Stowell v. SHHS

Court of Appeals for the First Circuit·Decided September 10, 1993·No. 93-1254·Published

Opinion

UNITED STATES COURT OF APPEALS FOR THE FIRST CIRCUIT

No. 93-1254

CHRISTINE STOWELL, ET AL., Plaintiffs, Appellants,

v.

SECRETARY OF HEALTH AND HUMAN SERVICES, Defendant, Appellee.

APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MAINE

[Hon. Gene Carter, U.S. District Judge]

Before

Selya, Cyr and Boudin, Circuit Judges.

Patrick Ende, with whom Jack Comart and Pine Tree Legal

Assistance were on brief, for appellants.

Robin S. Rosenbaum, Attorney, Civil Division, U.S.

Department of Justice, with whom Stuart Schiffer, Acting

Assistant Attorney General, Jay P. McCloskey, United States

Attorney, and Barbara C. Biddle, Attorney, U.S. Department of

Justice, were on brief, for appellee. Christopher C. Leighton, Deputy Attorney General, with whom

Michael E. Carpenter, Attorney General, and Thomas D. Warren,

Deputy Attorney General, were on brief for State of Maine, amicus curiae.

September 10, 1993

SELYA, Circuit Judge. Although this appeal presents an SELYA, Circuit Judge.

issue of first impression that requires us to navigate a complex

maze of statutes and regulations, its resolution turns on the

interpretation of two words in common usage. We hold, as did the

court below, that the Secretary of Health and Human Services (the

Secretary) permissibly concluded that the term "payment levels"

as used in 42 U.S.C. 1396a(c)(1) (1988) refers to baseline

payments received under the Aid to Families with Dependent

Children (AFDC) program. Consequently, we affirm.

I. BACKGROUND

AFDC is a voluntary, cooperative federal-state social

service program paid for by both sovereigns but administered

largely by the states. See 42 U.S.C. 601-615 (1988 & Supp.

III 1991); see also Doucette v. Ives, 947 F.2d 21, 23-24 (1st

Cir. 1991) (describing interactive nature of AFDC program). For

heuristic purposes, we limit our discussion of this intricate

program to the particular problem around which this case

revolves.

Through AFDC, poor families receive a monthly stipend

(the basic AFDC grant). The amount of the stipend varies from

state to state and also varies according to family size. If a

family unit has some other income, say, child support payments,

most states deem this money to offset the guaranteed AFDC stipend

pro tanto. Under such a regime, a dollar is subtracted from the

family's basic AFDC grant for every dollar of supplemental income

received. See, e.g., Hassan v. Bradley, 818 F. Supp. 1174, 1176

& n.4 (N.D. Ill. 1993) (describing methodology and identifying

states which employ it).

A few states, Maine among them, take a less

conventional approach to supplemental income. Up to a point,

Maine permits a family to receive such income without offsetting

it against the basic AFDC grant. Only when the family's

aggregate income reaches a designated level a level that Maine

calls the "standard of need" does Maine begin to shrink the

basic AFDC grant in proportion to the marginal amount of

supplemental income received. In the bureaucratic idiom, this

phenomenon is known as "gap filling" because no offsets are made

until the family's supplemental income has filled the gap between

the stipendiary amount of the basic AFDC grant and the (somewhat

higher) standard-of-need amount. Even then, the offset is

limited to the excess of familial receipts over the standard of

need. See Doucette, 947 F.2d at 23-24.

In 1991, Maine, faced with burgeoning budgetary woes,

narrowed this gap by upgrading basic AFDC grants while

simultaneously downgrading standards of need. This revision took

effect on April 1, 1992 (after the district court lifted a

temporary stay). As a result, AFDC-eligible families with

relatively high amounts of supplemental income receive lower

payments than before and families with little or no supplemental

income receive higher payments than before. More specifically,

because child support payments are collected by the state and

then transmitted to AFDC recipients as supplemental income, see

42 U.S.C. 602(a)(2) (1988), Maine's reduction in the standard

of need meant that certain AFDC-eligible families would receive

lower overall payments from the state than they would have

received prior to May 1, 1988.1 After the changes became

effective, the Secretary continued to authorize Medicaid funding

for Maine.

Although the revisions did not ruffle federal feathers,

they prompted the instant suit. Seeking declaratory and

injunctive relief, 5 U.S.C. 702 (1988), plaintiff-appellant

Christine Stowell accused the Secretary of violating a

maintenance-of-effort provision contained in the Medicare

Catastrophic Coverage Act of 1988, Pub. L. No. 100-360, 102 Stat.

683.2 That provision, codified at 42 U.S.C. 1396a(c)(1)

1A concrete example may help to illuminate the effect of the revisions. On May 1, 1988, a single mother with two dependent children would have received a basic AFDC grant of $416. Had the family unit also received $157 in child support payments, it would have retained the entire amount ($573 per month). While Maine's revisions boosted the same family's basic AFDC grant to $453 per month, the concomitant lowering of the standard of need, given the assumptions in our hypothetical, would have required an offset of all supplemental income over $100 per month, or $57. The net effect, then, would have been to cap the family's total monthly receipts at $553 ($20 per month less than the family would have retained under the earlier regime). On the other hand, if our hypothetical family had no supplemental income, the revisions would have increased its receipts by $37 per month (the amount by which Maine hiked the basic AFDC grant).

In constructing this example, we have excluded any reference to the $50 "pass-through" payment described in 42 U.S.C. 657(b)(1) (1988), which was unaffected by the revisions in question.

2Stowell also attempted to sue the state. That suit has gone by the boards as a result of our holding that the maintenance-of-effort provision imposed a duty only on the Secretary. See Stowell v. Ives, 976 F.2d 65, 71 (1st Cir. 1992).

(1988), directs the Secretary not to approve any state's Medicaid

plan if the state's AFDC program sets "payment levels" lower than

those in effect on May 1, 1988. Refined to bare essence,

Stowell's position has consistently been that the maintenance-of-

effort provision prohibits the Secretary from approving state

Medicaid plans if the state's AFDC payment levels are lower than

those in effect on May 1, 1988; that the total amount of money

Stowell and persons similarly situated currently receive from

Maine is lower than the amount they would have received under the

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