Morales v. Commissioner

465 N.E.2d 264, 18 Mass. App. Ct. 239, 1984 Mass. App. LEXIS 1475
CourtMassachusetts Appeals Court
DecidedJune 11, 1984
StatusPublished
Cited by2 cases

This text of 465 N.E.2d 264 (Morales v. Commissioner) is published on Counsel Stack Legal Research, covering Massachusetts Appeals Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Morales v. Commissioner, 465 N.E.2d 264, 18 Mass. App. Ct. 239, 1984 Mass. App. LEXIS 1475 (Mass. Ct. App. 1984).

Opinion

Cutter, J.

Mrs. Morales challenges the department’s method of calculating eligibility for Medicaid to the “medically needy,” i.e., those persons who would be eligible for Aid to Families with Dependent Children (AFDC) if their incomes and resources did not exceed AFDC limits, but whose incomes and assets, in certain circumstances, permit some Medicaid assistance. See Tinkham v. Department of Pub. Welfare, 11 Mass. App. Ct. 505, 506-516 (1981); Drysdale v. Spirito, [240]*240689 F.2d 252, 253-255 (1st Cir. 1982).2 As Justice Stevens noted in Schweiker v. Hogan, 457 U.S. 569, 571 (1982), “The statutory provisions governing the Medicaid program are complex.” The remark could be applied also to the relevant Federal and State regulations.3

Jane Morales (the mother) received AFDC benefits until May 9, 1982, when those benefits terminated, because the department determined that her monthly gross earnings of $793.06 by then “exceeded the standard of assistance for . . . [her] family,” consisting of herself and four children. See 42 C.F.R. 435, subparts E to I (1982). The mother’s application to the department for continued Medicaid assistance was rejected on May 18, 1982, and by a corrected letter on June 9, 1982, she was notified that, “if in the six month period beginning with the date of . . . [her] medical service . . . [she should] incur medical expenses of $416.18 . . . [she would] then be eligible to have medical bills which exceed this amount paid” under the department’s medical care plan. This determination meant that, before the mother would be eligible to re[241]*241ceive Medicaid assistance, she would have to incur, or “spend down,” $416.18 from her own assets for medical bills.4

The mother appealed and a hearing took place before an appeals referee of the department. See G. L. c. 18, § 16. The referee determined that the June 9 letter correctly stated the result provided for in the department’s regulations. The mother sought judicial review of this ruling under G. L. c. 30A, § 14, asserting that the department had misapplied certain of its own regulations, some of which are set out in the appendix to this opinion.

The mother contends that, under the applicable regulations, she was entitled to medical assistance through August, 1982, a period during which, taking into account the $30 plus Vi disregard (see notes 3 and 4, supra), she would have no surplus income. The department, in effect, contends that its regulations, viewed as a whole, set out a reasonable and not unduly abrupt method of cutting down Medicaid assistance for persons who (e.g., by obtaining employment) have ceased to be eligible for AFDC. See the discussion in the Drysdale case, 689 F.2d at 255-256, of the EID (see note 3, supra) as an incentive to those receiving public assistance to earn income and thereby remove themselves from AFDC.

[242]*242The department, as a matter of policy, could have recognized that the incentive to a person in the position of the mother to work to avoid being an AFDC recipient probably would be greater if its regulations should allow a former AFDC recipient to remain on Medicaid until she in fact (under the department’s regulations) receives excess income (after taking into account for four months the $30 plus Vá disregard). See the final sentence quoted in the appendix from 106 Code Mass. Regs. (C.M.R.) § 506.120(A) (3) (1981). On that basis the mother would not have been subject to any “spend down” of her own funds for medical aid until after August, 1982. The termination of Medicaid on that basis might have turned out to be less burdensome. Instead (compare 42 U.S.C. § 602[a][8][A][iv] [Supp. V. 1981]), the department adopted regulations which it interprets as requiring an estimate of the mother’s prospective earnings and work-related expenses (and any permissible $30 and V3 disregard) to be made for a future six-month period from the date of her first request for medical assistance after her AFDC has ceased. The mother’s contention would have postponed any further computations until September, 1982. Then, of course (if the mother’s income and circumstances remained unchanged) for the then succeeding six months she would be required by the regulations (as interpreted by the department) to expend for medical costs all or substantially all of her then current excess income before being eligible for Medicaid.

The regulations could have been expressed much more clearly and in a manner more intelligible, not only to recipients of aid but even to social workers and judges trying to understand the Medicaid structure. The trial judge5 felt constrained, however, to accept in this review under G. L. c. 30A, § 14, the de[243]*243partment’s interpretation (which he regarded as permissible) of its own regulations.6 We must consider whether the Massachusetts regulations are clear enough to permit that interpretation.

We asked the parties to file further briefs (see note 1, supra), because we recognized that the department was confronted with the intricate problem of adjusting its procedures and regulations to a complex, frequently changed, Federal statutory and administrative structure for Medicaid and AFDC. See Blum v. Bacon, 457 U.S. 132, 141-142 (1982).7 Because of this Federal-State problem, we were reluctant to reject the department’s somewhat obscure interpretation of its own regulations without being satisfied that a different interpretation would not complicate further an already difficult intergovernmental situation.

The new brief in behalf of the department essentially concedes that the mother’s contentions as to the “correct interpretation of [the department’s] current regulations,” if adopted by us, (1) “probably would not conflict with any [F]ederal statute or regulations,” and (2) that Federal financial participation in Medicaid payments is available for payments made by a State pursuant to a court order. 42 C.F.R. 431.250(b) (2) and (d) [244]*244(1983). Deference is ordinarily afforded to a department’s interpretation of its own regulations. See Purity Supreme, Inc. v. Attorney Gen., 380 Mass. 762, 782 (1980). The regulations set out in the appendix, however, especially §§ 505.300, 506.000, 506.510, 506.520, when read with § 506.120(A) (3), as the trial judge pointed out, do not clearly justify the department’s interpretation. Instead, they indicate that an aid recipient, for four months after he or she has ceased to receive AFDC, remains eligible for the “$30 and one-third ‘disregard’ ” and because of that disregard, such an aid recipient is likely to have no excess income for four months after receipt of the last AFDC payment. Section 506.510 (even when considered with the next to the last paragraph of G. L. c.

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Bluebook (online)
465 N.E.2d 264, 18 Mass. App. Ct. 239, 1984 Mass. App. LEXIS 1475, Counsel Stack Legal Research, https://law.counselstack.com/opinion/morales-v-commissioner-massappct-1984.