Court Opinion

ID: 9515250
Source: CourtListenerOpinion
Date Created: 2023-08-06 22:55:06.434689+00
Date Added: 2024-06-11T09:06:27.011346
License: Public Domain

ZINTER, Justice
(dissenting).
[¶ 22.] I concur that, as drafted, the state administrative regulations determining the extent of benefits failed to incorporate ARSD 67:46:03:24 (which further incorporated the federal SSI regulations that explicitly include alimony payments as “available income”). Consequently, DSS erred as a matter of law in using ARSD 6746:03:21 to include Mulder’s alimony as “available income.” See supra ¶¶ 9-10.
[¶ 23.] However, in determining Mulder’s support benefit, DSS’s other rules include the entire Social Security benefit as available income without deduction. As the Court points out, ARSD 67:46:06:01 provides that the rules in ARSD chapter 67:46:06 are used to determine the amount of assistance. Supra ¶ 10. One of those rules, ARSD 67:46:06:02, provides that the terms used in that chapter have the same meaning as those defined in ARSD 67:46:04:02. That later regulation broadly captures all sources of income “before deductions.” ARSD 67:46:04:02.7 Moreover, alimony payments are not on the list of *219exclusions. See ARSD 67:46:04:03.8 Finally, DSS was under no obligation to adopt a specific regulation granting a deduction for court-ordered support payments. Similar inclusions of support have been affirmed simply upon a state administrative official’s determination after consultation with federal authorities. Peura v. Mala, 977 F.2d 484, 486 (9thCir.1992) (affirming inclusion and noting that the “state administrators so concluded after consulting with the United States Department of Health and Human Services. Under this determination, Medicaid now pays significantly less to the Island View Manor nursing home, the institution where Peura resides”). Therefore, DSS properly determined. that Mulder’s Social Security benefit was a source of income and was available to him before he made his electronic deduction to pay his alimony. For this reason, DSS could consider Mulder’s entire $6719 Social Security benefit as “available income.”
[¶ 24.] Mulder, however, argues that DSS’s failure to grant a support deduction violates 42 USC § 1396a(17),10 which requires that state medical assistance plans include “reasonable” standards for determining eligibility and the extent of benefits. This Court also contends that DSS’s refusal to grant an alimony deduction was arbitrary, capricious, and unreasonable. I disagree.
[¶ 25.] It is now uniformly established that states may include spousal and child support payments as “available income” even though the inclusion adversely affects a recipient’s entitlement. As this Court itself notes, the “federal courts and the Federal Social Security Administration have come to the conclusion that alimony may be considered available income to the payer under the SSI statute.” Supra n. 5. See also Emerson, 959 F.2d at 124; Cervantes v. Sullivan, 963 F.2d 229, 234 (9thCir.1992).
[¶ 26.] The courts that have considered the question agree that it is reasonable because a state is only prohibited from adopting rules that are more restrictive than the federal guidelines. 42 USC § 1396a(r)(2)(A). Therefore, because federal regulations permit inclusion of court-ordered support as available income, the *220state may also include it as “available income.” “[T]he Secretary’s policy of including [analytically identical] child-support payments when determining available income is based on a permissible construction of the statute.” Emerson, 959 F.2d at 122. Therefore, it is “reasonable.”11 Id. In justifying its conclusion, the Eighth Circuit noted, “income which has been paid out in ... support cannot later be ‘used’ or ‘availed of to pay another bill, but neither can income which has been paid out for groceries. Although maybe different in kind, the two are both obligations of the person making the payments.” Id. at 121-22.
[¶ 27.] The Eighth Circuit Court of Appeals is not alone in concluding that money used for support payments may be counted as “available income” of the payer. See, e.g., Tarin v. Comm’r of the Div. of Med. Assistance, 424 Mass. 743, 678 N.E.2d 146 (1997) (money used to pay child support is “available” to Medicaid recipient); Ussery, 258 Kan. 187, 899 P.2d 461 (1995) (upholding inclusion oí court ordered spousal support payments in Medicaid recipient’s “available income”); Himes v. Shalala, 999 F.2d 684, 689 (2dCir.1993) (interpretation that money used to pay child support is available was reasonable and should be accorded deference); Peura, 977 F.2d at 491 (9thCir.1992); Cervantez, 963 F.2d 229 (decision to include garnished amounts for child support as unearned income is a reasonable interpretation of the SSI statutory language).
[¶ 28.] Mulder, however, argues that his case is distinguishable because some of the foregoing cases “involve eligibility12 for Medicaid assistance in general, as opposed to Medicaid assistance for long term care.” However, Mulder’s position has been rejected:
[T]he United States Court of Appeals for the Ninth Circuit concluded that it was “of little import” that the Secretary’s determination regarding [that recipient’s] child support obligations came “in the context of a post-eligibility determination.” ... [T]he court in Peura noted that 42 USC § 1396a(a)(17) concerns both applicants for and recipients of Medicaid and “its restrictions apply to *221both eligibility determinations and post-eligibility determinations regarding the extent of assistance.”
Tarin, 678 N.E.2d at 153 & n. 17 (citing Peura, 977 F.2d at 487 n. 4; Ussery, 899 P.2d at 461, 465 (upholding the inclusion of court-ordered spousal support payments in a Medicaid recipient’s “available” income when establishing benefit levels)).
These cases primarily relate to Medicaid eligibility, rather than to determining the level of benefits or the amount of patient liability. That distinction is irrelevant for our purposes. A state could adopt one income methodology for determining eligibility and another for determining the extent of benefits (as long as both methodologies were within the overall limits of the federal scheme if the state wanted to receive full federal participation).
Ussery, 899 P.2d at 465. Thus, the uniform case law on this question makes the distinction between eligibility and the extent of benefits irrelevant.
[¶ 29.] The Court and Mulder also believe that inclusion of support payments as available income is unreasonable “because Mulder [would be] effectively denied access to long-term care by its income determination.” Supra ¶ 12 (emphasis added); see also supra ¶¶ 13-18. I disagree.
[¶ 30.] First, it is at best speculative to surmise that Mulder would be effectively denied access to long-term care simply because DSS has agreed that Mulder is eligible to receive all but the $180 at issue. It must be remembered that the maximum payment for assisted-living is $993 per month. Therefore, under the Court’s “denial of access” logic, other recipients, whose actual long-term care costs exceed this maximum benefit by $180, would also be “denied access” to long-term care. So also, any eligible recipients whose monthly income is $180 less than their actual long-term care costs, would also be “effectively denied access” to care. This logic suggests the untenable result that DSS may never limit long-term care benefits by $180 more than the recipient can afford. Such a result is in contravention of the federal law that expressly permits the inclusion of support payments as available income.
[¶ 31.] More importantly, the Court’s “denial of access” rationale wholly fails to consider that Mulder’s daughter, guardian and petitioner herein, has the legal obligation to provide the $180 for his support if he is unable. In this jurisdiction, “[a]ny adult child, having the financial ability to do so, shall provide necessary food, clothing, shelter, or medical attendance for a parent who is unable to provide for oneself. ...” SDCL 25-7-27. Because Mulder’s daughter has not claimed financial inability, she has the legal obligation to pay the nursing home for the $180 in long-term care medical assistance not provided by Medicare.13 Americana Healthcare Ctr., a Div. of Manor Healthcare Corp. v. Randall, 513 N.W.2d 566 (S.D.1994).
[¶ 32.] The Court’s “denial of access” rationale also ignores the fact that spousal support is based upon ability to pay. See Dejong v. Dejong, 2003 SD 77, ¶ 7, 666 N.W.2d 464, 467. If Mulder is unable to pay for his own basic care and his court ordered spousal support, his remedy is to reduce his alimony obligation. See, e.g., Peura, 977 F.2d at 490 n. 7 (noting that Peura had available to him the option of returning to state court to seek a reduction of his support obligation).
*222[¶ 33.] Finally, it must be remembered that even though Mulder may not exclude the $180, the requirement is reasonable because he receives a financial benefit “from the discharge of the indebtedness.” Cervantez, 963 F.2d at 234; Emerson, 959 F.2d at 123 n. 3. As the federal courts have noted, inclusion of support payments is reasonable because of the competing needs of the destitute and the preservation of fiscal solvency of programs attempting to protect their coffers from payment of a recipient’s other legal obligations. Cervantez, 963 F.2d at 235.
[¶ 34.] In conclusion, we have not been cited to any authority holding the inclusion of support payments arbitrary, capricious or unreasonable. On the contrary, all relevant authority holds that absent an express state deduction, spousal and child support obligations are “available income.” Consequently, DSS’s decision was reasonable and comported with federal law. I would affirm the hearing examiner and the circuit court.
[¶ 35.] KONENKAMP, Justice, joins this dissent.

. " 'Income,' unless specifically excluded in § 67:46:04:03, [includes] any money or in-kind payments before deductions [.] ARSD 67:46:04:02(2) (emphasis added).

.ARSD 67:46:04:03 provides:
The following are not considered income when determining eligibility for long-term care or medical assistance:
(1) Third-party payments to medical providers;
(2) County welfare payments to medical providers;
(3) Money paid by a school district for educational purposes;
(4) Income tax or sales tax refunds;
(5) Unearned irregular income from all sources which totals $20 or less per month;
(6) Veteran’s aid and attendance benefits;
(7) Life insurance dividends;
(8) Any benefits received under the provisions of the Older Americans Act of 1965, except wages or salary; and
(9) Payments to volunteers under the Domestic Volunteer Service Act of 1973, such as from SCORE, VISTA, or the foster grandparent program.

. This is Mulder's "available income” from his Social Security benefit after undisputed adjustments, but without a deduction for his $180 alimony payment.

. 42 USC § 1396a(17) states in relevant part:
(a) Contents. A State plan for medical assistance must—
(17) ... include reasonable standards ... for determining eligibility for and the extent of medical assistance under the plan which
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(B) 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 or recipient and ... as would not be disregarded ... in determining his eligibility for such aid, assistance, or benefits!.]

. Under the relevant SSI requirements, court-ordered alimony is also included as available income. 20 CFR § 416.1123(b)(2). "It has been longstanding SSI policy that amounts withheld from earned and unearned income for payment of a debt or other legal obligation are included in income for purposes of determining eligibility and payment amount under the SSI program.” Supplementary Security Income for the Aged, Blind, and Disabled; How We Count Earned and Unearned Income; Funds Used to Pay Indebtedness, 56 Fed. Reg. 3209, 3211 (Jan. 29, 1991) (to be codified at 20 CFR pt. 416). In response to a comment which drew a distinction between court-ordered support obligations and other legal debts, the agency remarked:
While we do not disagree that there are distinctions between a debtor/creditor relationship and the obligation to pay alimony, the overall result, we believe, is basically the same; i.e., the payer benefits financially from the satisfaction of the debt/obligation. It is not the purpose of the SSI program to subsidize any types of indebtedness whether that indebtedness results from a debt- or/creditor relationship or from an obligation imposed by public policy.

. The federal SSI regulations have their origin in Title XIX of the Social Security Act. That Act clearly provides that, when determining the amount of assistance ("the extent of ... assistance”) a State plan may take into account only such income “as [is] determined in accordance with standards prescribed by the Secretary [Secretary of the Department of Health and Human Services]” that: (1) is "available to the applicant” and that (2) "would not be disregarded ... in determining ... eligibility." 42 U.S.C. § 1396a(17) (emphasis added). Therefore, it is not per se unreasonable to determine the extent of benefits, by use of federal law on eligibility.

. It is also significant that daughter's payment of the $180 would not render Mulder ineligible for assistance. ARSD 67:46:04:03(1) provides that third-party payments to medical providers are not considered income when determining eligibility for long-term care.