MITSON BY AND THROUGH JONES v. Coler

670 F. Supp. 1568, 1987 U.S. Dist. LEXIS 9110
CourtDistrict Court, S.D. Florida
DecidedOctober 5, 1987
Docket87-12020-Civ
StatusPublished
Cited by5 cases

This text of 670 F. Supp. 1568 (MITSON BY AND THROUGH JONES v. Coler) is published on Counsel Stack Legal Research, covering District Court, S.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
MITSON BY AND THROUGH JONES v. Coler, 670 F. Supp. 1568, 1987 U.S. Dist. LEXIS 9110 (S.D. Fla. 1987).

Opinion

MEMORANDUM OPINION AND ORDER GRANTING PLAINTIFFS’ MOTION FOR PRELIMINARY INJUNCTION

ARONOVITZ, District Judge.

I. Nature of the Case

This action concerns nursing home occupants in Florida seeking on behalf of themselves and others similarly situated to enjoin the Florida Department of Health and Rehabilitative Services (HRS) 1 from including as “countable income,” in determining their eligibility for Medicaid Institutional Care Payments (ICP) Program benefits, that portion of their Veterans Administration Improved Pensions (VAIP) which is awarded pursuant to 38 U.S.C. Section 503(a)(8) and represents a reimbursement for medical expenses. The plaintiff class and HRS have stipulated that the plaintiff class consists of approximately 250 members. ,

The Florida Medicaid ICP, which is the subject of Plaintiffs’ Complaint, is a wholly state-administered program designed to provide payment for medical care and services rendered to persons who would otherwise be unable to obtain such care and services because of their income. The ICP provides payment to nursing homes on behalf of individuals who are found to be aged, blind, or disabled. The program is jointly funded by state general revenue (43.83%) and federal matching funds (56.16%). In order to be eligible for federal matching funds, a state must follow policy established by the Health Care Financing Administration (HCFA) which governs the Medicaid and Medicare Programs (42 C.F.R.) and the Social Security Administration which governs the Federal Supplemental Security Income Program (SSI) (20 C.F. R.), including SSI’s definition of income. Florida’s Medicaid program is not otherwise controlled or regulated by the federal government except to the extent that the state receives federal funds.

The Plaintiff class consists of all persons who have been, or will be, denied benefits under the Florida Medicaid Institutional Care Payment Program due to the fact that the state Defendants include income received due to unreimbursed medical expenses under the Veterans Administration Improved Pension Program for the purpose of determining Medicaid ICP eligibility. By this action, Plaintiffs seek a preliminary injunction requiring the Defendants to immediately reinstate their Medicaid ICP benefits and/or refrain from denying Medicaid ICP benefits due to the inclusion of VAIP reimbursed medical expenses as income for determining eligibility. The identity and status of the named Plaintiffs and other specific members of the Plaintiff class are not generally in dispute. The circumstances of these Plaintiffs are evidenced by the affidavits of John Bryan, Gary Carroll, *1570 May A. Genelay, Aaron Hammond, General P. Kirkland, Rebecca Mitson, Daniel Rams-dell, Louis Ravina, Elizabeth Rubino, Rhoda Ruggiero, Grace Stevens, John Stunson and Margaret Lee Whaley.

Following the entry of an Order on September 14, 1987 certifying this action as a class action pursuant to Rule 23(a) and Rule 23(b)(2) of the Federal Rules of Civil Procedure, Plaintiffs moved for the entry of an order for preliminary relief against HRS, the state defendant only.

Oral argument on Plaintiffs’ Motion was scheduled and entertained by the Court. The Court has reviewed the pleadings, memoranda and affidavits on file and has fully considered the arguments of counsel. All parties were invited to present testimony and other evidence at the hearing on Plaintiffs’ Motion, but all parties declined to do so, except for the introduction of certain affidavits, referred to herein, by the Plaintiff. Based on the foregoing and for the following reasons, the Court finds that a preliminary injunction should issue prohibiting HRS from determining eligibility for Medicaid ICP benefits inconsistent with this Opinion.

II. Jurisdiction

The Court’s jurisdiction over this matter is predicated upon 42 U.S.C. Section 1983. Plaintiffs’ Complaint also alleges jurisdiction pursuant to 42 U.S.C. Section 1396, et. seq.

III. Introduction to Relevant Issues

Plaintiffs are eligible to receive pensions from the Veterans Administration (VA) under either 38 U.S.C. § 521, which provides pension benefits for veterans with non-service connected disabilities, or 38 U.S.C. § 541, which provides benefits for the surviving spouses of veterans with service-connected disabilities. The VA benefits for which Plaintiffs are eligible are means-tested; their pensions are subject to being reduced by the amount they receive in income from non-VA sources. 38 U.S.C. § 521(a) and 541(a). Generally speaking, each Plaintiff has less than $1,020 per month in non-VA income.

Each Plaintiff requires nursing home care and, accordingly, each Plaintiff incurs substantial unreimbursed medical expenses. As judged by the numerous affidavits submitted by Plaintiffs, these expenses are at least $1,020 per month. 2 Because Plaintiffs require nursing home care, they are in need of regular aid and attendance in accordance with 38 U.S.C. § 502(b), and are eligible for pension at a special “aid and attendance” rate, which is 60% above the otherwise, applicable pension rate. 38 U.S.C. §§ 521(d) and 541(d). For most veteran-pensioners this rate is presently $9,539 per year, $3,576 of which is for aid and attendance. 3 Applicants and recipients of ICP benefits must apply for all other benefits to which they may be entitled, including but not limited to, “aid and attendance.” 20 C.F.R. 416.210 and 42 C.F.R. 435.603.

In determining their incomes for VA pension purposes, Plaintiffs are permitted to exclude from their non-VA income substantially all of their unreimbursed medical expenses (UME). 38 U.S.C. § 503(a)(8). Because of the way in which the UME provision figures into the calculation of the pension, each Plaintiff is eligible to receive the full amount of VA pension at the appropriate aid and attendance rate.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Smith Ex Rel. Smith v. Benson
703 F. Supp. 2d 1262 (S.D. Florida, 2010)
Edmonds v. Levine
417 F. Supp. 2d 1323 (S.D. Florida, 2006)
Cordall v. STATE EX REL. DVA AND SHS
980 P.2d 253 (Court of Appeals of Washington, 1999)
Ashmus v. Calderon
935 F. Supp. 1048 (N.D. California, 1996)
Mitson by and Through Jones v. Coler
674 F. Supp. 851 (S.D. Florida, 1987)

Cite This Page — Counsel Stack

Bluebook (online)
670 F. Supp. 1568, 1987 U.S. Dist. LEXIS 9110, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mitson-by-and-through-jones-v-coler-flsd-1987.