LOCATION: United States Courthouse
DOCKET NO.: 83-727
DECIDED BY: Burger Court (1981-1986)
LOWER COURT: United States Court of Appeals for the Sixth Circuit
CITATION: 469 US 287 (1985)
ARGUED: Oct 01, 1984
DECIDED: Jan 09, 1985
G. Gordon Bonnyman, Jr. - on behalf of the Respondents
Paul M. Bator - as amicus curiae
W. J. Michael Cody - on behalf of the Petitioners
Facts of the case
Media for Alexander v. Choate
Audio Transcription for Oral Argument - October 01, 1984 in Alexander v. Choate
Warren E. Burger:
Mr. Attorney, General, I think you may proceed wherever you're ready.
W. J. Michael Cody:
Mr. Chief Justice, and may it please the Court:
This is a case involving the interpretation and application of Section 504 of the Rehabilitation Act of 1973, which prohibits discrimination against the handicapped in federally funded programs.
At issue is whether the Tennessee Medicaid program discriminated against the handicapped by reducing the number of inpatient hospital days provided each Medicaid recipient in a fiscal year from 20 until 14.
The district court ruled that the change did not violate Section 504.
A three-judge panel of the Sixth Circuit in a split decision found a prima facie violation of Section 504, reversed and remanded in order to allow the state to rebut the prima facie case.
The change which the Tennessee Medicaid program took in this case was an across-the-board deduction in inpatient hospital days from 14... from 20 days to 14 days.
It excluded no one.
It applied equally to the handicapped as well as the nonhandicapped.
This change was necessary because the Tennessee constitution prohibits deficit spending, and our program was in a condition that it would run out of money unless certain changes were made in order to reduce the financial commitment of the state.
And this change itself was made along with others which made the budget possible to have the Medicaid program run throughout the year and serve the public recipients.
This change, the state submits, was authorized by the Medicaid statutes and the regulations.
Congress has given the states discretion in setting benefit and service levels.
There are two restrictions that Congress places on those levels of services.
First, the level must be sufficient in amount, in duration, and in scope in order to achieve the purpose of the program; and secondly, the level must be set equally for everyone.
In addition to the Medicaid law, the State of Tennessee submits that the charge is consistent with the purpose of Section 504 and the specific regulations under Section 504 which refer to benefits and services.
The purpose of Section 504, we submit, is the evenhanded treatment of handicapped, not affirmative action in order to overcome disabilities which are caused by handicapped.
In the regulations which particularly refer to benefits and services, the regulation says that services are required to be equally effective, but in order to be equally effective, the benefits are not required to produce the identical result or level of achievement for the handicapped and the nonhandicapped persons, but must afford handicapped persons equal opportunity to obtain the same result.
In order to violate Section 504, we submit, we would have had to extend a lesser number of inpatient hospital days to the handicapped than to the nonhandicapped.
The district court recognized this and found that there was no discrimination under 504 when an equal number of hospital days were provided.
The court of appeals, however, felt that a prima facie case was made because on the statistics introduced, the 14 days limitation was unable to meet the hospital needs of the handicapped to the same extent as the nonhandicapped.
So even if an effects test is applied, a violation or a prima facie violation of Section 504 requires a finding that the handicapped were affected unequally with respect to some program benefit.
Here, the benefit which the state is providing, the 14 days of inpatient hospital care, is provided equally to all eligible for the program.
Sandra Day O'Connor:
I'd like to ask, General Cody, if an effects test is appropriate in this case.
How could you... how could you have the finding about whether the treatment is equal or unequal without letting it go to the hearing?
In other words, is a prima facie case made out on the facts such as existed here with the resolution of the effect to be made thereafter?
W. J. Michael Cody:
Justice O'Connor, we do not believe that that would be the result, and it's the error we think that the court of appeals made.
They... we contend that the benefit which is provided in this service is a certain number of inpatient hospital days.
And I might add as the Solicitor General points out in his brief, if you look at the studies, the disproportionate result is even greater at 19 days than it is at 14, so the cut... the figures would show that less handicapped needs proportional to nonhandicapped are met at 19 days than at what we cut it back to at 14.
But what we think the statute does is it provides equal access to the program, to the benefits, equal opportunity to receive those benefits, and not an equal result.