Task: sc_casesource

What follows is an opinion from the Supreme Court of the United States. Your task is to identify the court whose decision the Supreme Court reviewed. If the case arose under the Supreme Court's original jurisdiction, note the source as "United States Supreme Court". If the case arose in a state court, note the source as "State Supreme Court", "State Appellate Court", or "State Trial Court". Do not code the name of the state. 

Justice Ginsburg
delivered the opinion of the Court.
This case requires interpretation of the “spousal impoverishment” provisions of the Medicare Catastrophic Coverage Act of 1988 (MCCA or Act), 102 Stat. 754, 42 U. S. C. § 1396r-5 (1994 ed. and Supp. V), a complex set of instructions made part of the federal Medicaid statute. The spousal impoverishment provisions permit a spouse living at home (called the “community spouse”) to reserve certain income and assets to meet the minimum monthly maintenance needs he or she will have when the other spouse (the “institutionalized spouse”) is institutionalized, usually in a nursing home, and becomes eligible for Medicaid.
The Act shelters from diminution a standard amount of assets (called the “community spouse resource allowance,” “CSRA,” or “resource allowance”). The MCCA allows an increase in the standard allowance if either spouse shows, at a state-administered hearing, that the community spouse will not be able to maintain the statutorily defined minimum level of income on which to live after the institutionalized spouse gains Medicaid eligibility.
In determining whether the community spouse is entitled to a higher CSRA, i. e., to shelter assets in excess of the standard resource allowance, Wisconsin, like a majority of other States, uses an “income-first” method. Under that method, the State considers first whether potential income transfers from the institutionalized spouse, which the MCCA expressly permits, will suffice to enable the community spouse to meet monthly needs once the institutionalized spouse qualifies for Medicaid.
Respondent Irene Blumer, whose Medicaid eligibility was delayed by the application of petitioner Wisconsin Department of Health and Family Services’ income-first method, challenges that method as inconsistent with the MCCA provision governing upward revision of the community spouse resource allowance, § 1396r-5(e)(2)(C) (1994 ed.). The Wisconsin Court of Appeals upheld her challenge. We reverse that court’s judgment. Neither the text of § 1396r-5(e)(2)(C) nor the structure of the MCCA, we conclude, forbids Wisconsin’s chosen approach. Consistent with the position adopted by the Secretary of Health and Human Services, we hold that the income-first method represents a permissible interpretation of the Act.
I
A
The federal Medicaid program provides funding to States that reimburse needy persons for the cost of medical care. See Social Security Act, tit. XIX, as added, 79 Stat. 343, and as amended, 42 U. S. C. § 1396 et seq. (1994 ed. and Supp. V). “Each participating State develops a plan containing reasonable standards... for determining eligibility for and the extent of medical assistance” within boundaries set by the Medicaid statute and the Secretary of Health and Human Services. Schweiker v. Gray Panthers, 453 U. S. 34, 36-37 (1981) (internal quotation marks omitted); § 1396a(a)(17) (1994 ed.). In formulating those standards, States must “provide for taking into account only such income and resources as are, as determined in accordance with standards prescribed by the Secretary, available to the applicant.” § 1396a(a)(17)(B) (emphasis added).
Because spouses typically possess assets and income jointly and bear financial responsibility for each other, Medicaid eligibility determinations for married applicants have resisted simple solutions. See, e.g., id., at 44-48. Until 1989, the year the MCCA took effect, States generally considered the income of either spouse to be “available” to the other. We upheld this approach in Gray Panthers, observing that “from the beginning of the Medicaid program, Congress authorized States to presume spousal support.” Id., at 44; see id., at 45 (quoting passage from S. Rep. No. 404, 89th Cong., 1st Sess., pt. 1, p. 78 (1965), including statement that “it is proper to expect spouses to support each other”). Similarly, assets held jointly by the couple were commonly deemed “available” in full to the institutionalized spouse.
At the same time, States generally did not treat resources held individually by the community spouse as available to the institutionalized spouse. Accordingly, assets titled solely in the name of the community spouse often escaped consideration in determining the institutionalized spouse’s Medicaid eligibility. See H. R. Rep. No. 100-105, pt. 2, pp. 66-67 (1987).
As Congress later found when it enacted the MCCA in 1988, these existing practices for determining, a married applicant’s income and resources produced unintended consequences. Many community spouses were left destitute by the drain on the couple’s assets necessary to qualify the institutionalized spouse for Medicaid and by the diminution of the couple’s income posteligibility to reduce the amount payable by Medicaid for institutional care. See id., at 66-68. Conversely, couples with ample means could qualify for assistance when their assets were held solely in the community spouse’s name.
In the MCCA, Congress sought to protect community spouses from “pauperization” while preventing financially secure couples from obtaining Medicaid assistance. See id., at 65 (bill seeks to “end th[e] pauperization” of the community spouse “by assuring that the community spouse has a sufficient — but not excessive — amount of income and resources available”). To achieve this aim, Congress installed a set of intricate and interlocking requirements with which States must comply in allocating a couple’s income and resources.
Income allocation is governed by §§1396r-5(b) and (d). Covering any month in which “an institutionalized spouse is in the institution,” § 1396r-5(b)(l) provides that “no income of the community spouse shall be deemed available to the institutionalized spouse.” The community spouse’s income is thus preserved for that spouse and does not affect the determination whether the institutionalized spouse qualifies for Medicaid. In general, such income is also disregarded in calculating the amount Medicaid will pay for the institutionalized spouse’s care after eligibility is established.
Other provisions specifically address income allocation in the period after the institutionalized spouse becomes Medicaid eligible. Section 1396r-5(b)(2)(A) prescribes, as a main rule, that if payment of income is made solely in the name of one spouse, that income is treated as available only to the named spouse (the “name-on-the-check” rule). Section 1396r-5(d) provides a number of exceptions to that main rule designed to ensure that the community spouse and other dependents have income sufficient to meet basic needs. Among the exceptions, § 1396r-5(d)(3) establishes for the community spouse a “minimum monthly maintenance needs allowance,” or MMMNA. The MMMNA is calculated by multiplying the federal poverty level for a couple by a percentage set by the State. Since 1992, that percentage must be at least 150%, §§ 1396r-5(d)(3)(A)-(B), but the resulting MMMNA may not exceed $1,500 per month in 1988 dollars ($2,175 in 2001 dollars), §§ 1396r-5(d)(3)(C), (g).
If the income of the community spouse determined under § 1396r-5(b)(2), which states the “name-on-the-check” rule, is insufficient to yield income equal to or above the MMMNA, § 1396r-5(d)(l)(B) comes into play. Under that provision, the amount of the shortfall is “deducted” from the income of the institutionalized spouse — reducing the amount of income that would otherwise be considered available for the institutionalized spouse’s care — so long as that income is actually made available to the community spouse. The amount thus reallocated from the institutionalized spouse to the community spouse is called the “community spouse monthly income allowance,” or CSMIA, § 1396r-5(d)(l)(B). The provision for this allowance ensures that income transferred from the institutionalized spouse to the community spouse to meet the latter’s basic needs is not also considered available for the former’s care. As a result, Medicaid will pay a greater portion of the institutionalized spouse’s medical expenses than it would absent the CSMIA provision.
Resource allocation is controlled by §§ 1396r-5(c) and (f). For purposes of establishing the institutionalized spouse’s Medicaid eligibility, a portion of the couple’s assets is reserved for the benefit of the community spouse. §1396r-5(c)(2). To determine that reserved amount (the CSRA), the total of all of the couple’s resources (whether owned jointly or separately) is calculated as of the time the institutionalized spouse’s institutionalization commenced; half of that total is then allocated to each spouse (the “spousal share”). § 1396r-5(c)(l)(A). The spousal share allocated to the community spouse qualifies as the CSRA, subject to a ceiling of $60,000 indexed for inflation (in 2001, the ceiling was $87,000) and a floor, set by the State, between $12,000 and $60,000 (also indexed for inflation; in 2001, the amounts were $17,400 and $87,000). §§ 1396r-5(c)(2)(B), (f)(2)(A), (g). The CSRA is considered unavailable to the institutionalized spouse in the eligibility determination, but all resources above the CSRA (excluding a small sum set aside as a personal allowance for the institutionalized spouse, currently $2,000, see 20 CFR §416.1205 (2001)) must be spent before eligibility can be achieved. § 1396r-5(c)(2).
The MCCA provides for a “fair hearing” mechanism through which a couple may challenge the State’s determination of a number of elements that affect eligibility for, or the extent of assistance provided under, Medicaid. §§1396r-5(e). The dispute in this case centers on § 1396r-5(e)(2)(C), which allows a couple to request a higher CSRA. That section provides in relevant part:
“If either... spouse establishes that the [CSRA] (in relation to the amount of income generated by such an allowance) is inadequate to raise the community spouse’s income to the [MMMNA], there shall be substituted, for the [CSRA] under subsection (f)(2) of this section, an amount adequate to provide [the MMMNA].”
If the couple succeeds in obtaining a higher CSRA, the institutionalized spouse may reserve additional resources for posteligibility transfer to the community spouse. The enhanced CSRA will reduce the resources the statute deems available for the payment of medical expenses; accordingly, the institutionalized spouse will become eligible for Medicaid sooner.
In allocating income and resources between spouses for purposes of § 1396r-5(e)(2)(C), the States have employed two divergent methods: an “income-first” method, used by most States; and a “resources-first” method, preferred by the others. The two methods differ in their construction of the term “community spouse’s income” in subsection (e)(2)(C). Under the income-first method, “community spouse’s income” is defined to include not only the community spouse’s actual income at the time of the § 1396r-5(e) fair hearing, but also a potential posteligibility income transfer from the institutionalized spouse — the CSMIA authorized by § 1396r-5(d)(1)(B), see supra, at 481-482. Thus, only if the community spouse’s preeligibility income plus the CSMIA will fall below the MMMNA may the couple reserve a greater portion of assets through an enhanced CSRA.
. The resources-first method, by contrast, excludes the CSMIA from consideration. “Community spouse’s income” under that approach includes only income actually received by the community spouse at the time of the § 1396r-5(e) hearing, not any anticipated posteligibility income transfer from the institutionalized spouse pursuant to § 1396r-5(d)(l)(B). If the community spouse’s income so defined will fall below the MMMNA, the CSRA will be raised to reserve additional assets sufficient to generate income meeting the shortfall, whether or not the CSMIA could also accomplish that task.
In sum, the income-first method, because it takes account of the potential CSMIA, makes it less likely that the CSRA will be increased; it therefore tends to require couples to expend additional resources before the institutionalized spouse becomes Medicaid eligible.
The Secretary of Health and Human Services has issued several statements supporting the income-first method. Initially, the Secretary interpreted the MCCA as requiring state hearing officers to use that method. See HCFA, Chicago Regional State Letter No. 51-93 (Dec. 1993), App. to Pet. for Cert. 78a-83a. More recently, the Secretary has concluded that the Act permits both income-first and “some other reasonable interpretation of the law.” HCFA, Chicago Regional State Letter No. 22-94, p. 2 (July 1994), App. to Pet. for Cert. 89a.
The Secretary has circulated for comment a proposed rule “allowing] States the threshold choice of using either the income-first or resources-first method when determining whether the community spouse has sufficient income to meet minimum monthly maintenance needs.” 66 Fed. Reg. 46763, 46765 (2001). The proposed rule details the Secretary’s reasons for concluding that the Act does not “clearly requir[e] the use of either [method] to the exclusion of the other.” Id., at 46767. Accordingly, “in view of the cooperative federalism considerations embodied in the Medicaid program,” id., at 46765, the Secretary found it appropriate to “leave to States the decision as to which alternative to use,” id., at 46767.
B
The facts of this case illustrate the operation of the Act and the different consequences of the income-first and resources-first. approaches. Irene Blumer was admitted to a Wisconsin nursing home in 1994 and applied for Medicaid assistance in 1996 through her husband Burnett. In accord with § 1396r-5(c), the Green County Department of Human Services (County) determined that as of Irene’s institutionalization in 1994, the couple’s resources amounted to $145,644. Dividing this amount evenly between the Blumers, the County attributed $72,822 to each spouse. Burnett was allocated this $72,822 share as his CSRA, and Irene was entitled to reserve a personal allowance of $2,000, 20 CFR §416.1205 (2001). Combining these sums, the County determined that the Blumers could retain $74,822 in assets.
The County next found that, as of the date of Irene’s application, the Blumers’ resources had been reduced from $145,644 to $89,335. That amount exceeded by $14,513 the couple’s resource eligibility threshold. The County accordingly concluded that Irene would not be eligible for Medicaid until the couple’s assets were spent down to the $74,822 limit.
Seeking to obtain a higher CSRA, Irene requested a hearing. For purposes of the hearing, Burnett’s monthly income amounted to $1,639, consisting of $1,015 in Social Security benefits, $309 from an annuity, and $315 generated by the assets protected in his CSRA. Irene argued that because Burnett’s monthly income fell below the applicable MMMNA of $1,727, the examiner was obliged to increase his CSRA, thereby protecting additional assets capable of covering the income shortfall.
Excluding Irene’s $2,000 personal allowance, the Blumers’ total remaining assets exceeded Burnett’s $72,822 standard CSRA, as just noted, by $14,513, an amount generating roughly $63 in monthly income. Attributing that income to Burnett would have raised his monthly income to $1,702, still $25 short of the MMMNA. Thus, had the hearing officer applied the resources-first method — addressing Burnett’s income shortfall by first reserving additional assets for his benefit — the examiner would have increased Burnett’s CSRA to encompass all of the Blumers’ remaining available resources, and Irene would have become immediately eligible for Medicaid. The remaining $25 deficit in Burnett’s income could then have been covered posteligi-bility by a monthly transfer of income (or CSMIA) from Irene, who at the time of the hearing received $927 per month in Social Security and $336 from a pension.
Wisconsin, however, has adopted the income-first rule by statute:
“If either spouse establishes at a fair hearing that the community spouse resource allowance determined under sub. (6)(b) without a fair hearing does not generate enough income to raise the community spouse’s income to the [MMMNA]..., the department shall establish an amount to be used under sub. (6)(b)3. that results in a community spouse resource allowance that generates enough income to raise the community spouse’s income to the [MMMNA].... Except in exceptional cases which would result in financial duress for the community spouse, the department may not establish an amount to be used under sub. (6)(b)3. unless the institutionalized spouse makes available to the community spouse the maximum monthly income allowance permitted under sub. a)(b).” Wis. Stat. §49.455(8)(d) (1999-2000) (emphasis added).
Applying this rule, the hearing examiner concluded that he was without authority to increase Burnett’s CSRA: The difference between Burnett’s monthly income and the MMMNA could be erased if, after achieving eligibility, Irene made available to Burnett $88 per month from her own income. This, the examiner concluded, Irene would be able to do; accordingly, there was no need to reserve additional assets for Burnett, and no acceleration in Irene’s Medicaid eligibility.
The following table illustrates the differences between the income-first and resources-first methods as applied to the Blumers:
The hearing examiner’s determination was affirmed by the Circuit Court of Green County. The Wisconsin Court of Appeals, however, reversed. Concluding that the MCCA unambiguously mandates the resources-first method, the Wisconsin appellate court declared that the State’s income-first statute impermissibly conflicts with federal law. 2000 WI App. 150, 237 Wis. 2d 810, 615 N. W. 2d 647. The Wisconsin Supreme Court denied discretionary review.
The decision of the Wisconsin Court of Appeals, holding the income-first method impermissible and the resources-first method required, accords with the position adopted by Ohio intermediate appellate courts. See, e. g., Kimnach v. Ohio Dept. of Human Servs., 96 Ohio App. 3d 640, 647, 645 N. E. 2d 825, 829-830 (1994), appeal not allowed, 71 Ohio St. 3d 1447, 644 N. E. 2d 409 (1995). Most courts to consider the issue, however, including the highest courts of New York and Massachusetts, as well as two Federal Courts of Appeals, have upheld the Secretary’s view that the Act permits the income-first method. See Cleary ex rel. Cleary v. Waldman, 167 F. 3d 801, 805 (CA3), cert. denied, 528 U. S. 870 (1999); Chambers v. Ohio Dept. of Human Servs., 145 F. 3d 793, 801 (CA6), cert. denied, 525 U. S. 964 (1998); Golf v. New York State Div. of Soc. Servs., 91 N. Y. 2d 656, 662, 697 N. E. 2d 555, 558 (1998); Thomas v. Commissioner of Div. of Medical Assistance, 425 Mass. 738, 746, 682 N. E. 2d 874, 879 (1997). We granted certiorari to resolve this conflict, 533 U. S. 927 (2001), and now reverse the judgment of the Wisconsin Court of Appeals.
II
The question presented is whether the income-first prescription of the Wisconsin statute, requiring that potential income transfers from the institutionalized spouse be considered part of the “community spouse’s income” for purposes of determining whether a higher CSRA is necessary, conflicts with the MCCA. The answer to that question, the parties agree, turns on whether the words “community spouse’s income” in § 1396r-5(e)(2)(C) may be interpreted to include potential, posteligibility transfers of income from the institutionalized spouse permitted by § 1396r-5(d)(l)(B).
In line with the decision of the Wisconsin Court of Appeals, 2000 WI App. 150, ¶ 20, but in conflict with the weight of lower court authority, see, e. g., Cleary, 167 F. 3d, at 807; Chambers, 145 F. 3d, at 802, Blumer first argues that the plain meaning of the term “community spouse’s income” unambiguously precludes the income-first method. She does not dispute that a monthly allowance regularly transferred from one spouse to the other could qualify as “income” under any relevant definition, but instead focuses on the modifier “community spouse’s,” contending that “[b]y choosing the possessive... Congress clearly expressed its intent that the income possessed by the community spouse” is the relevant measure. Brief for Respondent 16. We disagree. Congress’ use of the possessive case does not demand construction of “community spouse’s income” to mean only income actually possessed by, rather than available or attributable to, the community spouse; to the contrary, the. use of the possessive is often indeterminate. See J. Taylor, Possessives in English: An Exploration in Cognitive Grammar 2 (1996) (“[T]he entity denoted by a possessor nominal does not necessarily possess (in the everyday, legalistic sense of the term) the entity denoted by the possessee.”); see also Smiley v. Citibank (South Dakota), N. A., 517 U. S. 735, 739 (1996) (questioning characterization of a statutory term as unambiguous when its meaning has generated a division of opinion in the lower courts).
Blumer maintains as well that the “design of the Act as a whole” precludes use of the income-first method. K mart Corp. v. Cartier, Inc., 486 U. S. 281, 291 (1988). She relies heavily, as did the Wisconsin Court of Appeals, 2000 WI App. 150, ¶¶ 21-23, on the Act’s distinction between rules governing the initial Medicaid eligibility determination and those that apply posteligibility to the extent-of-assistance calculation. See Brief for Respondent 17-18. Blumer notes that the (e)(2)(C) hearing to obtain an enhanced CSRA occurs only at the time an eligibility assessment is conducted, while no CSMIA income is transferred until after eligibility has been achieved, see supra, at 481-482. This sequence, she contends, shows that Congress intended the CSRA enhancement and the CSMIA to operate at discrete stages: The former remedies a shortfall in the income possessed by the community spouse prior to eligibility, while the latter provides further relief posteligibility if the previous CSRA enhancement proves inadequate. See Brief for Respondent 18. Because the Wisconsin statute requires imputation of the CSMIA to the community spouse before additional assets may be reserved, Blumer concludes, the statute reverses the priority established by the MCCA.
In accord with the Secretary, we do not agree that Congress circumscribed the (e)(2)(C) hearing in the manner Blumer urges. Although that hearing is conducted pre-eligibility, its purpose is to anticipate the posteligibility financial situation of the couple. The procedure seeks to project what the community spouse’s income will be when the institutionalized spouse becomes eligible. See Tr. of Oral Arg. 14 (officer conducting (e)(2)(C) hearing makes a calculation that “concerns the post eligibility period”; question is will “the at-home spouse... have sufficient income in the post eligibility period, or does the resource allowance need to be jacked up in order to provide that additional income”). The hearing officer must measure that projected income against the MMMNA, a standard ■ that, like the CSMIA, is operative only posteligibility. §§ 1396r~5(b)(2), (d)(3).
In short, if the (e)(2)(C) hearing is properly comprehended as a preeligibility projection of the couple’s posteligibility situation, as we think it is, we do not count it unreasonable for a State to include in its estimation of the “community spouse’s income” in that posteligibility period an income transfer that may then occur.
Blumer’s skewed view of the (e)(2)(C) hearing also underlies the contention, advanced at oral argument, see Tr. of Oral Arg. 6-10, that the income-first method renders meaningless the Act’s key prohibition against deeming income of the community spouse available to the institutionalized one. § 1396r-5(b)(l). According to this argument, including the CSMIA as part of the “community spouse’s income” under subsection (e)(2)(C) effectively converts some income of the institutionalized spouse into income of the community spouse. And prior to eligibility, the argument continues, all of the institutionalized spouse’s income is considered available for medical expenses. § 1396a(a)(10)(A); 42 CFR §435.120 (2000). Thus, the theory concludes, under income-first the CSMIA would, as a logical matter, be considered both “community spouse’s income” and “available” for the institutionalized spouse’s medical expenses in clear contravention of subsection (b)(1).
This argument confuses the inclusion of a projected CSMIA in the preeligibility calculation of the community spouse’s posteligibility income with the actual transfer of income contemplated by the CSMIA provision. The (e)(2)(C) hearing is, again, simply a projection of the state of affairs that will exist posteligibility. The theoretical incorporation of a CSMIA into the community spouse’s future income at that hearing has no effect on the preeligibility allocation of income between the spouses. A CSMIA becomes part of the community spouse’s income only

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询. Missouri U.S. Circuit for (all) District(s) of Missouri
符. Nevada U.S. Circuit for the District of Nevada
未. New Hampshire U.S. Circuit for the District of New Hampshire
程. New Jersey U.S. Circuit for (all) District(s) of New Jersey
常. New York U.S. Circuit for (all) District(s) of New York
条. North Carolina U.S. Circuit for (all) District(s) of North Carolina
当. Ohio U.S. Circuit for (all) District(s) of Ohio
情. Oregon U.S. Circuit for the District of Oregon
口. Pennsylvania U.S. Circuit for (all) District(s) of Pennsylvania
合. Rhode Island U.S. Circuit for the District of Rhode Island
车. South Carolina U.S. Circuit for the District of South Carolina
实. Tennessee U.S. Circuit for (all) District(s) of Tennessee
组. Texas U.S. Circuit for (all) District(s) of Texas
版. Vermont U.S. Circuit for the District of Vermont
周. Virginia U.S. Circuit for (all) District(s) of Virginia
址. West Virginia U.S. Circuit for (all) District(s) of West Virginia
记. Wisconsin U.S. Circuit for (all) District(s) of Wisconsin
二. Wyoming U.S. Circuit for the District of Wyoming
同. Circuit Court of the District of Columbia
业. Nebraska U.S. Circuit for the District of Nebraska
权. Colorado U.S. Circuit for the District of Colorado
其. Washington U.S. Circuit for (all) District(s) of Washington
进. Idaho U.S. Circuit Court for (all) District(s) of Idaho
试. Montana U.S. Circuit Court for (all) District(s) of Montana
验. Utah U.S. Circuit Court for (all) District(s) of Utah
料. South Dakota U.S. Circuit Court for (all) District(s) of South Dakota
传. North Dakota U.S. Circuit Court for (all) District(s) of North Dakota
述. Oklahoma U.S. Circuit Court for (all) District(s) of Oklahoma
集. Court of Private Land Claims
Answer:

Answer: 主