Trustees of Indiana University v. County Department of Public Welfare of Kosciusko County

426 N.E.2d 74, 1981 Ind. App. LEXIS 1642

• Court: Indiana Court of Appeals
• Decided: September 28, 1981
• Docket: 3-281A56
• Status: Published

Opinions

HOFFMAN, Presiding Judge.

Anna B. Bradley was admitted to the Indiana University Hospital on February 11, 1979, March 31, 1979 and May 6, 1979 suffering from a disease, defect or deformity. On April 20, 1979, she applied for Hospital Commitment Assistance with the County Department of Public Welfare of Kosciusko County pursuant to IC 1971, 12-5-1-1 (Burns 1981 Repl.).¹ The Welfare Department determined that she did not qualify for Hospital Commitment Assistance for the reason of “financial ineligibility.” Anna Bradley was a member of a three person household with a total income from Social Security and Black Lung benefits of $771.98 per month. Upon her admission to the hospital, she reported the family’s debts to be in excess of $3,430, however, $1,100 of that total were debts of her husband’s for which she was not responsible. In addition, she incurred expenses of $8,410.98 for hospital care and services. $2,000 of this bill has been paid by the Indiana Vocational Rehabilitation Program, leaving a balance of $6,410.98 due and owing.

Bradley was joined by the Indiana University Trustees, a party effected by the determination, in a trial de novo. The trial court found that Anna Bradley was financially able to defray the necessary expenses of her hospital care and rendered a judgment against her and the Trustees. From this judgment, the Indiana University Trustees appeal.

The facts were stipulated by the parties and the single issue raised on appeal is whether as a matter of law the trial court erred in determining that Bradley was financially able to defray the necessary expense of her medical, surgical and hospital care.

The Trustees argue that the Welfare Department should not have used the standards for the Aid to Dependent Children Program in making Bradley’s eligibility determination. They also argue that the Welfare Department did not take into consideration the size of the hospital bill and the length of time it would take Bradley to pay off her debts.

The term “financially unable to defray” is very broad and has not been defined in Indiana by statute or case law. In construing a statute the words should be accorded their plain and ordinary meaning. Murphy v. State (1980), Ind.App., 414 N.E.2d 322. The American Heritage Dictionary of the English Language, 1976, defines “defray” as: “[t]o meet or satisfy by payment; pay.”

The county welfare departments were given the power to make these determinations without being given any specific criteria to use. The Welfare Department involved in this cause chose to apply the standards used in the Aid to Dependent Children Program in making its eligibility determinations for hospital assistance. In using the formula chosen the Welfare Department determined that Bradley’s monthly income exceeded the “subsistence” level by $225 per month, and thus Bradley was financially ineligible.

The Trustees argue that because of the size of the hospital bill it would have taken Bradley many months to pay it off. Applying the entire amount over “subsistence” strictly to the hospital bill, it would take approximately 29 months to pay it off.

The Trustees feel this is unreasonable. They contend that the Welfare Department should pay the bill and then obtain reimbursement from Bradley pursuant to IC 1971, 12-5-1-16, which provides that the county welfare departments may be reimbursed by executing a repayment contract with someone who is able to repay part or all of his medical care costs over a period of time.- This provision can be interpreted to cover a situation where a change of circumstances in the future enables the patient to repay the welfare department. It is only reasonable to conclude that if a patient is able to execute a repayment contract at the time of the eligibility determination, then the patient should pay that money to the hospital instead.

The Hospital Commitment Assistance Program can be differentiated from other medical assistance programs. In programs such as Medicaid, Medicare and the Crippled Children’s Program, Bradley would qualify for assistance only if she agreed to pay the excess resources, over the “subsistence” level, to the Welfare Department under a repayment or “spend-down” agreement. Granted, Bradley would not qualify for these programs for reasons other than financial. However, with the amount of excess resources of Bradley, to be financially eligible for any of the other welfare programs, she would have first had to agree to repayment or “spend-down” conditions. Under the Hospital Commitment Assistance Program, there is no such requirement for eligibility, only a provision that the welfare departments may be reimbursed when and if a contract can be entered into with the party. The local welfare department, which has a finite amount of resources, cannot force a party with funds to repay it, but a hospital can.

With these circumstances, the Legislature gave the local welfare departments the power to make the eligibility determinations. The evidence contained in the stipulated facts is sufficient to support its decision and the decision is reasonable. The decision was affirmed when reviewed by' the trial court. Absent some showing of abuse, arbitrariness or capriciousness in the decision, as a matter of law the trial court should be affirmed. No such showing has been made and therefore, the trial court is affirmed.

Affirmed.

GARRARD, J., concurs. STATON, J., dissents with opinion.

1 . Effective January 1, 1982, IC 12-5-1-1 is repealed. P.L. 144, Senate Enrolled Act No. 243 (1981) created IC 12-5-6-1 et seq. to replace IC 12-5-1-1.