Connecticut Department of Income Maintenance v. Heckler

PETITIONER: Connecticut Department of Income Maintenance
LOCATION: Public Schools

DOCKET NO.: 83-2136
DECIDED BY: Burger Court (1981-1986)
LOWER COURT: United States Court of Appeals for the Second Circuit

CITATION: 471 US 524 (1985)
ARGUED: Mar 27, 1985
DECIDED: May 20, 1985

Charles Alvin Miller - on behalf of the petitioner
Charles A. Miller - on behalf of the Petitioner
Kathryn Anne Oberly - on behalf of the respondent-- resumed
Ms. Kathryn A. Oberly - on behalf of the Respondent

Facts of the case


Media for Connecticut Department of Income Maintenance v. Heckler

Audio Transcription for Oral Argument - March 27, 1985 in Connecticut Department of Income Maintenance v. Heckler

Warren E. Burger:

Mr. Miller, you may proceed whenever you're ready.

Charles Alvin Miller:

Thank you, Mr. Chief Justice, and may it please the Court:

This case presents questions as to the meaning of terms in the Medicaid law, and the State of Connecticut is grateful for the Court for hearing its case today.

The outcome of this case is unusually important because of its bearing on the future care of needy mentally ill in the United States, and because of its impact on the states and their position as partners with the federal government in carrying out the Medicaid program.

Two statutory terms must be construed in this case.

The first is the term IMD.

That is an exception in the statute that limits the coverage that otherwise would be extended for certain medical services.

The second term is ICF.

This is one category of facility that is covered by the Medicaid program, and it is defined in the statute to mean a facility that provides a specified level of service to persons requiring it because of their mental or physical condition.

And the ultimate question presented is the extent to which, if at all, the IMD exception limits Medicaid coverage for ICFs.

The briefs of the parties have treated that question exhaustively, and in so doing have exposed the complexity of the Medicaid laws and the subtlety of many of its standards and distinctions.

Sandra Day O'Connor:

May I inquire about the consequences of a ruling adverse to your position?

If the Government is correct in its view of this statute, would it be possible for states to simply scatter mental patients around among the intermediate care facilities and just not put as many of them in a single facility, as existed here, and succeed in having reimbursement by that device?

Charles Alvin Miller:

Yes, Justice O'Connor, from the point of view of the mentally ill that would be the principal consequence.

Sandra Day O'Connor:


And so we're not really talking about the money so much as the inconvenience perhaps of having to scatter them?

Charles Alvin Miller:

I wouldn't call it inconvenience.

The principal impact is on the care that would be given to mentally ill people.

As the record shows in this case, because Middletown Haven was recognized by everyone involved as being a very fine facility, a facility that specializes in the care of people with mental conditions, it does a much better job for them, even at this intermediate level, than a facility which is treating people for a broad range of conditions, including the many physical conditions associated with those who need some sort of residential care, albeit not the intensive care of hospitals.

So that is a major distinction, and the evidence has shown that in this facility and others like it that specialize in the care of the mentally ill, those people get the kind of care they need and they cannot get elsewhere.

Sandra Day O'Connor:

What do you know about the practical application of the Government's test?

Do they look to see whether 50 percent or more of the patients are mental cases, or 30 percent, or how is that being applied in your experience?

Charles Alvin Miller:

Well, we have the experience of the present case and the three companion cases that started out with them at the administrative level.

And there are some other cases that are working their way through the system now.

The answer is that, to begin with, the Government has applied a 50 percent litmus test.

It has a number of other standards as well that it seeks to apply.

All of those standards are designed to find out whether the facility in question is functioning as an alternative to the care of persons in mental hospitals.

And that's one of the points I wanted to make in the argument this morning, that that set of criteria is fundamentally flawed in the sense that it looks to apply a distinction contrary to what the statute applies.

And as I will try to say later, the whole point of the statute here which I am going to refer to, specifically the Long amendment, was designed to encourage the development of alternatives to mental hospitals and to provide funding for the care of people who are placed in these alternatives to the extent the alternative types of facilities are covered by the statute.

Not all alternatives to mental hospitals are covered by the Medicaid program.