriate for deciding in which public institutions a person can reside and still be eligible for some SSI payment. The importation of eligibility criteria from one statute to another creates significant risks that irrational distinctions will be made between equally needy people. See United States Dept. of Agriculture v. Murry, 413 U. S. 508, 413 U. S. 514 (1973); Medora v. Colautti, 602 F.2d 1149 (CA3 1979).
"is rationally related to the legitimate legislative desire to avoid spending federal resources on behalf of individuals whose care and treatment are being fully provided for by state and local government units."
in present need of the comfort allowance; indeed, he concedes that "the statutory classification does not exclude [appellees] because they were thought to be less needy." Id. at 32. [Footnote 3/7] Nor does the Secretary suggest that, because a State provides health care and the necessities of life to inmates of mental hospitals, the State also will provide the inmate with a comfort allowance. Indeed, the probability that a State will pay a patient a comfort allowance does not increase when the Federal Government refuses to relieve it of part of the cost of the patient's medical care. The Court apparently recognizes this, as it states that whether or not a State actually provides a comfort allowance is irrelevant. Ante at 450 U. S. 237, n. 20. Appellees simply are denied a benefit provided to other institutionalized, disabled patients.
by Medicaid or "other programs." H.R.Rep. No. 96-451, pt. 1, p. 153 (1979). If SSI pays a cash benefit relating to personal needs other than maintenance and medical care, it is irrelevant whether the State or the Federal Government is paying for the maintenance and medical care; the patients' need remains the same; the likelihood that the policies of SSI will be fulfilled remains the same.
I conclude that Congress had no rational reason for refusing to pay a comfort allowance to appellees while paying it to numerous otherwise identically situated disabled indigents. This unexplained difference in treatment must have been a legislative oversight. I therefore dissent.
Other classes of institutionalized people denied the reduced SSI allowance include patients in tubercular institutions and prison inmates.
The Court too quickly dispatches the argument that § 1611(e) classifies on the basis of mental illness. While it is true that not all mentally ill people are denied the benefit, and that some people denied the benefit are not mentally ill, it is inescapable that appellees are denied the benefit because they are patients in mental institutions. Only the mentally ill are treated in mental institutions. While I would agree that there is no indication that Congress intended to punish or slight the mentally ill, the history of Medicaid demonstrates Congress' disinclination to involve the Federal Government in state treatment of mental illness in public institutions. See infra at this page and 450 U. S. 242. Because I find the classification irrational, I do not reach the question whether classifications drawn in part on the basis of mental health require heightened scrutiny, as appellees suggest .
The only indication of congressional intent states: "No assistance benefits will be paid to an individual in a penal institution." H.R.Rep. No. 92-231, p. 150 (1971). A mental hospital is not a penal institution. Neither the Secretary nor the Court argues that the exclusion of appellees from the comfort allowance rationally furthers this purpose.
The Court has employed numerous formulations for the "rational basis" test. United States Railroad Retirement Bd. v. Fritz, 449 U. S. 166, 449 U. S. 176-177, n. 10 (1980). Members of the Court continue to hold divergent views on the clarity with which a legislative purpose must appear, see id. at 449 U. S. 180-181 (STEVENS, J., concurring in judgment); id. at 449 U. S. 187-188 (BRENNAN, J., dissenting), and about the degree of deference afforded the legislature in suiting means to ends, compare Lindsley v. Natural Carbonic Gas Co., 220 U. S. 61, 220 U. S. 78-79 (1911), with F. S. Royster Guano Co. v. Virginia, 253 U. S. 412, 253 U. S. 416 (1920).
Congress' failure to make policy judgments can distort our system of separation of powers by encouraging other branches to make essentially legislative decisions. See Cannon v. University of Chicago, 441 U. S. 677, 441 U. S. 743 (1979) (POWELL, J., dissenting).
Some of our cases suggest that the actual purpose of a statute is irrelevant, Flemming v. Nestor, 363 U. S. 603, 363 U. S. 612 (1960), and that the statute must be upheld "if any state of facts reasonably may be conceived to justify" its discrimination, McGowan v. Maryland, 366 U. S. 420, 366 U. S. 426 (1961). Although these cases preserve an important caution, they do not describe the importance of actual legislative purpose in our analysis. We recognize that a legislative body rarely acts with a single mind, and that compromises blur purpose. Therefore, it is appropriate to accord some deference to the executive's view of legislative intent, as similarly we accord deference to the consistent construction of a statute by the administrative agency charged with its enforcement. E.g., Udall v. Tallman, 380 U. S. 1, 380 U. S. 16 (1965). Ascertainment of actual purpose to the extent feasible, however, remains an essential step in equal protection.
This concession makes it difficult to accept the Court's conclusion that Congress rationally could have decided that "Medicaid recipients in public institutions . . . are the most needy and the most deserving of the small monthly supplement." Ante at 450 U. S. 239.

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