LOCATION: José Aponte de la Torre Airport, formerly Roosevelt Roads Naval Station
DOCKET NO.: 81-213
DECIDED BY: Burger Court (1981-1986)
CITATION: 457 US 569 (1982)
ARGUED: Mar 24, 1982
DECIDED: Jun 21, 1982
George W. Jones - on behalf of the Appellant
William H. Simon - on behalf of the Appellees
Facts of the case
Media for Schweiker v. Hogan
Audio Transcription for Oral Argument - March 24, 1982 in Schweiker v. Hogan
Warren E. Burger:
We will hear arguments next in Schweiker against Hogan.
Mr. Jones, you may proceed whenever you are ready.
George W. Jones:
Mr. Chief Justice, and may it please the Court:
The issue in this case is whether differences in the financial eligibility requirements prescribed in Section 1903(f) of the Social Security Act for the two major groups of potential Medicaid beneficiaries violate the equal protection component of the Fifth Amendment.
The first group is the categorically needy.
Aged, blind and disabled individuals whose income is less than the income limits established in the cash assistance programs.
The second group is referred to as the medically needy, and includes aged, blind and disabled individuals whose income is greater than the cash assistance limits.
All of the appellees are in the second group.
The decision in this case, however, will not only determine the constitutional validity of the differences in the income requirements, but also, the validity of Congress's decision to require participating states to provide Medicaid coverage to the categorically needy but not to the medically needy.
The Medicaid program was established in Title 19 of the Social Security Act and provides federal financial assistance to states that choose to pay for medical treatment for certain groups of poor people.
States that choose to participate in the program must provide Medicaid coverage to all individuals who are receiving benefits under one of two cash assistance programs.
Either the federally-financed supplement security income for the aged, blind and disabled program, or the jointly-financed program for providing aid to families with dependent children, the AFDC program.
Participating states are not required as a general matter to provide Medicaid benefits to any other group of individuals.
Therefore, a person who is not eligible for benefits under one of the cash assistance programs is also ineligible for benefits under the Medicaid program unless his state chooses to provide benefits to one of the optional categories.
The major optional coverage group is the medically needy; people who are ineligible for cash assistance only because of the amount of their income.
Section 1903, however, provides that states are only entitled to federal financial assistance for providing Medicaid benefits to a medically needy individual if he incurs medical expenses in excess of the difference between his income and the state's spend down level.
The spend down level for a person with a family of a given size must not exceed 133 1/3 percent of the state AFDC payment amount for a family of the same size.
The SSI program guarantees a federal minimum benefit, but the states may supplement that amount.
If the state chooses to make supplemental payments to individuals who are receiving SSI benefits or who would be eligible for SSI benefits except for the amount of their income, the state may also provide Medicaid benefits to those individuals without regard to the 133 1/2 percent limitation prescribed in Section 1903.
Massachusetts participates in the Medicaid program, provides Medicaid benefits to the medically needy, makes supplemental benefits to SSI benefit recipients or people who would be eligible for SSI except for the amount of their income, and provides Medicaid benefits to people who are eligible for supplemental payments.
All of those choices are voluntary choices on the part of the state of Massachusetts.
Appellees filed this lawsuit in the United States District Court for the District of Massachusetts challenging the maximum medically needy spend down level prescribed in Section 1903(f) as inconsistent with the equal protection component of the Fifth Amendment.
Appellees also challenge the corresponding provisions of the Massachusetts Medicaid plan as inconsistent with the equal protection clause of the Fourteenth Amendment.
Was there a statutory argument eventually presented?
George W. Jones:
Appellees represent a class of all present and future Social Security benefit recipients who live in Massachusetts, are disabled or older than 65 years old, are ineligible for cash assistance because of the amount of their income, and have medical expenses not subject to payment by third parties that are greater than the difference between their countable income and the cash assistance income limits.
The district court in this case held that to the extent that Section 1903(f) requires the state of Massachusetts to establish a spend down level that is less than the state supplemental payment income limits, the statute discriminated against appellees, in violation of the equal protection component of the Fifth Amendment.
The district court concluded that the time for comparing the circumstances of the medically needy including the appellees, the group to whom Section 1903(f) applies, and the circumstances of the categorically needy, to whom Section 1903(f) is not applicable, was after the medically needy had incurred medical expenses.
According to the district court, at that point there is no difference between the medically needy and the categorically needy, and consequently, no basis for distinguishing between the two groups, as Section 1903(f) does.
Mr. Jones, is this... your footnote 9, is that an example of the difference?