{ "id": 3547740, "name": "CHRISTOPHER HESSION, Plaintiff-Appellant, v. THE DEPARTMENT OF PUBLIC AID et al., Defendants-Appellees", "name_abbreviation": "Hession v. Department of Public Aid", "decision_date": "1987-11-19", "docket_number": "No. 86\u20140607", "first_page": "553", "last_page": "561", "citations": [ { "type": "official", "cite": "163 Ill. App. 3d 553" } ], "court": { "name_abbreviation": "Ill. App. Ct.", "id": 8837, "name": "Illinois Appellate Court" }, "jurisdiction": { "id": 29, "name_long": "Illinois", "name": "Ill." }, "cites_to": [ { "cite": "393 N.E.2d 1212", "category": "reporters:state_regional", "reporter": "N.E.2d", "opinion_index": 0 }, { "cite": "74 Ill. App. 3d 862", "category": "reporters:state", "reporter": "Ill. App. 3d", "case_ids": [ 3267858 ], "opinion_index": 0, "case_paths": [ "/ill-app-3d/74/0862-01" ] }, { "cite": "116 Ill. 2d 397", "category": "reporters:state", "reporter": "Ill. 2d", "case_ids": [ 5542921 ], "opinion_index": 0, "case_paths": [ "/ill-2d/116/0397-01" ] }, { "cite": "590 F.2d 1250", "category": "reporters:federal", "reporter": "F.2d", "case_ids": [ 823093 ], "year": 1987, "opinion_index": 0, "case_paths": [ "/f2d/590/1250-01" ] }, { "cite": "714 F.2d 878", "category": "reporters:federal", "reporter": "F.2d", "opinion_index": 0 }, { "cite": "148 Ariz. 385", "category": "reporters:state", "reporter": "Ariz.", "case_ids": [ 1471830 ], "weight": 5, "pin_cites": [ { "page": "390" }, { "page": "883" } ], "opinion_index": 0, "case_paths": [ "/ariz/148/0385-01" ] }, { "cite": "476 N.E.2d 572", "category": "reporters:state_regional", "reporter": "N.E.2d", "weight": 15, "year": 1986, "pin_cites": [ { "page": "578" }, { "page": "578" }, { "page": "578" }, { "page": "578" }, { "page": "578" }, { "page": "578" }, { "page": "578" }, { "page": "578" }, { "page": "578" }, { "page": "579" }, { "page": "575" }, { "page": "578" } ], "opinion_index": 0 }, { "cite": "394 Mass. 466", "category": "reporters:state", "reporter": "Mass.", "case_ids": [ 385188 ], "weight": 15, "year": 1986, "pin_cites": [ { "page": "474" }, { "page": "474" }, { "page": "474" }, { "page": "474-75" }, { "page": "474" }, { "page": "475" }, { "page": "475" }, { "page": "475" }, { "page": "475-76" }, { "page": "476" }, { "page": "471-72" }, { "page": "475" } ], "opinion_index": 0, "case_paths": [ "/mass/394/0466-01" ] }, { "cite": "608 F. Supp. 1324", "category": "reporters:federal", "reporter": "F. Supp.", "case_ids": [ 5718277 ], "opinion_index": 0, "case_paths": [ "/f-supp/608/1324-01" ] }, { "cite": "772 F.2d 329", "category": "reporters:federal", "reporter": "F.2d", "case_ids": [ 306802 ], "year": 1984, "opinion_index": 0, "case_paths": [ "/f2d/772/0329-01" ] }, { "cite": "783 F.2d 454", "category": "reporters:federal", "reporter": "F.2d", "case_ids": [ 1544047 ], "year": 1985, "opinion_index": 0, "case_paths": [ "/f2d/783/0454-01" ] }, { "cite": "453 U.S. 34", "category": "reporters:federal", "reporter": "U.S.", "case_ids": [ 11721956 ], "weight": 3, "year": 1986, "opinion_index": 0, "case_paths": [ "/us/453/0034-01" ] }, { "cite": "42 U.S.C. \u00a71381", "category": "laws:leg_statute", "reporter": "U.S.C.", "weight": 2, "year": 1982, "pin_cites": [ { "page": "et seq." }, { "page": "et seq." } ], "opinion_index": 0 }, { "cite": "472 N.E.2d 877", "category": "reporters:state_regional", "reporter": "N.E.2d", "weight": 2, "opinion_index": 0 }, { "cite": "129 Ill. App. 3d 566", "category": "reporters:state", "reporter": "Ill. App. 3d", "case_ids": [ 3489499 ], "weight": 2, "opinion_index": 0, "case_paths": [ "/ill-app-3d/129/0566-01" ] } ], "analysis": { "cardinality": 729, "char_count": 17279, "ocr_confidence": 0.772, "pagerank": { "raw": 7.720594442308067e-08, "percentile": 0.45408574013388425 }, "sha256": "a41215649c3262c9e9ad09d525932d7014ce995e781ffc5b73cc54a92430068f", "simhash": "1:93d6b1d5ad8ab9d8", "word_count": 2790 }, "last_updated": "2023-07-14T17:50:46.695850+00:00", "provenance": { "date_added": "2019-08-29", "source": "Harvard", "batch": "2018" }, "casebody": { "judges": [], "parties": [ "CHRISTOPHER HESSION, Plaintiff-Appellant, v. THE DEPARTMENT OF PUBLIC AID et al., Defendants-Appellees." ], "opinions": [ { "text": "PRESIDING JUSTICE McMORROW\ndelivered the opinion of the court:\nPlaintiff Christopher Hession (Hession) requested that the Illinois Department of Public Aid (the IDPA) provide him medical assistance for certain medical bills he incurred during a three-month stay at a Chicago hospital in 1982. The IDEA denied his application following evidentiary hearings, and Hession filed an action for administrative review in the circuit court of Cook County. The trial court affirmed the IDEA\u2019S decision to deny medical assistance to Hession for his medical bills with respect to the first month of his hospital stay, but reversed the IDEA\u2019S decision denying assistance with regard to the second and third months. Hession appeals.\nOn review, the question presented is whether the IDEA should have granted Hession\u2019s application for medical assistance relating to his first month\u2019s medical bills. The IDEA denied this request on the ground that Hession had approximately $400 in savings above the appropriate eligibility limit. Hession\u2019s medical bills for the first month amounted to about $16,000. He argues that the IDEA should have offset his $16,000 medical bills by $400, the amount of his excess savings, and that the IDEA should have provided him medical assistance for the remaining $15,600 in bills. This offset, which Hession and the IDEA refer to herein as a \u201cresource spend down\u201d is, according to Hession, required by pertinent Federal and State statutes and regulations, and equal protection of the law under the United States and Illinois Constitutions.\nWe find that the IDEA should have applied resource spend down to determine Hessions\u2019 eligibility for medical assistance for his first month\u2019s medical bills. In view of this conclusion, we reverse the order of the trial court and the decision of the IDEA, and remand the matter to the IDEA for further consideration consistent with the views expressed herein.\nBackground\nHession was hospitalized in Chicago from October 7, 1982, to December 5, 1982. He applied for medical assistance with the IDEA on November 8, 1982. At the time of his application, Hession\u2019s only asset was his savings account, which contained $1,953.05. His total medical bills, for which he requested assistance, amounted to over $38,000.\nThe IDEA denied Hession\u2019s request for medical assistance on the ground that \u201cthe value of [his] assets exceeded] the amount allowable by agency standards.\u201d Thereafter Hession filed an action for administrative review of the IDEA\u2019S denial of his application for medical assistance. Based upon Brengola-Sorrentino v. Department of Public Aid (1984), 129 Ill. App. 3d 566, 472 N.E.2d 877, the trial court remanded the matter to the IDEA. The court ordered further determination of whether the IDEA informed Hession, before it denied his application, that he could reduce his assets below the maximum allowed by agency standards in order to be eligible for benefits.\nFollowing an evidentiary hearing, the IDPA reaffirmed its denial of Hession\u2019s medical assistance application. Upon administrative review of the matter before the circuit court, the trial court affirmed in part the IDEA\u2019S decision, on the ground that Hession was not eligible for assistance in October 1982. The trial court determined that the IDEA was not required to use resource spend down, according to the provisions of pertinent Federal and State statutes and regulations, or equal protection of the law.\nThe trial court also reversed the IDEA\u2019S decision in part, on the basis that Hession was eligible for medical assistance in November and December 1982 because the IDEA failed to advise Hession when he applied for assistance, in November, that he could reduce his assets in order to become eligible for assistance. The IDEA does not appeal from the trial court\u2019s partial reversal of its decision. Hession appeals from the portion of the court\u2019s order that found him ineligible for assistance with respect to the medical bills he incurred in October 1982.\nOpinion\nHession applied for medical assistance on the basis of eligibility under the Federal Aid to the Aged, Blind, and Disabled Frogram (AABD) (42 U.S.C. \u00a71381 et seq. (1982)) and the Illinois Medical Assistance Frogram (Ill. Rev. Stat. 1983, ch. 23, par. 5\u20141 et seq). He claimed that he qualified for this assistance because he was \u201celigible for basic maintenance under [AABD] [because he was disabled], *** failfed] to qualify thereunder on the basis of need, *** [but] ha[d] insufficient income and resources to meet the costs of necessary medical care.\u201d Ill. Rev. Stat. 1983, ch. 23, par. 5\u20142(2).\nAABD medical assistance in Illinois is a cooperative Federal-State program, regulated by the Supplemental Security Income Act (the SSI Act) (42 U.S.C. \u00a71381 et seq. (1982)) and the Fublic Aid Code (Illinois Medical Assistance Act) (Ill. Rev. Stat. 1983, ch. 23, par. 5\u20141 et seq.), and administered in Illinois by the IDEA. (See 42 U.S.C. \u00a7\u00a71396a(a)(5), 1396b(a) (1982); Schweiker v. Gray Panthers (1981), 453 U.S. 34, 69 L. Ed. 2d 460, 101 S. Ct. 2633; Morris v. Morrow (4th Cir. 1986), 783 F.2d 454; State of Illinois v. Department of Health & Human Services (7th Cir. 1985), 772 F.2d 329; Cohen v. Quern (N.D. Ill. 1984), 608 F. Supp. 1324.) The asset eligibility requirement for AABD medical assistance was $1,500. See Ill. Rev. Stat. 1983, ch. 23, par. 5-2(2); 89 Ill. Adm. Code 120.382(a) (1985).\nThe SSI Act sets forth certain elements which a State AABD medical assistance plan must contain. As relevant here, the State plan must \u201cinclude reasonable standards *** for determining eligibility for and the extent of medical assistance under the plan.\u201d (42 U.S.C. \u00a71396a(a)(17) (1982).) These \u2019\u2019reasonable standards\u201d regarding eligibility for and amount of medical assistance must: (a) \u201cprovide for taking into account only such income and resources as are *** available to the applicant or recipient and *** would not be disregarded *** in determining his eligibility\u201d; (b) \u201cprovide for reasonable evaluation of any such income or resources\u201d; and (c) \u201cprovide for flexibility in the application of such standards with respect to income by taking into account *** the costs *** incurred for medical care or for any other type of remedial care recognized under State law.\u201d (Emphasis added.) 42 U.S.C. \u00a7 1396a(a)(17)(B), (a)(17)(C), (a)(17)(D) (1982).\nBetween 1972 and 1980, both the United States Department of Health and Human Services (the HHS) and the IDPA permitted an applicant\u2019s reduction in the amount of his assistance by the amount appearing in his nonexempt assets above the $1,500 limitation (the resource spend down). In 1980, the HHS\u2019s Health Care Financing Administration (the HCFA) issued an administrative interpretation of section 1396a(a)(17) of the SSI Act, to the effect that resource spend down was not permissible under that provision. (Medicaid Action Transmittal No. 80 \u2014 58, August 1980.) The IDEA modified its position, to eliminate resource spend down, effective February 1982. See IDEA AABD Manual FO \u2014 620.3a.\nHession argues that the IDEA should have applied resource spend down to his request for medical assistance. He maintains that the Illinois Fublic Aid Code calls for resource spend down and notes that the IDEA applied such a procedure prior to 1982. IDEA responds that its regulations must conform to interpretations of the SSI Act announced by the HHS. IDEA asserts that it is therefore obligated to adhere to the HCFA\u2019s action transmittal order in which HCFA stated its view that the SSI Act does not permit resource spend down and advised State agencies to discontinue its use.\nRelying upon recent decisions from other jurisdictions, Hession argues that the HCFA transmittal order is an erroneous interpretation of section 1396a(a)(17) of the SSI Act. (Haley v. Commissioners of Public Welfare (1985), 394 Mass. 466, 476 N.E.2d 572; Walter O. Boswell Memorial Hospital, Inc. v. Yavapai County (1986), 148 Ariz. 385, 714 F.2d 878 (appellate court).) In Haley, the Massachusetts Supreme Court reasoned that HCFA\u2019s action transmittal No. 80 \u2014 58 \u201cshould not be accorded great deference\u201d (394 Mass. at 474, 476 N.E.2d at 578), because it constituted \u201ca clear departure from HCFA\u2019s prior view *** [without any] concurrent change in the applicable statutes and regulations.\u201d (394 Mass. at 474, 476 N.E.2d at 578.) The court therefore determined to undertake its own independent analysis of the SSI Act and applicable Federal regulations adopted pursuant thereto.\nIn considering the pertinent Federal statutes and regulations, the Haley court concluded that the SSI Act does not \u201cclearly and unambiguously preclude resource spend down.\u201d (394 Mass. at 474, 476 N.E.2d at 578.) The court noted that the Act \u201crequires that eligibility determinations \u2018provide for reasonable evaluation of any [nonexempt] income or resources\u2019 42 U.S.C. sec. 1396a(a)(17)(C)\u201d and that the State administering agency \u201cdetermine eligibility in a manner \u2018consistent with the objectives of [the SSI Act].\u2019 42 U.S.C. sec. 1396a(a)(17)(A).\u201d (394 Mass. at 474-75, 476 N.E.2d at 578.) Based upon this statutory language, the court concluded, the SSI Act\u2019s clause \u201crequiring \u2018flexibility in the application of such standards with respect to income-by taking into account *** the costs *** incurred for medical care *** recognized under State law\u2019 42 U.S.C. sec. 1396a(a)(17)(D),\u201d although not specifically referring to an applicant\u2019s resources, does not \u201cpreclude a resource spend down.\u201d 394 Mass. at 474, 476 N.E.2d at 578.\nThe Haley court observed that \u201cthe ambiguity in the statute is also evidenced by the HHS\u2019s and HCFA\u2019s actions.\u201d (394 Mass. at 475, 476 N.E.2d at 578.) The court noted that regulations adopted by HHS \u201csubstantially track the underlying statute. See 42 C.F.R. secs. 435.840, 435.841 (1984).\u201d (394 Mass. at 475, 476 N.E.2d at 578.) It also noted that \u201c[p]rior to medicaid action transmittal No. 80\u201458, HCFA interpreted the statute and regulations as permitting a resource spend down.\u201d 394 Mass. at 475, 476 N.E.2d at 578.\nThe court in Haley next determined that resource spend down is consistent with the SSI Act. The court reasoned:\n\u201c[The SSI Act] was \u2018designed to liberalize Federal law under which States operate their medical assistance programs so as to make medical services for the needy more generally available.\u2019 S. Rep No. 404, 89th Cong., 1st Sess., reprinted in 1975 U.S. Code Cong. & Ad. News 1943, 2014 (hereinafter S. Rep.). To fulfil this goal, Congress sought to ensure eligibility to individuals with income and resources which prevented eligibility for other programs when the income and resources were exceeded by incurred medical costs. See 42 U.S.C. sec. 1396a(a)(17); S. Rep. at 2017-2020, 2147. A State must \u2018take into account only such income and resources as (determined in accordance with standards prescribed by the Secretary) are actually available to the applicant or recipient and as would not be disregarded (or set aside for future needs).\u2019 S. Rep. at 2018. A State may not \u2018require the use of income or resources which would bring the individual\u2019s income below the amount established as the test of eligibility under the State plan. Such action would reduce the individual below the level determined by the State as necessary for his maintenance.\u2019 S. Rep. at 2019. We conclude that, although Congress did not require use of a resource spend down, such use is a reasonable method of evaluating resources.\u201d 394 Mass. at 475-76, 476 N.E.2d at 578.\nThe Haley court then found that the pertinent Massachusetts statute required resource spend down. 394 Mass. at 476, 476 N.E.2d at 579.\nWe agree with the Massachusetts Supreme Court\u2019s analysis in Haley regarding the SSI Act, and determine that section 1396a(a)(17) of the Act permits a State plan to utilize resource spend down in determining an applicant\u2019s eligibility for medical assistance benefits. The action transmittal of the HCFA is not binding authority upon this court with respect to the interpretation to be given to the SSI Act. (See, e.g., Daughters of Miriam Center for the Aged v. Matthews (3rd Cir. 1978), 590 F.2d 1250; Haley, 394 Mass. at 471-72, 476 N.E.2d at 575; cf., Central Illinois Public Service Co. v. Pollution Control Board (1987), 116 Ill. 2d 397.) Furthermore, the SSI Act does not prohibit a State\u2019s use of resource spend down, and a State\u2019s adoption of such a procedure would be in conformity with the purpose and spirit of the Act. See 42 U.S.C. \u00a71396a(a)(17); S. Rep. No. 404, 89th Cong., 1st Sess., reprinted in 1965 U.S. Code Cong. & Admin. News 1943, 2014; H.R. Rep. No. 213, 89th Cong., 1st Sess. 67 (1965); Haley, 394 Mass. at 475, 476 N.E.2d at 578; Walter O. Boswell Memorial Hospital, Inc. v. Yavapai County (1986), 148 Ariz. 385, 714 P.2d 878.\nWe also find that the Illinois Public Aid Code requires the IDEA to utilize resource spend down with regard to Hession\u2019s request for AABD medical assistance benefits. The stated purpose of Illinois\u2019 Medical Assistance Act is \u201cto provide a program of essential medical care and rehabilitative services for *** persons who are unable, because of inadequate resources, to meet their essential medical needs.\u201d (Emphasis added.) (Ill. Rev. Stat. 1983, ch. 23, par. 5\u20141.) The Code specifically notes, \u201cFor persons who are medically indigent but otherwise able to provide themselves with a livelihood, it is of special importance to maintain their incentives for continued independence and preserve their limited resources for ordinary maintenance needs to prevent their total or substantial dependency.\u201d (Emphasis added.) Ill. Rev. Stat. 1983, ch. 23, par. 5\u20141.\nAlso, the Code defines as eligible for medical assistance those persons who, inter alia, are eligible for AABD basic maintenance \u201cbut who fail to qualify thereunder on the basis of need, and who have insufficient income and resources to meet the costs of necessary medical care.\u201d (Emphasis added.) (Ill. Rev. Stat. 1983, ch. 23, par. 5\u20142(2).) It further provides that \u201c[i]n determining eligibility for medical assistance, for which federal reimbursement is available under the [SSI Act], the assets of a single person not exceeding $1,500 *** shall be disregarded.\u201d (Ill. Rev. Stat. 1983, ch. 23, par. 5\u20142(6)(c).) Similarly, the IDPA\u2019s regulations state in pertinent part that the \u201camount a recipient unit is to pay toward its medical expenses is the sum of that unit\u2019s nonexempt income and assets minus the amount of the appropriate medical assistance standard.\u201d 89 Ill. Admin. Code 120.395 (1985).\nIn our view, to preclude resource spend down places an applicant in the \u201cparadoxical\u201d position of being obligated to use excess resources to pay down medical bills during a period of hospitalization wherein the applicant may be in no physical or mental condition to do so; \u201c[t]his result would occur regardless of how miniscule the excess resources were in comparison to the medical expenses incurred.\u201d Haley, 394 Mass. at 476 n.8, 476 N.E.2d at 579 n.8.\n\u201cAn individual\u2019s qualification for benefits should not be dependent upon the fortuitous circumstances of his being advised or being physically capable to make the actual expenditure.\u201d (Walter O. Boswell Memorial Hospital, Inc. v. Yavapai County (1986), 148 Ariz. 385, 390, 714 P.2d 878, 883.) Given the purpose of both the SSI Act and the Illinois Medical Assistance Program is to provide assistance to those individuals who are aged, blind, or disabled and \u201chave insufficient income and resources to meet the costs of necessary medical care\u201d (Ill. Rev. Stat. 1983, ch. 23, par. 5\u20142(2); see also 42 U.S.C. \u00a71396a(a)(17)), we find that the \u201cunreasonableness\u201d of the IDPA\u2019s position is \u201cself-evident\u201d (Haley, 394 Mass. at 476 n.8, 476 N.E.2d at 579 n.8).\nIn view of these considerations, we determine that the Illinois Public Aid Code requires that the IDPA take into account an AABD applicant\u2019s resources, as well as income, in determining the applicant\u2019s eligibility for medical assistance, and that the IDPA apply resource spend down in determining the amount of assistance to which the applicant is entitled. (Cf. Brengola-Sorrentino v. Department of Public Aid (1984), 129 Ill. App. 3d 566, 472 N.E.2d 877; Drogolewicz v. Quern (1979), 74 Ill. App. 3d 862, 393 N.E.2d 1212.) As a result, the IDEA should have applied resource spend down in determining Hession\u2019s eligibility for AABD medical assistance with respect to his first month\u2019s medical bills.\nIn light of these conclusions, we do not address Hessions\u2019 remaining arguments.\nFor the reasons stated, the order of the circuit court of Cook County and the decision of the IDEA are reversed, and the cause remanded to the IDEA for further consideration consistent with the views expressed herein.\nReversed and remanded.\nLINN and JOHNSON, JJ., concur.", "type": "majority", "author": "PRESIDING JUSTICE McMORROW" } ], "attorneys": [ "Martin Z. Craig, Barry J. Novak, and Charles R. Goldstein, all of Hayt, Hayt & Landau, of Evanston, for appellant.", "Neil F. Hartigan, Attorney General, of Springfield (Roma Jones Stewart, Solicitor General, and Karen Konieczny, Assistant Attorney General, of Chicago, of counsel), for appellees." ], "corrections": "", "head_matter": "CHRISTOPHER HESSION, Plaintiff-Appellant, v. THE DEPARTMENT OF PUBLIC AID et al., Defendants-Appellees.\nFirst District (4th Division)\nNo. 86\u20140607\nOpinion filed November 19, 1987.\nMartin Z. Craig, Barry J. Novak, and Charles R. Goldstein, all of Hayt, Hayt & Landau, of Evanston, for appellant.\nNeil F. Hartigan, Attorney General, of Springfield (Roma Jones Stewart, Solicitor General, and Karen Konieczny, Assistant Attorney General, of Chicago, of counsel), for appellees." }, "file_name": "0553-01", "first_page_order": 575, "last_page_order": 583 }