Pope v. Wisconsin Department of Health & Social Services

522 N.W.2d 22, 187 Wis. 2d 207, 1994 Wisc. App. LEXIS 1034
CourtCourt of Appeals of Wisconsin
DecidedAugust 25, 1994
DocketNo. 93-1664
StatusPublished

This text of 522 N.W.2d 22 (Pope v. Wisconsin Department of Health & Social Services) is published on Counsel Stack Legal Research, covering Court of Appeals of Wisconsin primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pope v. Wisconsin Department of Health & Social Services, 522 N.W.2d 22, 187 Wis. 2d 207, 1994 Wisc. App. LEXIS 1034 (Wis. Ct. App. 1994).

Opinion

SUNDBY, J.

In this appeal, we decide that the Wisconsin Department of Health and Social Services correctly determined that petitioner-appellant Jessica M. Pope is not a resident of Wisconsin entitled to Medical Assistance (MA). We, therefore, affirm the trial court's order; however, we conclude that it is unnecessary to remand this matter to the Department to determine the residence of Pope's parents at the time of her placement because Pope stipulated that her mother was a Tennessee resident and her father's residence was unknown. On remand, the trial court shall affirm the decision of the Department.

[210]*210Pope was born June 6, 1970. She was admitted to Bethesda Lutheran Home (Bethesda) February 26, 1981. On September 16, 1991, the Jefferson County Circuit Court appointed Mary Heiden as Pope's general guardian. On that date, the court placed Pope at Bethesda pursuant to ch. 55, STATS. Heiden filed an affidavit stating it was her intent that Pope reside in Wisconsin and be placed at Bethesda.

This appeal requires that we construe various provisions of the Wisconsin Statutes, the Department's administrative rules, and the Code of Federal Regulations. Interpretation of these laws, rules, and regulations presents a question of law. See Guertin v. Harbour Assurance Co. of Bermuda, 141 Wis. 2d 622, 627, 415 N.W.2d 831, 833 (1987). Pope informs us that we may substitute our judgment for that of the trial court or the agency. See Hall Chevrolet Co. v. Department of Revenue, 81 Wis. 2d 477, 483, 260 N.W.2d 706, 709 (1978).

Pope argues that the definition of "residence" in § 49.01(8g) and (8r), Stats., controls in determining-whether she is a resident of Wisconsin eligible for MA. Section 49.01 provides in part:

As used in this chapter:
(8g) "Residence" means the voluntary concurrence of physical presence with intent to remain in a place of fixed habitation. Physical presence is prima facie evidence of intent to remain.
(8r) "Voluntary" means according to a person's free choice, if competent, or by choice of a guardian if incompetent.

If these definitions control, Pope is a Wisconsin resident.

[211]*211The Department has adopted administrative rules for implementing the state's MA program. WlS. Adm. Code § HSS 103. Section HSS 103.01(l)(a) provides:

Eligibility for medical assistance (MA) shall be determined pursuant to ss. 49.455, 49.46(1) and 49.47(4), Stats., and this chapter, except that MA shall be provided without eligibility determination to persons receiving AFDC or SSI.

Section HSS 103.03 establishes nonfinancial conditions for MA eligibility. Section HSS 103.03(3) provides in part:

(b) Physical presence and intention. An eligible person shall be a Wisconsin resident, as determined under 42 CFR 435.403.1 Residence shall be based on physical presence, except as provided in an interstate agreement, and on the person's intent to maintain Wisconsin residence indefinitely, except as otherwise provided in pars. (c) to (g). [Second emphasis added.]
(e) Institutionalized persons. 1. For any institutionalized person who is under age 21, or who is age 21 or older and became incapable of indicating intent before age 21, the state of residence is that of:
a. The parents or the legal guardian, if one has been appointed, and parental rights have terminated at the time of placement in an institution....
(g) Establishment of residence. Once established, residence is retained until superseded by a new place of residence.

[212]*212Pope has an IQ under 49 and is legally incapable of forming an intent as to her residence. However, that intent has been supplied by her guardian.

Pope makes three arguments. First, the state may provide MA to persons who are not state residents under federal regulations. Second, Pope qualifies as a Wisconsin resident under 42 C.F.R. § 435.403. Finally, those portions of WlS. Adm. CODE § HSS 103.03(3)(e) which conflict with § 49.01, Stats., are invalid because they exceed the Department's authority.

The MA program is familiarly known as "Medicaid." States choosing to participate in this program are required to follow federal guidelines. 42 U.S.C. § 1396; see Rickaby v. Wisconsin Dep't of Health & Social Servs., 98 Wis. 2d 456, 457, 297 N.W.2d 36, 37 (Ct. App. 1980) (once a state accepts Title XIX funds, it must abide by the MA act and applicable regulations).

Title 42 C.F.R. § 435.403 provides extremely detailed provisions for determining state residence. Paragraph (a) provides that "[t]he [state] agency must provide Medicaid to eligible residents of the State ...." Pope argues that this provision simply insures that the state will provide MA to persons who are state residents under federal regulations. She argues that there is nothing in the federal regulations which prohibits participating states from providing services to persons not covered by the Medicaid program. These regulations, she asserts, "simply let[] participating states know which services the federal government will pay for."

She further argues that she has a "statutory right" to receive MA from the state. "[Federal regulations] only mean[ ] the state may not receive federal reimbursements for the benefits Ms. Pope receives."

[213]*213We agree that the state could establish a MA program financed solely by the state for persons who do not meet federal requirements. However, Pope did not present any evidence to the Department or to the trial court and has not shown this court that the state has established a MA program which is not integrated with Medicaid. Her reliance on the definition of "residence" in § 49.01(8g), STATS., does not support such an intent. That definition applies equally to those subchapters of ch. 49, Stats., which do not apply to MA. Chapter 49 governs general relief, aid to dependent children and the administration of security aids, in addition to medical assistance. When a subject matter is affected by a statute of general application as well as one of specific application, generally, the more specific controls. State v. Amato, 126 Wis. 2d 212, 217, 376 N.W.2d 75, 78 (Ct. App. 1985).

Medical assistance grants are accepted from the federal government under §§ 16.54, 46.016 and 49.45(2)(a)7, STATS. The latter provision provides that "[t]he department shall:...

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Related

George Hogan v. Margaret Heckler, Phillip Johnston
769 F.2d 886 (First Circuit, 1985)
State v. Amato
375 N.W.2d 75 (Court of Appeals of Wisconsin, 1985)
Hall Chevrolet Co., Inc. v. Dept. of Revenue
260 N.W.2d 706 (Wisconsin Supreme Court, 1978)
Rickaby v. Wisconsin Department of Health & Social Services
297 N.W.2d 36 (Court of Appeals of Wisconsin, 1980)
Guertin v. Harbour Assurance Co. of Bermuda
415 N.W.2d 831 (Wisconsin Supreme Court, 1987)
Hogan v. Bowen
478 U.S. 1007 (Supreme Court, 1986)

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Bluebook (online)
522 N.W.2d 22, 187 Wis. 2d 207, 1994 Wisc. App. LEXIS 1034, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pope-v-wisconsin-department-of-health-social-services-wisctapp-1994.