Roloff v. Sullivan

772 F. Supp. 1083, 1991 U.S. Dist. LEXIS 11732, 1991 WL 160326
CourtDistrict Court, N.D. Indiana
DecidedJuly 24, 1991
DocketS87-31 (RLM)
StatusPublished
Cited by7 cases

This text of 772 F. Supp. 1083 (Roloff v. Sullivan) is published on Counsel Stack Legal Research, covering District Court, N.D. Indiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Roloff v. Sullivan, 772 F. Supp. 1083, 1991 U.S. Dist. LEXIS 11732, 1991 WL 160326 (N.D. Ind. 1991).

Opinion

MEMORANDUM AND ORDER

MILLER, District Judge.

This cause is before the court on cross-motions for summary judgment filed both by the plaintiffs and the defendants in this cause. The plaintiffs are a class of individuals certified by the court pursuant to Federal Rule of Civil Procedure 23. The named defendants can be separated into two groups, certain officials of the United States Department of Health and Human *1085 Services (“federal defendants”) 1 and certain officials of the Indiana Department of Public Welfare (“state defendants”). 2 The federal defendants and the state defendants have filed separate summary judgment motions.

The parties have fully briefed the motions which are now ripe for the court’s ruling. For the reasons that follow, the defendants’ motions will be granted.

I.

A.

Medicaid is a federal benefits program administered by the Health Care Financing Administration within the United States Department of Health and Human Services and in conjunction with those states which choose to participate in the program. Harris v. McRae, 448 U.S. 297, 301, 100 S.Ct. 2671, 2680, 65 L.Ed.2d 784 (1980). Congress established the Medicaid program in 1965. 42 U.S.C. § 1396 et seq. The federal-state Medicaid program is distinct from Medicare, a completely federally-operated medical insurance system for beneficiaries and dependents through the Social Security Administration.

The Medicaid program originally was categorized into four sub-programs: Old Age Assistance, Aid to Families with Dependent Children (“AFDC”), Aid to the Blind, and Aid to the Permanently and Totally Disabled. In 1972, Congress consolidated three of these sub-programs into one program known as Supplemental Security Income (“SSI”). AFDC remained independent from the SSI program.

When Congress reorganized the Medicaid program in 1972, that legislature realized that the restructuring would increase the costs of Medicaid for certain states. The federal government assumed the duty for funding payments and setting the standards of need with respect to the SSI program’s benefits. Accordingly in some states, the number of individuals eligible for SSI was significantly larger than the number eligible under the pre-1972 state-administered need programs. Because of the anticipated increase in Medicaid eligibility, Congress feared that some states would choose to withdraw from the Medicaid program entirely, rather than expand their programs to accommodate SSI. See Schweiker v. Gray Panthers, 453 U.S. 34, 37-38 & n. 1, 101 S.Ct. 2633, 2636-37 & n. 1, 69 L.Ed.2d 460 (1981).

To relieve the financial burden on the states, Congress offered an option to states wishing to remain part of the Medicaid program. Under the “§ 209(b) option”, states could elect to provide Medicaid assistance only to those individuals who would have been eligible under the state Medicaid plan in effect on January 1, 1972. States thus became either “SSI States” or “§ 209(b) States”. 42 U.S.C. § 1396a(f); see also Mattingly by Mattingly v. Heckler, 784 F.2d 258, 262 & n. 3 (7th Cir.1986); Winter v. Miller, 676 F.2d 276, 278 (7th Cir.1982).

After the 1972 restructuring, all states participating in Medicaid were required to provide Medicaid coverage to the “categorically needy” or SSI and AFDC recipients. In addition to the mandatory coverage of the categorically needy, a state could elect to provide Medicaid to another group described as “medically needy”, regardless of whether the state had opted for § 209(b) or SSI. The medically needy are defined as those “who meet the nonfinancial eligibility requirements for cash assistance under AFDC or SSI, but whose income or resources exceed the financial eligibility standards for those programs.” Atkins v. Rivera, 477 U.S. 154, 157, 106 S.Ct. 2456, 2459, 91 L.Ed.2d 131 (1986).

*1086 A state opting to provide benefits to the medically needy establishes income and resource standards for those persons that generally are higher than those applicable to the state’s categorically needy programs. See generally 42 C.F.R. §§ 435.-811, 434.812, 435.840, 435.841. Because of this differential, a state deducts from the determination of an applicant’s income those “incurred medical expenses that are not subject to payment by a third party ...” 42 C.F.R. § 435.831(c); see 42 U.S.C. § 1396a(a)(17). This deduction of incurred medical expenses from income to determine eligibility for medically needy Medicaid benefits is referred to as an “income spend down”. In states that have added the medically needy option into their Medicaid programs, an applicant who is financially ineligible for any of the categorically needy cash assistance programs may nevertheless establish eligibility for Medicaid by spending down their medical expenses to offset their income. Atkins v. Rivera, 477 U.S. 154, 158, 106 S.Ct. 2456, 2459, 91 L.Ed.2d 131 (1986).

For § 209(b) States, a debate developed concerning the restrictiveness of eligibility standards applicable to the categorically needy and the medically needy. Congress resolved this matter in 1988 by passing legislation permitting § 209(b) States to use less restrictive methodologies than SSI in establishing eligibility of either medically needy or categorically needy individuals for Medicaid benefits. Section 209(b) States could continue to employ methodologies more restrictive than SSI methodologies to determine eligibility for categorically needy Medicaid programs, as long as such methodologies are no more restrictive than those in effect in January 1, 1972. 42 U.S.C. § 1396a(r)(2); see Mowbray v. Kozlowski, 914 F.2d 593 (4th Cir.1990).

The State of Indiana participates in the Medicaid program and has enacted legislation authorizing the IDPW to administer Medicaid in Indiana. IND.CODE 12-1-7-14.4. Under that program, Indiana has adopted the § 209(b) option.

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Bluebook (online)
772 F. Supp. 1083, 1991 U.S. Dist. LEXIS 11732, 1991 WL 160326, Counsel Stack Legal Research, https://law.counselstack.com/opinion/roloff-v-sullivan-innd-1991.