Willey v. Ives

696 F. Supp. 1388, 1988 U.S. Dist. LEXIS 11447, 1988 WL 108477
CourtDistrict Court, D. Maine
DecidedSeptember 30, 1988
DocketCiv. No. 85-0295-B
StatusPublished
Cited by4 cases

This text of 696 F. Supp. 1388 (Willey v. Ives) is published on Counsel Stack Legal Research, covering District Court, D. Maine primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Willey v. Ives, 696 F. Supp. 1388, 1988 U.S. Dist. LEXIS 11447, 1988 WL 108477 (D. Me. 1988).

Opinion

MEMORANDUM AND ORDER

CYR, Chief Judge.

I. BACKGROUND

This case arises under the Medicaid Program. Medicaid was established in 1965

as a cooperative federal and state cost-sharing venture for the provision of basic medical services to eligible applicants, Pub.L. No. 89-97, 79 Stat. 343 (1965), as amended, 42 U.S.C. §§ 1396 et seq. States choosing to participate in the program are required to follow federal guidelines, 42 U.S.C. § 1396. The United States Secretary of Health and Human Services (formerly the Secretary of Health, Education and Welfare) is entrusted with the administration of the Act and must approve the state plans of medical assistance before the participating states are allowed to receive any federal monies.

Hogan v. Heckler, 769 F.2d 886, 887-88 (1st Cir.1985), cert. denied sub nom, Hogan v. Bowen, 478 U.S. 1007, 106 S.Ct. 3301, 92 L.Ed.2d 715 (1986).

There are two groups of eligible beneficiaries under Medicaid. The first group, the “categorically needy,” consists of those [1390]*1390individuals who qualify for Medicaid by virtue of their eligibility for Aid to Families with Dependent Children [AFDC] or Supplemental Security Income [SSI]. Congress considers the categorically needy “especially deserving of public assistance” for medical expenses, Schweiker v. Gray Panthers, 453 U.S. 34, 37, 101 S.Ct. 2633, 2636, 69 L.Ed.2d 460 (1981), because they “earn[ ] less than what has been determined to be required for the basic necessities of life,” Atkins v. Rivera, 477 U.S. 154, 157, 106 S.Ct. 2456, 2458, 91 L.Ed.2d 131 (1986). Since AFDC and SSI cover only basic necessities (other than medical expenses), payment of medical expenses by categorically needy persons would have to be made from funds provided under AFDC or SSI for other basic necessities. Therefore, medical coverage is mandated for the categorically needy, and states electing to participate in the Medicaid program are required to provide coverage to the “categorically needy.” Id.

The second group eligible for Medicaid, the “medically needy,” consists of those individuals whose incomes are too high to qualify for AFDC or SSI, but too low to meet medical expenses without financial assistance.

The medically needy may qualify for financial assistance for medical expenses if they incur such expenses in an amount that effectively reduces their income to the eligibility level. Only when they “spenddown” the amount by which their income exceeds that level are they in roughly the same position as persons eligible for AFDC or SSI: any further expenditures for medical expenses then would have to come from funds required for basic necessities. Id. at 158, 106 S.Ct. at 2459.

States electing to participate in the Medicaid program may opt to provide coverage for the “medically needy.”

A state which elects to cover the “medically needy” must determine eligibility under “standards that are ‘reasonable’ and ‘comparable for all groups.’ ” 42 U.S.C. § 1396a(a)(17).

In addition, ... state plans for Medicaid must describe “the single standard to be employed in determining income and resource eligibility for all such groups, and the methodology to be employed in determining such eligibility which shall be the same methodology which would be employed under [AFDC or SSI].” 42 U.S.C. § 1396a(a)(10)(C)(i)(III).

Id. (emphasis in original). See also Hogan, 769 F.2d at 887-88.

The State of Maine, which participates in the Medicaid program, has elected to extend coverage to its “medically needy.”

II. THE PARTIES AND THEIR POSITIONS

The plaintiff class consists of:

All individuals in the State of Maine who have received or applied for Medicaid benefits under the SSI-related Medically Needy Program since July 1, 1985 and who own resources having an equity value in excess of $1,600 and who have made a “bona fide effort to sell” such resource, as defined in the Secretary’s Program Operations Manual System (POMS) SI 01130.330, but who have been unable to do so notwithstanding such “bona fide effort to sell” or because the resource is unsalable due to a specified condition.

Willey v. Ives, Civ.No. 85-0295-B (D.Me. Feb. 10, 1986) (order granting class certification).

Plaintiffs contend that a memorandum, issued by Henry R. Desmarais, M.D., Di[1391]*1391rector of the Bureau of Eligibility, Reimbursement and Coverage of the Health Care Financing Administration of the United States Department of Health and Human Services, [Desmarais Memorandum], precipitated the elimination of the bona-fide-effort-to-sell exclusion rule in Maine. Accordingly, plaintiffs request that the court (1) declare unlawful the policy of the Secretary of Health and Human Services [Secretary] rendering medically needy persons ineligible for Medicaid by reason of their ownership of excess resources, which they are making a bona-fide effort to sell; and (2) permanently enjoin the defendants from implementing policies and regulations rendering medically needy persons ineligible for Medicaid due to their ownership of excess resources which they are making a bona-fide effort to sell.

The Secretary contends that the Desma-rais Memorandum does not preclude a state from excluding the value of resources which the individual lacks the power to sell. Therefore, the Secretary argues, neither the Desmarais Memorandum nor the Department’s bona-fide-effort-to-sell policy violates “the comparability or the same methodology requirements of the Medicaid provisions of the Social Security Act.” Memorandum of the Defendant Secretary in Support of Motion to Dismiss or for Summary Judgment, and in Opposition to Plaintiff’s Motion for Summary Judgment, at 3 [Secretary’s Memo].

The Commissioner of the Maine Department of Human Services [Commissioner] asserts that the State of Maine eliminated the bona-fide-effort-to-sell provision from the Maine Public Assistance Payments Manual [MPAPM]1 in direct response to the Desmarais Memorandum. The MPAPM previously provided that property would be excluded from the computation of an individual’s resources for Medicaid eligibility if a bona-fide effort had been made in the relevant geographic area to sell the property at a fair market value, or if two knowledgeable sources in the geographic area agreed that the property was not salable due to a specified condition. State Defendant’s Memorandum in Support of Summary Judgment, at 2 [Commissioner’s Memo].

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Cite This Page — Counsel Stack

Bluebook (online)
696 F. Supp. 1388, 1988 U.S. Dist. LEXIS 11447, 1988 WL 108477, Counsel Stack Legal Research, https://law.counselstack.com/opinion/willey-v-ives-med-1988.