State of Mississippi, Office of the Governor Division of Medicaid v. Louis W. Sullivan, Secretary of U.S. Department of Health and Human Services

951 F.2d 80, 1992 U.S. App. LEXIS 471, 1992 WL 169
CourtCourt of Appeals for the Fifth Circuit
DecidedJanuary 17, 1992
Docket90-4795
StatusPublished
Cited by5 cases

This text of 951 F.2d 80 (State of Mississippi, Office of the Governor Division of Medicaid v. Louis W. Sullivan, Secretary of U.S. Department of Health and Human Services) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fifth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State of Mississippi, Office of the Governor Division of Medicaid v. Louis W. Sullivan, Secretary of U.S. Department of Health and Human Services, 951 F.2d 80, 1992 U.S. App. LEXIS 471, 1992 WL 169 (5th Cir. 1992).

Opinion

W. EUGENE DAVIS, Circuit Judge:

The State of Mississippi (Mississippi) appeals the order of the Administrator of the Health Care Financing Administration imposing a penalty on Mississippi for violations of federal Medicaid rules. Because Mississippi’s policies were protected under a congressional moratorium and did not violate any other provision of the Social Security Act, we reverse.

I.

Medicaid is jointly administered and financed by states and the federal government to provide needy persons financial aid for medical care. The Secretary of Health and Human Services (the Secretary) delegates oversight of the Medicaid program to the Health Care Financing Administration (HCFA). States choose whether they wish to participate in the Medicaid program. All participating states must submit Medicaid plans to the HCFA for approval, detailing the state’s Medicaid procedures and policies. A participating state must provide aid to three categories of persons described in § 1902(a)(10)(A)(i) of the Social Security Act (the Act) 1 those who receive cash assistance under the Supplemental Security Income for the Aged, Blind, and Disabled (SSI) program; and the Aid to Families with Dependent Children (AFDC) program (together, the “categorically needy”); and those who are “medically needy” under § 1902(a)(10)(C).

In addition, a State may elect to provide aid to the “optional categorically needy” of § 1902(a)(10)(A)(ii). These persons satisfy all eligibility requirements of the categorically needy, except they have too many financial resources to qualify as categorically needy. There are eleven subcategories of the optional categorically needy. At issue here is Mississippi’s treatment of one such subcategory: those who are in medical institutions for at least thirty days (primarily nursing homes). § 1902(a)(10)(A)(ii)(V). These are known as “Category V” persons.

Under HCFA rules, states currently have two options for determining the Medicaid eligibility of optional categorically needy persons. A state may establish its own eligibility criteria, or it may provide Medicaid to all persons eligible for SSI. A state that uses its own criteria is known as a “209(b) state”; a state that ties its aid to SSI criteria has “1634 status.” 2 States must choose which one method to employ to all potential recipients. Mississippi was a 209(b) state until it converted to 1634 status on July 1, 1981.

Though Mississippi applied the SSI eligibility criteria to all new Category V applicants after July 1, 1981, it did not redetermine the eligibility of the ten thousand Category V persons who were currently receiving aid; instead, Mississippi chose to phase in the new' SSI criteria over the *82 course of the year as each recipient came up for his annual eligibility review. In other words, as each recipient came up for review, his eligibility was determined under the SSI criteria. The recipient’s aid was either continued or terminated depending upon whether he or she met the SSI criteria. Mississippi’s conversion to 1634 status resulted in an increase in the number of persons eligible for Medicaid benefits in that state; that is, more recipients satisfied the SSI criteria than satisfied the 209(b) criteria. But Mississippi’s 209(b) criteria were more generous to Category V persons than the corresponding SSI criteria. Thus, because of Mississippi’s phase-in policy, some Category V persons continued to receive Medicaid assistance during that year who would not have received such aid had the proper SSI criteria been used. In short, Mississippi distributed more Category Y aid than HCFA rules permitted. In its periodic audit of Mississippi’s program, the HCFA discovered these overpayments and informed Mississippi that it was subject to a potential fine of $732,509.

In 1984, as part of the Deficit Reduction Act of 1984 (DEFRA 1984), Congress imposed a moratorium that forbade the HCFA from taking any adverse action against states that violated § 1902(a)(10) by using eligibility procedures that were more liberal than the corresponding SSI criteria. The moratorium was made retroactive to October 1, 1981. Congress amended the moratorium in 1987 (Medicare and Medicaid Patient and Program Protection Act of 1987 (MMPPPA 1987)). The question presented to us is whether the moratorium protects Mississippi from the penalty HCFA imposed against it.

Mississippi received a hearing before the HCFA and was denied relief. The Administrator of the HCFA affirmed the hearing officer’s decision, and this appeal followed.

II.

The Secretary concedes that the DEFRA 1984 moratorium would protect Mississippi’s policies had Mississippi violated § 1902(a)(10) by wrongfully applying more-liberal § 209(b) criteria to all recipients. 3 The Secretary argues, however, that Mississippi forfeited this protection by applying its eligibility requirement in a discriminatory manner in violation of § 1902(a)(17). Mississippi contends that the moratorium protects its phase-in procedure.

A.

The Secretary argues first that the HCFA hearing officer correctly denied protection because Mississippi does not comply with the moratorium’s precise terms. The moratorium applies to state plans “having *83 a standard or methodology” that is more liberal than the SSI standard or methodology. The hearing officer denied protection to Mississippi’s phase-in policy because “a scheme that uses different sets of resource rules for determining the eligibility of individuals at different times within an eligibility/group cannot reasonable [sic] be considered a ‘single standard’ or ‘methodology’ as contemplated in the statute.” (Emphasis in original.)

We consider Mississippi’s phase-in policy to be a single methodology. There is no reason why a single methodology cannot have two subparts. Indeed, the ordinary definition of “methodology” contemplates as much: “the processes, techniques, or approaches employed in the solution of a problem or in doing something.” Philip Babcock Gove, Webster’s Third New International Dictionary 1423 (1981) (unabridged). Thus the Secretary’s semantic argument is without merit. Mississippi’s phase-in policy constitutes a single methodology and satisfies the moratorium’s terms. We turn, therefore, to the Secretary’s main argument concerning subsection (a)(17).

B.

The Secretary argues next that Mississippi’s phase-in policy violates the comparability requirement of § 1902(a)(17) and that the moratorium does not protect such a violation. Although we have considerable doubt that the moratorium would not also protect any (a)(17) violations that did occur, we need not address this issue because we find that Mississippi did not violate subsection (a)(17). Section 1902(a)(17) provides that:

A State plan for medical assistance must—

(17) ... include reasonable standards {which shall be comparable for all groups and may, in accordance with standards prescribed by the Secretary, differ with respect to income levels, but only in the case of

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951 F.2d 80, 1992 U.S. App. LEXIS 471, 1992 WL 169, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-of-mississippi-office-of-the-governor-division-of-medicaid-v-louis-ca5-1992.