Document: 457 U.S. 569 102 S.Ct. 2597 73 L.Ed.2d 227 Richard S. SCHWEIKER, Secretary of Health and Human Services, Appellantv.George HOGAN, et al. No. 81-213. Argued March 24, 1982. Decided June 21, Syllabus Section 1903(f) the Social Security Act provides that federal reimbursement to States electing provide Medicaid benefits "medically needy" is available only if income those persons, after deduction incurred medical expenses, less than 133 1/3% state Aid Families With Dependent Children (AFDC) payment level. specifically excepts from this rule "categorically needy"—those receiving Supplemental Income (SSI) because lack meet their basic needs. As applied in Massachusetts, § results a distribution recipients SSI more generous such persons who are self-supporting. Appellees, each whom (or his spouse) receives an amount renders him ineligible for either or supplementary payments, filed suit Federal District Court, alleging 1903(f), as violates equal protection component Fifth Amendment. Appellees asserted that, since Massachusetts AFDC level them lower level, they until income, recipients, which receive, appellees thus have nonmedical expenses individuals who—possibly never worked receive no benefits—are dependent upon public assistance support. The Court entered judgment appellees. Held: 1. There merit appellees' contention itself compels conclusion services provided needy," may not be forced incur would reduce remaining below applicable standard. legislative history provisions does justify departure literal clear language 1903(f). Nor 1903(f)'s conflict with any other provision Act. Moreover, adherence section's consistent its interpretation by Services. Thus, discrimination challenged case required Pp. 584-588. 2. violate constitutional principles treatment. While powerful equities support claim unfair treatment insofar needs do belief Congress inequitable unwise insufficient basis on conclude it unconstitutional. optional character congressional scheme—whereby participating must categorically needy but elect at all medically needy—does equality. Since State deny needy—while providing rendering some better off others not—it narrow gap between two classes partial needy, even though certain members class remain position fortunate assistance. fact has force make immediate need sole standard entire program. 588-593 501 F.Supp. 1129, reversed remanded. George W. Jones, Chicago, Ill., appellant, pro hac vice, special leave Court. William H. Simon, Jamaica Plain, Mass., Justice STEVENS delivered opinion 1 At issue meaning validity Act, 81 Stat. 898, amended, 42 U.S.C. 1396b(f). (SSI)—a aged, blind, disabled sufficient needs—that latter class. Because expenses—for reimbursed—before become eligible Medicaid, SSI. concluded was irrational held Hogan v. Harris, 1129 (Mass.1980). We disagree reverse. 2 statutory governing program complex. See 1396 seq. (1976 ed. Supp. IV). first consider specific case, then relate circumstances gave rise present controversy, finally address legal issues presented. 3 * (Act) enacted 1968. To understand however, necessary amendments made 1965, 1967, 1972. A. 4 established 1965 Title XIX "for purpose financial choose reimburse costs persons." Harris McRae, 448 297, 301, 100 2671, 2680, 65 784. 1902(a)(10) 1396a(a)(10), sets forth scope program, changed significantly enactment 1965. 79 345. Participating coverage individuals—now described needy"; option also (and reimbursement) individuals—described needy." Schweiker Gray Panthers, 453 34, 37, 101 2633, 2636, 69 460.1 These defined reference programs. 5 In programs existed disabled, families children.2 time, these administered States, both "standard need" "level benefits." Jefferson Hackney, 406 535, 92 1724, 32 285; Rosado Wyman, 397 397, 90 1207, 25 442.3 establishing received cash payments under one 345, 1396a(a)(10)(A). House Report explained: "These people most country appropriate care met, first, people."4 They 6 could offer fell within categories whose aid were deemed "less needy"5 resources "to remedial services." 1396a(a)(10)(C). limit placed extent elected might needy."6 7 limits categorical programs, addition, eligibility standards 1902(a)(17) 1396a(a)(17), set requirements determining eligibility. particular, "provide flexibility application respect taking into account, except prescribed Secretary, (whether form insurance premiums otherwise) type recognized law." 346; see 1396a(a)(17).7 8 Most promptly participate program.8 Many chose Within year, fiscally improvident rely exclusively aspects H.R.Rep. 2224, 89th Cong., 2d Sess., 1-3 (1966). It cautioned avoid unrealistic levels title purposes." Id., 3. B 9 participation Representative Mills introduced bill, sponsored Johnson administration, significant changes H.R. 5710, 90th 1st Sess. (1967). Under 220 been entitled 150% highest State's need.9 202 bill revise annually reflect living and, circumstances, pay 100% provision, Department Health, Education, Welfare explained "33 children [under program] themselves human needs."10 10 After extensive consideration, Ways Means Committee reported out substantially revised bill. 12080, primary proposed limitation participation: 11 "Your committee proposing . sharing will exceeds 1331/3 percent ordinarily paid family same size (without resources) money (AFDC are, generally speaking, lowest used programs)." 1967 Report, 119. 12 noted, n. 10, supra, many qualifying need.11 reasons move noting few had beyond anticipated Congress, stated: 13 expected plans submitted afford unable adequate care. 14 neither nor intended supplant health presently carried collective bargaining agreements close average range. Your concerned operation greatly incentives aged over [Medicare] XVIII Amendments directed toward eliminating, concerned, clearly unintended your committee's judgment, undesirable actual potential effects legislation." 118. 15 75% need, need.12 16 proposal severely criticized floor.13 nevertheless passed sent Senate.14 Senate returned different matter referred conference.15 17 Conference adopted H.R.Conf.Rep. 1030, 63 (1967), U.S.Code Cong. & Admin.News p. 2834. added, express exception needy. Ibid. Opposition voiced Senate.16 approved law 1396b(f).17 C 18 1972, replaced three four state-administered new Aged, Blind, Disabled (SSI), 1381 Supp.IV).18 establishes federally guaranteed minimum disabled. Wilson, 450 221, 223, 1074, 1077, 67 186. cases must) raise supplement Government. 1382e Supp.IV). supplemental persons. 1396a(a)(10)(C)(ii).19 II 19 Commonwealth chosen benefits—to available—to income. Finally, payments. combined level.20 20 1980 court, contending Act—as Amendment.21 Each For appellee spouse employed time "Social Security" taxes. currently (Federal Old-Age, Survivors, Disability Insurance, 401 Supp.IV)) recipients. By reason possibly support.22 21 granted motion summary judgment.23 ruled unconstitutional reduced levels. court later declared explicitly 1396b(f), Massachusetts. App. Juris. Statement 25a. noted probable jurisdiction. 454 891, 385, 70 204. III 22 contend Although did advance argument precluded asserting affirm court's judgment.24 "Where party raises arguments we order unnecessary resolution issue." Blum Bacon, 132, 137, 2355, 2359, 72 728. U.S., 306-307, S.Ct., 2682-2683. 23 "fundamental Congressional creation feature achieve equity similarly situated." Brief 12. contention, cite requirement imposed "include reasonable (which shall comparable groups ) plan .," 346 (emphasis added), note statements require individual use, "which bring test plan." 7, supra. 24 "comparability requirement" argue separate bills affected needy.25 Only when accepted added argue, 1968 modification potentially change comparability groups. assert intended; rather, ensure adversely excepted figure because, urge construe or—to maintain comparability—100% SSI-state higher. justifies Secretary's provision. 26 cannot agree. stated excepting rule, statute implicitly "assumed" simply Even true years old; aware process adopting programs.26 assume unaware 1903(f)—which needy—could operate States—which knew existed—in demean intelligence Congress. prepared interpret unsupported assumption little idea what doing.27 27 1902(a)(17), 345-346, among various "categories" available, treated comparably respects. 6, supra.28 Indeed, broad inconsistent excluded entirely intent, considered determining, where appropriate, individual's Medicaid. determined greater so long retained needs, he expenses. That appear unreasonably low, chose. find inconsistency 1902(a)(17). 28 sum, ignore analysis "We often agency charged administration substantial deference." 141, 2361. hold IV 29 contend—and held—that irrationally discriminates needy.29 unfairness stems assistance, accentuated disfavored consists largely taxes retirement while favored includes done so. Powerful unquestionably 30 A course classification properly judged focusing solely portion harshly terms. Califano Jobst, 434 47, 98 95, 54 228. differentiated needy—a very income—and similar characteristics Members former automatically Medicaid; unless elects consideration eligibility.30 31 According scheme, then, Before considering constraints exist chooses class, confront question whether constitutionally permissible. Government finance meaningful measure everyone. Both funds limited. structuring direct limited impoverished who—because physical characteristics—were least able overcome poverty. makes group administrative convenience. people."31 decision allocate poor equality; terms ability essential services, wealthy situated same. rational distribute 33 choosing permitted exclude who—by large expenses—often just much Yet found 66. them, Amendments, 577-580, 14, prepare future through private Medicare 34 Fullington Shea, 404 963, 282, affirmed three-judge holding Colorado decided summarily. scarce incomes words, define income—who unwilling save enough earnings needs—may actually gross involve arbitrariness offensive.32 35 challenge Fullington. line drawn not. attack manner impermissible 36 view unchallenged Fullington, self-defeating. injury regard avoided denying benefits, placing worse financially now. No interest "equality" furthered result. If not—a surely 37 distinction undermined impact falls 30, function 1331/3% place availability prevents (although appellees) needy; determines reimbursed differently others. complain (all needy) performs function.33 unrelated 38 unlike doing expenses—does essence computation period adding clause, not, offend Accordingly, without endorsing wisdom particular selected—a us consider—we command. reversed. remanded further proceedings opinion. 39 ordered. But 18, infra. entitled: Old Age Assistance (OAA), 301 (1970 ed.); 1201 seq.; Permanently Totally Disabled, 1351 (AFDC), 601 §§ 1381-1385 ed.). fundamentally Age, Insurance (OASDI Security), benefits" need." benefits; provided, merely fraction difference need. Hackney. typically varied 213, 66 (1965) (1965 Report). S.Rep. 404, pt. 1, 77 Report), 1943. contained comparative beneficiaries afforded qualified 1396a(a)(10)(B)(i). amount, duration, blind. "This assure aided eliminate unevenness apparent 77, 2017. "comparability" group, obligated others, "the determination who, resources, maintenance programs." 67; 1396a(a)(10)(C)(i). scope. 1396a(a)(10)(C)(ii). people," 67, criteria determine group. 346, 1396a(a)(17). 2018 ("Although aid, maintaining people"). 1396a(a)(10)(B)(ii). included sure comprehensive discussion statute, 68, explains: "The contains designed correct weaknesses identified current law, contain cutoff point individual. specified qualify plan. Individuals, excess small compared cost needed. flexible requires take cost—whether otherwise—incurred law. before part measured allowance requires." 78-79, pp. 2018-2019. extent, mirrors language. describing immediately continues: use proportion amount. event, deductibles items service, should $2,000 $2,000. This action maintenance." 79. additional comment foundation 544, 117 (1967) (1967 course, effect necessarily President's Proposals Revision System: Hearings 5710 Means, 118 January there another participation. "a per capita upper program." noteworthy proposals insignificant was—admittedly—a complex setting outset "principal purposes bill," provides: "Fifth, modify establish add would— "(a) Impose matching related State, lower." 5. resulted denial although need—had higher alter 113 Cong.Rec. 23065 (remarks Rep. King); id., 23077 Burke); 23082 Vanik); 23084 Bingham); 23087 Halpern); 23093 Ryan); 23104 23125 Boland); 23128 Kastenmeier). 23131 Farbstein); 23083 Gilbert); 23092 Burton). defended against criticism above unfair. He "only walked seen fit put it," 23093, added: "I think fair tax general Treasury undoubtedly means buy defray own costs." 23061-23062 Byrnes); 23084-23085 Hanley); 23090 Stratton); 23090, 23091 McCarthy); 23105 Taft); 22783 Quillen). hearings Finance Committee, HEW official recommended administration's adopted. Indiana Texas, 133% 1967: 12080 Finance, 280 pointed result exclusion suggested probably intended. Senator Robert Kennedy proposal, subsequently expenditures behalf person OAA standard, standards. 744, 177 formula computing 176-177. encountered resistance floor. Javits, speaking amendment offered Kuchel substituted ground discriminated 33168, 33169 response, Long acknowledged "encourages concentrate welfare assistance." 33169, 33171. rejected 36380 Burton); 36381 36385 Reid); 36387 36389 Farbstein). Senate, complained Mississippi amounted incurred, $80 month four. 36784. Mondale quoted testimony Hearings, 15, 36819 1396b(f) "(f) Limitation "(1)(A) Except paragraph (4), preceding section expended calendar quarter, member annual paragraph. "(B)(i) clause (ii) subparagraph, determined, accordance equivalent Part subchapter chapter. "(2) family's (1), "(4) limitations subsection apply individual— "(A) I, X, XIV XVI, IV, security being XVI chapter, "(B) paid, (i) him, institution, "(C) eligible, 1396a(a)(10)(A) title, (as 1382a (b) thereof) exceed 300 benefit rate 1382(b)(1) giving expenditure." funded name indicates, continues partially number 38, 2637, 460. expansion accomplished increased obligations States. guarantee reason, withdraw known "§ 209(b) option." it, 38-39, 2637-2638. State. aspect recipient 300% limitation. 1396b(f)(4)(C); 17, amounts benefits. Bolling Sharpe, 347 497, 499, 74 693, 694, L.Ed. 884. contended violated Equal Protection Clause Fourteenth alleged accept condition 1382(e)(2). Appellees' grievances best illustrated situation Hunter. Hunter 41 during period. result, trial $534 $20 apparently disregarded payments; $513 month. qualified, $300, $400. regularly $200 expenses; thus, ($400 month) ($513 month). $1 ($534 $1) rendered fully 1132 $1, $100 certified "consisting recipients; reside Massachusetts; (iii) old older; (iv) (v) have, regulations, subject third countable regulations standard." 23a-24a. "It well filing cross-appeal cross-petition, appearing record below." n.5, n.5. raised appellees, presented developed court. 12, definition likely requirement. 117-118. "congressional ignorance" rests unsupportable premise. bill—which admit vigorously debated—had "comparable" propose likely—in light 1902(a)(10)—that assumed affect supra n.15, (describing possibility "drafting error"). explicit added—with discussion—a Relying 1396a(a)(10)(C)(i) courts Caldwell Blum, 621 F.2d 491 (CA2 1980), cert. denied, 452 909, 3039, 412; Fabula Buck, 598 869 (CA4 1979); Greklek Toia, 565 1259 1977), sub nom. Toomey, 436 962, 3081, 57 1128; Aitchison Berger, 1137 (S.D.N.Y. 1975), aff'd, 538 307 1976), 429 890, 97 246, 50 172. Whatever persons—after expenses—to discriminatory arises disputed 45 Fed.Reg. 31782 (1980); 46 27076 (1981). focused classes, three: (1) (2) (a) qualifies 238, 1084, 186 ("This 'strong presumption constitutionality' legislation conferring monetary Mathews De Castro, 181, 185, 431, 434, 389, believes discretion deciding how expend resources"). governmental benefit—such indigent defendant represented defender—may wealthier undermine payable impeach rationality defining considered.

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