Wisconsin Department of Health and Family Services v. Blumer

PETITIONER: Wisconsin Department of Health and Family Services
RESPONDENT: Blumer
LOCATION: Oklahoma School District

DOCKET NO.: 00-952
DECIDED BY: Rehnquist Court (1986-2005)
LOWER COURT: State appellate court

CITATION: 534 US 473 (2002)
ARGUED: Dec 03, 2001
DECIDED: Feb 20, 2002

ADVOCATES:
Jeffrey A. Lamken - Argued the cause for the United States as amicus curiae, by special leave of the Court, supporting the petitioner
Maureen M. Flanagan - Madison, Wisconsin, argued the cause for the petitioner
Mitchell Hagopian - Argued the cause for the respondent

Facts of the case

The spousal impoverishment provisions of the Medicare Catastrophic Coverage Act of 1988 (MCCA) permit a spouse living at home to reserve certain income and assets to meet the minimum monthly maintenance needs he or she will have when the other spouse is institutionalized, usually in a nursing home, and becomes eligible for Medicaid. The MCCA's resource allocation rules provide that, in determining the institutionalized spouse's Medicaid eligibility, a portion of the couple's resources, called the "community spouse resource allowance" (CSRA), shall be reserved for the benefit of the community spouse. The MCCA allows an increase in the standard allowance if either spouse shows, at a state-administered hearing, that the community spouse will not be able to maintain the statutorily defined minimum level of income on which to live after the institutionalized spouse gains Medicaid eligibility. In 1996, after entering a Wisconsin nursing home, Irene Blumer applied for Medicaid through her husband Burnett and ultimately sought a higher CSRA. Under the "income-first" method for determining whether the community spouse is entitled to a higher CSRA, which Wisconsin uses, the State considers first whether potential income transfers from the institutionalized spouse will suffice to enable the community spouse to meet monthly needs once the institutionalized spouse qualifies for Medicaid. Subsequently, an examiner denied Blumer's request. The Court of Appeals affirmed, but the Wisconsin Court of Appeals reversed, concluding that the State's income-first statute conflicted with the MCCA, which, the appeals court held, unambiguously mandates the resources-first method.

Question

Is the income-first method of determining whether a community spouse is entitled to a higher community spouse resource allowance consistent with the Medicare Catastrophic Coverage Act of 1988?

Media for Wisconsin Department of Health and Family Services v. Blumer

Audio Transcription for Oral Argument - December 03, 2001 in Wisconsin Department of Health and Family Services v. Blumer

William H. Rehnquist:

We'll hear argument first this morning in Number oh oh nine five two, the Wisconsin Department of Health and Human Services versus Irene Blumer.

Ms. Flanagan.

[Inaudible]

Maureen M. Flanagan:

Mr. Chief Justice, and may it please the Court.

In nineteen eighty-eight, Congress enacted the spousal impoverishment protections of the Federal Medicaid Act, forty two US Code section thirteen ninety-six R five, to accomplish two competing purposes.

First, Congress sought to protect spouses living at home from impoverishment when the other spouse is institutionalized and requires long-term nursing home care.

Secondly, Congress sought to ensure that married couples seeking Medicaid bear a fair share of the cost of such care.

This case concerns whether States have the discretion to achieve those competing goals by taking into account at the time Medicaid eligibility is determined available income which the nursing home spouse is permitted to use after eligibility to support the at-home spouse.

When the nursing home spouse applies for Medicaid, section thirteen ninety-six R five permits the community spouse to retain certain income and resources to mit- to meet his own monthly maintenance needs.

The statute permits an increase in the standard resource allowance, however, if the at-home spouse can show at a fair hearing that the allowance will be inadequate to provide him with income at the State-protected level once the nursing home spouse qualifies for Medicaid.

When making this determination, Wisconsin, like more than thirty other States, first considers whether income available to the at-home spouse from the nursing home spouse will be sufficient to ensure the protected level of income once Medicaid eligibility occurs.

This method of determining whether to increase or to substitute the standard resource allowance is called the income-first rule.

[Inaudible]

William H. Rehnquist:

And what do the other States do?

Maureen M. Flanagan:

The the remaining States use a methodology called resource first, in which they look first to the additional resources above the standard resource allowance.

The- These cases only arise where the couple has resources above the standard allowance.

In...

this case...

John Paul Stevens:

It'd be very helpful to me if, right at this point, you pointed the statutory pointed out the statutory provision that authorizes the State to transfer income at this stage.

Maureen M. Flanagan:

The the statutory provision, I think, specifically is found in forty-two US Code thirteen ninety-six A, sub A seven- sub seventeen, which deals with State standards for eligibility and and the Secretary's authority to set standards for...

determining availability.

William H. Rehnquist:

a handy reference in the brief somewhere to the, where we can see that?

Maureen M. Flanagan:

It's in the Attor- the Solicitor General's appendix at the first thing in their appendix is the codified statute, thirty- s- thirteen ninety-six R five, the one we are discussing primarily, and no, I'm sorry, thirteen ninety-six A is in the first thing in the Solicitor General's appendix.

William H. Rehnquist:

Page one A?

Maureen M. Flanagan:

Yes, and A seventeen.

John Paul Stevens:

That's eight A.

Antonin Scalia:

Eight A?

It looks like seven...

Maureen M. Flanagan:

Honor, it is.

William H. Rehnquist:

Then where in s- s- number seventeen is the language that you're answering Justice Stevens with?