20 CFR 416.231(b)(3)
MALONE v. SECY. HEW, USDC, W.D. Wash., Civ. No. 75-425s (10/26/77)
The 22 year old claimant for Supplemental Security Income at times was confined to hospitals which were determined to be public institutions within the meaning of section 1611(e)(1) of the Social Security Act and Social Security Regulations No. 16, section 416.231(b), making her ineligible for benefits. She contended that since she was being billed for, and is paying, the cost of her care, the type of institution to which she was confined was immaterial and, therefore, she should be eligible for benefits. The above cited section of the regulations implementing section 1611(e)(1) of the Social Security Act which excludes inmates of a public institution from Supplemental Security Income benefits[*], defines an "inmate of a public institution" as ". . .a person who is living in a public institution and receiving treatment and/or services which are appropriate to the person's requirements . . ." It does not take into consideration the fact that the claimant is bearing the cost of the treatment or services. Held, since the claimant is confined to a public institution receiving treatment and/or services appropriate to her requirements, she is not eligible for Supplemental Security Income benefits.
RP, District Judge:
In this petition for a review of the denial of social security benefits, the facts are agreed, and the case turns on an issue of statutory construction.
Petitioner, who will be twenty-two years of age on September 23, 1977, suffered a broken neck and paralysis in an automobile accident on March 9, 1974. She is a quadriplegic, and at times relevant to this case was hospitalized at the University of Washington Hospital and at Harborview Medical Center. She is "disabled" as that term is employed in the Social Security Act. Petitioner has been billed for and has paid the costs of her hospitalization, by virtue of private insurance coverage.
Petitioner applied for and was granted regular disability benefits under title II of the Social Security Act. This case involves her application for supplemental security income ("SSI") benefits, under 42 U.S.C. §1381a. Any such benefits would be entirely separate and additional to the title II disability benefits she is receiving.
The statutes and regulations set up a complex scheme for determining whether persons are entitled to receive SSI benefits. In this case, however, there is agreement that there is only one possible impediment to petitioner's claim. The Secretary has determined that petitioner is not entitled to benefits because she ". . . is an inmate of a public institution."
The statute in question is 42 U.S.C. §1382(e)(1)(A), which at the time of petitioner's application provided as follows:
"(e)(1)(A) Except as provided in subparagraph (B) [not here relevant], no person shall be an eligible individual or eligible spouse for purposes of this subchapter with respect to any month if throughout such month he is an inmate of a public institution."
It is further agreed that both University Hospital and Harborview Medical Center are "public institutions" within the meaning of the statute. The issue in this case therefore comes down to whether petitioner should be considered "an inmate of a public institution" where she is being billed for, and is paying the cost of her care at such an institution.
The Secretary has adopted regulations which bear some relevance to this question. 20 C.F.R. §416.231(b) sets forth definitions of several terms used in the governing statute, including "institution," "public institution," and "inmate of a public institution". As there is no dispute that the hospitals in question are "public institutions," attention must focus on the definition of "inmate of a public institution," which is as follows:
"(3) An 'inmate of a public institution' is a person who is living in a public institution and receiving treatment and/or services which are appropriate to the person's requirements. A person is not considered an inmate when he is in a public educational or vocational training institution, for purposes of securing education or vocational training." (20 C.F.R. §416.231(b)(3).)
Under this definition, a person's status as an "inmate of a public institution" does not in any way turn upon who is bearing the cost of the treatment and services. As plaintiff meets both of these tests, she would be precluded, under the regulation, from receiving SSI benefits.
The Secretary also advises the court that the Social Security Claims Manual, §5710(B)(1), states that it is immaterial that the costs of the stay in public medical treatment facilities are paid from outside funds. (Defendant's Memo, page 9.) This is further evidence of the administrative interpretation given the statute.
Plaintiff argues, however, that such an interpretation of the statute and regulation is contrary to the intent of Congress. Neither party has cited, nor have I located, any case addressing this issue. Furthermore, the parties have directed the court's attention to no relevant language in the Committee reports or elsewhere reflecting Congressional intent in this respect. Plaintiff has quoted some language from the Committee reports relating to the provision of "pocket money" to inmates of certain public institutions, but concedes that his language does not deal with the same issue. ("Memorandum in Reply," page 4.)
Given the absence of any helpful case authority or legislative history, this court is required to give strong weight to the interpretation given the statute by the agency responsible for administering it.
"When faced with the problem of statutory construction, this court shows great deference to the interpretation given the statute by the officers or agency charged with its administration. 'To sustain the Commission's application of this statutory term, we need not find that its construction is the only reasonable one, or even that it is the result that we would have reached had the question arisen in the first instance in judicial proceedings.' Unemployment Comm'n v. Aragon, 329 U.S. 143, 153. See also e.g. Gray v. Powell, 314 U.S. 402; Universal Battery Co. v. United States, 281 U.S. 580, 583. 'Particularly is this respect due when the administrative practice at stake "involves a contemporaneous construction of a statute by the men charged with the responsibility of setting its machinery in motion, of making the parts work efficiently and smoothly while they are yet untried and new." ' Power Reactor Co. v. Electricians, 367 U.S. 396, 409." Udall v. Tallman, 380 U.S.1, 16 (1965).
In the regulation quoted above, and in its Claims Manual, the Social Security Administration has interpreted 42 U.S.C. §1382(d)(1)(A) to exclude from benefits any person living in a public institution and receiving treatment and services appropriate to his requirements, regardless of who is paying the cost for those treatment and services. Although such an interpretation works a harsh result in this case, I suggest this court is bound to accept it, and to affirm the decision of the Secretary denying SSI benefits. If Congress determines it is desirable for a person in plaintiff's situation to receive SSI benefits, it must enact the necessary amendments. Although plaintiff's case presents tragic circumstances, nevertheless this court cannot as a matter of law determine she is entitled to SSI benefits under current statutory and regulatory provisions.
[*]Section 1611(e)(1) provides for the eligibility of individuals in certain public institutions which are receiving payments for the individual's care from Medicaid.
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