Idabelle Benton and William Wisebaker v. James A. Rhodes, Governor, State of Ohio, and Raymond McKenna Director, Ohiodepartment of Public Welfare

586 F.2d 1, 1978 U.S. App. LEXIS 9634
CourtCourt of Appeals for the Sixth Circuit
DecidedAugust 10, 1978
Docket76-2177
StatusPublished
Cited by26 cases

This text of 586 F.2d 1 (Idabelle Benton and William Wisebaker v. James A. Rhodes, Governor, State of Ohio, and Raymond McKenna Director, Ohiodepartment of Public Welfare) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Idabelle Benton and William Wisebaker v. James A. Rhodes, Governor, State of Ohio, and Raymond McKenna Director, Ohiodepartment of Public Welfare, 586 F.2d 1, 1978 U.S. App. LEXIS 9634 (6th Cir. 1978).

Opinions

WEICK, Circuit Judge.

The suits in the District Court were brought by plaintiffs under 28 U.S.C. § 134313), as class actions of all Ohio Medicaid recipients, against James A. Rhodes, the Governor of Ohio, and Raymond McKenna, the Director of the Ohio Department of Public Welfare, iu enjoin the proposed reduction of a number of optional benefits from the state’s medicaid program, and seeking declaratory relief.

The defendants have appealed from an order of the District Court entered on May 11, 1975, which still remains in effect, and which granted plaintiffs’ motion for a preliminary injunction, restraining defendants from reducing the optional benefits, on the alleged grounds that the notice of reduction was defective and was not in compliance with the applicable federal regulations, and that no hearing was afforded to the medicaid recipients on such reduction in services.

We disagree and reverse. We are of the opinion that the notice of termination sufficiently complied with the regulations and that the applicable regulations required no hearing on the state’s reduction of optional benefits.

[2]*2I

The finding of the District Court with respect to the form and contents of the notice, is as follows:

On or about April 1, 1976, the Ohio Department of Public Welfare included in its monthly mailing to med'caid recipients an enclosure approximately the size of a computer card, styled “Reduction in Medical Benefits.” The front of the card contained the following language:
State law requires that the Department not spend more monr- than it has been given by the State Legislature for medical benefits. The amount of money provided by the State Legislature is not sufficient for the rest of the budget period ending 6-30-77. It is with deep regret that I must announce that the medical benefits listed on the reverse of this card will no longer be available beginning May 1, 1976. If you have any questions regarding your eligibility for any specific medical service, contact your county welfare department or medical provider.
The reverse side of the card read as follows:
The following optional benefits (other than physician services) are no longer covered by the Medicaid program effective May 1, 1976.
• Drugs that can be bought without a Doctor’s prescription such as aspirin (except for insulin which remains a covered item), and therapeutic tranquilizers such as Darvon, Librium and Valium.
• Medical supplies except for a few life sustaining items. See CWD or medical providers for list.
• Ambulance except for emergency transportation to hospital.
• Dental Services
• Optometrist
• Podiatrist
• Psychologist
• Chiropractor
• Physical Therapy
• Speech Therapy
• Occupational Therapy
• Private Duty Nursing
• Mechanotherapy
• Cosmetherapy

The pertinent provision of the Medicaid regulations, 45 C.F.R. § 205.10, reads as follows: § 205.10 Hearings.

(a) State plan requirements. A State plan . . . shall provide for a system of hearings under which:

(5) An opportunity for a hearing shall be granted ... to any recipient who is aggrieved by any agency action resulting in suspension, reduction, discontinuance or termination of assistance. A hearing need not be granted when either State or Federal law require automatic grant adjustments for classes of recipients unless the reason for an individual appeal is incorrect grant computation. [Emphasis added.]

When the regulation was introduced in final form, 38 Fed.Reg. 22006 (Aug. 15, 1973), the Secretary of Health, Education and Welfare explained the revision of the regulation as follows:

5. Grievance procedures in lieu of hearings on questions of law or policy. Section 205.10(a)(5). Most of the comments in this area argued against this provision on the basis that the hearing procedure provides a viable mechanism for effecting changes in policy. Many legal aid groups pointed out that a recent court case [Yee-Litt v. Richardson, 353 F.Supp. 996 (N.D.Cal.) (three-Judge Court), aff’d, 412 U.S. 924, 93 S.Ct. 2753, 37 L.Ed.2d 152 (1973)] cast doubt on the viability of distinguishing between fact or judgment and policy or law. Those in favor stressed reduction of administrative cost.
In response to these comments and the court case, the regulations have been modified. The States may provide for group hearings on questions of policy or law. They need not provide a hearing where either State or Federal law requires automatic grant adjustments for classes of recipients. On individual requests not resulting from such a change in State or Federal law, assistance must be continued pending a hearing decision unless the hearing officer determines at the hearing that the sole issue is one of State or Federal law or policy or a change in State or Federal law. The provision [3]*3regarding a grievance system has been deleted since “expression of views” on program policy is part of legislative and rulemaking procedures. [Emphasis added.]

The Secretary’s comments indicate a plain intent to distinguish the right to a hearing to contest an agency action curtailing applied-for, currently-received benefits, on the basis of the specific facts of the recipient’s case, from the proposed right to a hearing or other grievance procedure as a means of contesting issues of State or Federal law or policy, whether after or in advance of their implementation. Because, in the Secretary’s view, expression of views on program policy is a normal part of legislative and rulemaking procedures, it was not thought necessary to require either hearings or an alternative grievance procedure to consider issues of law or policy.

Even when a hearing is requested on the facts of an individual case, in which case the recipient is entitled to the continuation of benefits until a hearing decision is rendered, 45 C.F.R. § 205.10(a)(6)(i)(A), benefits may be terminated before such decision if “the hearing officer determines at the hearing that the sole issue is one of State or Federal law or policy or a change in State or Federal law.” Id.; 38 Fed.Reg. 22006 (Aug. 15, 1973).

In our opinion, when a state decides to terminate optional benefits on the basis of lack of appropriated funds, or for any other state reason, this is a matter of state law or policy which it was permitted to adopt. We find nothing in the Federal or State Constitutions giving prospective recipients of optional benefits a constitutional right to their perpetual continuance.

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Cite This Page — Counsel Stack

Bluebook (online)
586 F.2d 1, 1978 U.S. App. LEXIS 9634, Counsel Stack Legal Research, https://law.counselstack.com/opinion/idabelle-benton-and-william-wisebaker-v-james-a-rhodes-governor-state-ca6-1978.