Lewis v. Hegstrom

767 F.2d 1371, 1985 U.S. App. LEXIS 21232
CourtCourt of Appeals for the Ninth Circuit
DecidedAugust 8, 1985
DocketNo. 84-3679
StatusPublished
Cited by18 cases

This text of 767 F.2d 1371 (Lewis v. Hegstrom) is published on Counsel Stack Legal Research, covering Court of Appeals for the Ninth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lewis v. Hegstrom, 767 F.2d 1371, 1985 U.S. App. LEXIS 21232 (9th Cir. 1985).

Opinion

WIGGINS, Circuit Judge:

This class action civil rights suit involves the proper computation of the period of ineligibility for Medicaid applicants in the state of Oregon who transfer their home for less than fair market value within two years of applying for Medicaid assistance. The sole issue before this court is whether proposed Or.Admin.R. 461-04-070(6)(e), which defines the period of ineligibility for such applicants, is invalid under the Supremacy Clause on the ground that it conflicts with 42 U.S.C. § 1396p(c)(2)(B).

The district court conducted a careful review of the statute and its legislative history. It concluded that “[t]he logical reading of [the language of the statute] supports plaintiffs’ position,” Lewis v. Hegstrom, 581 F.Supp. 183, 187 (D.Or.1983), and awarded judgment accordingly.1

We believe that the court below placed undue emphasis upon isolated words of the statute in seeking an understanding of Congress’ intent and in doing so failed to construe ambiguous statutory language in a manner which achieved the statute’s overall object. We hold that proposed Or. [1373]*1373Admin.R. 461-04-070(6)(e) is consistent with federal law, and we reverse.

BACKGROUND

A. Medicaid

Medicaid is a cooperative federal-state program established in 1965 as Title XIX of the Social Security Act (the Act), 79 Stat. 343, as amended, codified at 42 U.S.C. § 1396 et seq., to provide federal financial assistance to states that elected to reimburse specified costs of medical treatment for needy individuals. See generally Schweiker v. Gray Panthers, 453 U.S. 34, 36, 101 S.Ct. 2633, 2636, 69 L.Ed.2d 460 (1981). Participating states must each develop a plan containing “reasonable standards for determining eligibility for and the extent of medical assistance.” Id. (quoting 42 U.S.C. § 1396a(a)(17)). State plans must comply with the requirements imposed by the Act and the implementing regulations. See 42 U.S.C. 1396a(b); Schweiker v. Gray Panthers, 453 U.S. at 37, 101 S.Ct. at 2636. As long as a state complies with the requirements of the Act, it has wide discretion in administering its local program. Dawson v. Meyers, 622 F.2d 1304 (9th Cir.1980), vacated on other grounds sub nom, Beltran v. Myers, 451 U.S. 625, 101 S.Ct. 1961, 68 L.Ed.2d 495 (1981).

An applicant is entitled to Medicaid if he or she satisfies the eligibility criteria established by the applicant’s state. Schweiker v. Gray Panthers, 453 U.S. at 36-37, 101 S.Ct. at 2636.

In its state plan, each state determines the rate of reimbursement to medical facilities for medical care provided. 42 U.S.C. § 1396a(a)(13)(A). The state reimbursement rates are subject to the Secretary’s approval. Id. Once a state plan is approved by the Secretary, the state is reimbursed by the federal government for a portion of the funds expended by the state.

Oregon has adopted a state plan which fixes the maximum rate at which a facility may be reimbursed at 75 percent of its actual allowable costs. Or.Admin.R. 411-70-440(2) (1983). In Oregon, Medicaid recipients are required to contribute to the cost of their care all of their income and resources above a minimal amount which may be kept for personal needs. Or.Admin.R. 411-70-045(2) and 411-70-095 (1983). In practice, participating medical facilities in Oregon receive, on the average, $1,350 per month per patient under this reimbursement formula, $1,000 of which is paid by the state and the balance of $350 is paid to the facility by the Medicaid patient for his or her own care.

Since the enactment of the Boren-Long amendment in 1980, P.L. 96-611, § 5, 94 Stat. 3567 (1980), codified at 42 U.S.C. §§ 1382b(c) and 1396a(j)(l) (1981), the Medicare Act has recognized that the principle of providing assistance only to those in need could be defeated by transfers of assets for less than fair market value in order to establish eligibility. To bar improper claims by individuals who transfer assets for less than fair market value, the federal statute declared, in general, that applicants who make such transfers may be rendered temporarily ineligible for assistance. 42 U.S.C. § 1396a(j)(l) (1981). This statute was commonly referred to as the federal transfer of assets rule.

A transfer of the home, however, continued to be accorded more solicitous treatment. In 1982, when this action was commenced, federal law provided that homes were exempt from the federal transfer of assets rule. 42 U.S.C. § 1382b(a)(l) (1982). Notwithstanding the federal exclusion of homes from the transfer of assets rule, Oregon elected to include homes as a resource in determining Medicare eligibility under its state transfer of assets rule. Or. Admin.R. 461-04-070 (1982). This action was filed in July 1982, to challenge that Oregon practice.

While this suit was pending in district court, Congress enacted the Tax, Equity and Fiscal Responsibility Act, P.L. 97-248, 96 Stat. 370 (1982), (TEFRA). TEFRA repealed 42 U.S.C. § 1396a(j) (1981) and replaced it with a more detailed transfer of [1374]*1374assets rule, 42 U.S.C. § 1396p(c).2 Effective September 3, 1982, TEFRA made the home countable as a resource for purposes of determining Medicaid eligibility, under specified circumstances. States were expressly authorized to establish a period of ineligibility in cases where Medicaid applicants had transferred their home for less than fair market value within two years of applying for benefits. 42 U.S.C. § 1396p(c)(2)(B)(i).

Pursuant to the authority granted under 42 U.S.C. § 1396p(c)(2)(B)(i), Oregon amended various of its rules pertaining to Medicaid eligibility, including Or.Admin.R. 461-04-070. The amendment to Rule 461-[1375]*137504-070 initially was in the form of a temporary rule. Or.Admin.R. 461-04-070 (September 1982).

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Lewis v. Hegstrom
767 F.2d 1371 (Ninth Circuit, 1985)

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Bluebook (online)
767 F.2d 1371, 1985 U.S. App. LEXIS 21232, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lewis-v-hegstrom-ca9-1985.