Court Opinion

ID: 9550441
Source: CourtListenerOpinion
Date Created: 2023-08-07 18:35:14.080393+00
Date Added: 2024-06-11T15:21:32.610247
License: Public Domain

BURNETT, Judge,
specially concurring.
Based upon the record presented, I am constrained to join in today’s decision. Nevertheless, I write separately to note some continuing concerns.
Madsen has challenged the manner in which the State of Idaho operates the Personal Care Services (PCS) component of its Medicaid program. PCS is an alternative to institutional care. It allows needy individuals to receive health-related services in their own homes rather than in nursing homes or other facilities. PCS gives such individuals a sense of dignity and independence, while alleviating pressure on institutional resources. However, Madsen claims that PCS is not accomplishing these objectives in Idaho. He argues that the state regulations require him to pay so much for PCS benefits that he has insufficient money left for shelter, food and other essentials. He asserts, in essence, that state regulations are forcing him either to rely on private charity or to live in a nursing home.
Madsen has presented this challenge to a hearing officer for the Idaho Department of Health and Welfare, to a district judge, and now to us. In each instance he has received the same response. It is, simply, that Idaho’s regulations have been applied correctly to him. While this rejoinder may be true, it leaves unanswered the more fundamental thrust of Madsen’s attack— that there are problems within the regulations themselves.
Our inquiry into the validity of state regulations, adopted to carry out a federally funded program, is threefold: (1) whether the regulations are consistent with constitutional standards; (2) whether they conform to the intent of Congress in establishing the program; and (3) whether they are consistent with federal regulations developed to implement the program. As to each point, the party challenging the regulatory scheme bears the burden of proving facts sufficient to show a fatal defect in the design or application of the scheme. See Gem State Homes v. Department of Health & Welfare, 113 Idaho 23, 29, 740 P.2d 65, 71 (Ct.App.1987) (concurring opinion).
Although Madsen’s pleadings and briefs are drafted inartfully, it is clear that his challenge goes mainly to the first level of inquiry — the constitutionality of the state regulations. Specifically, he has alleged that the regulations deprive him of property without due process because they employ irrationally low subsistence allowances *188to determine the net income available for contribution to the Medicaid program. However, Madsen has presented only anecdotal evidence concerning his individual circumstances. He states that he cannot afford to remain where he presently resides if he makes the required contribution to the state. However, this alone does not prove that the regulations lack a rational basis, nor does it show a deprivation of property in a constitutional sense. The PCS program is an option. The institutional alternative remains available. At most, Madsen has shown that the PCS option does not fit his circumstances. I cannot conclude upon this narrow information that the state regulations suffer from a substantive due process infirmity.
The remaining questions, which Madsen raises by implication, are whether the Idaho regulations are consistent with the intent of Congress and whether they conform to federal regulations implementing the home care program. I find nothing in the federal regulations to contravene the state regulations challenged here. Regarding the intent of Congress, there is a dearth of legislative history. However, Congress evidently envisioned home and community-based services as a genuine alternative to institutional living, allowing health needs to be met in a more dignified setting and, possibly, saving money on institutional care. See 42 U.S.C. § 1396n(c); 42 C.P.R. § 441.300-.310 (1987).
Upon the record presented, I cannot say that the Idaho scheme violates this congressional intent. It may well be that Mad-sen cannot afford living arrangements of his choice if he participates in the PCS program. However, this does not necessarily signify — and Madsen has not otherwise attempted to prove — that it would be impossible for anyone to obtain safe and sanitary housing, food and other essentials on the subsistence budget contained in the Department’s regulations.
In sum, Madsen has not made the record necessary to support his broad challenge to the state regulations. Accordingly, I agree that he has not presented a claim entitling him to relief. However, I reserve for another day and another record the question whether the Idaho regulations create a genuine home care alternative as envisioned by Congress.