2009-091, Megan Smith v. City of Franklin

The plaintiff, Megan Smith, appeals an order of the

on the brief and orally), for the defendant. Wescott, Dyer, Fitzgerald & Nichols, P.A., of Laconia (Paul T. Fitzgerald

brief, and Mr. Feltes orally), for the plaintiff. New Hampshire Legal Assistance, of Concord (Daniel Feltes & a. on the to press. Errors may be reported by E-mail at the following address:

page is: http://www.courts.state.nh.us/supreme. MEGAN SMITH

No. 2009-091 editorial errors in order that corrections may be made before the opinion goes Merrimack Hampshire, One Charles Doe Drive, Concord, New Hampshire 03301, of any Readers are requested to notify the Reporter, Supreme Court of New ___________________________

THE SUPREME COURT OF NEW HAMPSHIRE

a.m. on the morning of their release. The direct address of the court's home reporter@courts.state.nh.us. Opinions are available on the Internet by 9:00

well as formal revision before publication in the New Hampshire Reports. NOTICE: This opinion is subject to motions for rehearing under Rule 22 as appeal followed. p. 2 language of the statute. The trial court adopted the City’s position. This

disabled” and is therefore precluded from local assistance under the plain not see fit to include.” what the legislature might have said or add language that the legislature did decision.

incompatible with local general assistance. she receives from the “cash assistance” programs that RSA 167:27 declares defined under New Hampshire law. She distinguished the Medicaid benefits the plain and ordinary meanings to the words the legislature used. We begin by examining the language of the statute and ascribing

acknowledged is medically needy, receives “aid to the permanently and totally Id. payments from the State. interpret legislative intent from the statute as written and will not consider RSA 167:6, VII. She did not, however, receive direct financial assistance decision. Following a hearing, the hearings officer upheld the City’s July 30 intent as expressed in the words of the statute considered as a whole.” Id. “We ground. The plaintiff requested a “Fair Hearing” concerning the City’s July 30 matters of statutory interpretation, we are the final arbiters of the legislature’s 26. On July 30, 2007, the City again denied her application on the same State of N.H. (State v. Milner), 159 N.H. ___, ___ (decided Dec. 4, 2009). “In “We review the trial court’s statutory interpretation de novo.” Petition of

assistance,” and not “aid to the permanently and totally disabled” as it is

permanently and totally disabled,” and that the plaintiff, whom it “medically needy” and “categorically needy” recipients of “aid to the received medical assistance through the Medicaid-APTD program, pursuant to The City asserted that RSA 167:27 makes no distinction between

reapplied for financial assistance with her electric and gas utility bills on July

aid she receives through the Medicaid-APTD program constitutes “medical RSA 167:27 does not preclude her eligibility for local assistance because the The plaintiff sought review in the superior court, where she argued that

plaintiff and $88.50 for her husband. Throughout July of 2007, she also Supplemental Security Income totaling $177, comprised of $88.50 for the federal Social Security Disability Insurance benefits of $777, and federal plaintiff was ineligible for general assistance under RSA 167:27. The plaintiff RSA chapter 165. The City denied the application on July 13, stating that the with her electric and gas utility bills under the general assistance provisions of On July 2, 2007, the plaintiff applied to the City for financial assistance

Franklin. In July 2007, the plaintiff’s monthly household income consisted of The following facts are undisputed. The plaintiff is a resident of p. 3 Hampshire law, or is subsumed under NH-APTD.

under the Medicaid-APTD program constitutes “medical assistance” under New is compatible. We must therefore determine whether the plaintiff’s coverage NH-APTD is not compatible with local financial assistance, medical assistance

type of relief that may be received in conjunction with NH-APTD. Thus, while

RSA 167:27 specifically permits “medical and surgical assistance” as the only 167:6, VII (setting eligibility standards for “medical assistance”). Moreover, NH-APTD, in large part by reference to the Social Security Act), and under RSA

unjust result.

political subdivision thereof, the legislature did not enact legislation with superfluous or redundant words. assistance.” We must give effect to all words in a statute, and presume that

separate and distinct programs. NH-APTD and “medical assistance” also have read together establish that NH-APTD and “medical assistance” are two

together to effectuate its overall purpose and avoid an absurd or one reasonable interpretation. We construe all parts of a statute where the statutory language is ambiguous or subject to more than same time receive any other relief from the state, or from any

and services provided to eligible individuals shall be designated as medical

Giving effect to all words in the statutes, RSA 167:27 and RSA 167:5 totally disabled.

(2002). Winnacunnet Coop. Sch. Dist. v. Town of Seabrook, 148 N.H. 519, 525-26

legislative intent. We review legislative history to aid our analysis and totally disabled under this chapter or RSA 161 shall at the

aid to the permanently and totally disabled” (NH-APTD), while “[m]edical care granted to the needy permanently and totally disabled shall be designated as (Emphasis added.) RSA 167:5, I (2002) defines the relevant terms: “assistance

revocation of old age assistance or aid to the permanently and assistance, and the acceptance of such relief shall operate as a

unambiguous, we do not look beyond it for further indications of No person receiving old age assistance or aid to the permanently statute. When the language of a statute is plain and RSA 167:27 provides, in relevant part: words or phrases in isolation, but in the context of the entire

Franklin v. Town of Newport, 151 N.H. 508, 509-10 (2004) (citations omitted).

statutory language to determine legislative intent, we will not read Although we look to the plain and ordinary meaning of the the earlier, state-run categorical need programs. p. 4 assistance was significantly larger than the number eligible under

need. In some States, the number of individuals eligible for SSI

“error rate” as “the rate of erroneous excess payments for medical assistance”).

responsibility for both funding payments and setting standards of aid to the permanently and totally disabled. the Federal Government displaced the States by assuming Security Income for the Aged, Blind, and Disabled (SSI). Under SSI, 4

qualify for categorical assistance.”

families that are determined to exceed the error rate permitted” and defining

welfare programs established elsewhere in the [Social Security Act],” including ‘categorically needy’ individuals who received cash payments under one of four assistance programs with a new program called Supplemental Medicaid required participating States to provide medical assistance to portended increased Medicaid obligations for some States because Services.” (quotation omitted)); The expansion of general welfare accomplished by SSI

who could not pay for their medical expenses but who had incomes too large to

under the State Medicaid plan with respect to ineligible individuals and

referred to interchangeably with “medical assistance.”

In 1972, Congress replaced three of the four categorical must explore the nature of the Medicaid-APTD program. “As originally enacted, omitted). boundaries set by the Medicaid statute and the Secretary of Health and Human Id. at 416-17 (quotations and citations

were also allowed to offer assistance to the ‘medically needy,’ meaning persons these four programs to be especially deserving of public assistance. States needy persons.” (e)(13)(E)(iii) – (iv) (referring to a federal statutory penalty “for payments made (citations omitted). “Congress deemed the individuals who participated in

assistance program.”). Within the federal statute itself, Medicaid is often

While, therefore, Medicaid generally constitutes medical assistance, we

determining eligibility for and the extent of medical assistance within

assistance to states that opt to reimburse certain costs of medical treatment for § 1396a (e)(13)(F)(v)(V) (defining “State Medicaid Plan”); 42 U.S.C. § 1396a two statutory schemes. Medicaid is the program that “offers federal financial See, e.g., 42 U.S.C. federal and state law. However, the phrase has different meanings under the for providers of services to Medicaid-eligible persons through the state medical Servs., 158 N.H. 104, 106 (2008) (“DHHS establishes rates of reimbursement

participating State develops a plan containing reasonable standards . . . for of Health & Family Servs. v. Blumer, 534 U.S. 473, 479 (2002) (“Each

Appeal of Huff, 154 N.H. 414, 416 (2006); see also Wisc. Dep’t

by the use of the phrase “aid to the permanently and totally disabled” in both In analyzing this issue, we recognize the potential confusion engendered pursuant to the mandates of federal law or regulation or pursuant

p. 5 needy or as medically needy who is eligible for medical assistance

needy program. A person shall also be eligible as categorically and assets meet the standards as prescribed for the medically requirements under RSA 167:6, I, IV, V or VI, and if his income

as medically needy if he meets the categorical, age, and technical APTD by virtue of her disability, she receives medical assistance.

provides in full: Medicaid plan in effect on January 1, 1972.

totally disabled.

to receive such assistance but does not. A person shall be eligible disability criteria. Here, because the plaintiff meets the criteria for Medicaid- assistance under RSA 167:6, I, IV, V or VI, or is otherwise eligible shall be eligible as categorically needy if he receives financial 5

if they are not “categorically needy” under New Hampshire law. That statute those individuals who would have been eligible under the state

1972 that provided assistance for the blind, the aged, and the permanently and

Medicaid benefits to people who qualify by fitting within the pre-1972 federal (SSI) on the basis of disability.”). The Medicaid-APTD program thus provides assistance as categorically p. 5 needy or as medically needy. A person the most common route to eligibility is receiving Supplemental Security Income

2009), allows medical assistance to people who qualify under federal law, even Under it, States could elect to provide Medicaid assistance only to Congress offered what has become known as the § 209(b) option. also qualify for one of the three adult assistance programs” in place prior to burden on these States or discourage them from participating,

For purposes hereof, a person shall be eligible for medical limited resources and must fit into an eligibility category. For disabled adults,

New Hampshire’s “medical assistance” statute, RSA 167:6, VII (Supp.

security income (SSI) are eligible for Medicaid in New Hampshire only if they categorical assistance. In order not to impose a substantial fiscal

eligible under the pre-1972 plan.

eligible for Medicaid-funded treatment; to be eligible, an individual must have see also Bryson v. Shumway, 308 F.3d 79, 82 (1st Cir. 2002) (“Not everyone is

Baker v. City of Concord, 916 F.2d 744, 745 (1st Cir. 1990);

U.S. 34, 39 n.6 (1981). Accordingly, “[r]ecipients of federal supplemental coverage in a manner commensurate with the expansion of cooperative Medicaid program rather than expand their Medicaid Id.; see also Schweiker v. Gray Panthers, 453 therefore required to provide Medicaid only to those who would have been Congress feared that these States would withdraw from the Id. at 417 (quotation omitted). New Hampshire is a § 209(b) state, and is

welfare assistance — now SSI — were entitled to Medicaid. Congress retained the requirement that all recipients of categorical property tax collected by the cities and towns.

assistance program,’ NH RSA 1 p. 6 65:1.” funding source.”

that the wellspring of the counties’ revenue stream is the local assistance program is locally funded and administered.” still provided indirect support to [NH-]APTD and OAA, however, in the immediate fiscal burden of these programs. The municipalities

cities and towns from direct fiscal obligations in respect to programs,’ 42 U.S.C. § p. 6 601 et seq. and 42 U.S.C. § 801 et seq., and the ‘general Id. at 749. O n the other hand, “Medicaid is a joint federalwelfare benefit models, [NH-]APTD and OAA tap into a unique county-state to funding the [NH-]APTD program. Id. at 746. “It is notable that, alone among New Hampshire’s assortment of

Supp. 1989).

“income and assets meet the standards as prescribed for the medically needy and XVI and the regulations adopted under such act,” RSA 1 p. 6 67:6, VI, and her funded and administered by a central state agency, whereas the general [NH-] APTD and OAA, leaving the counties and the State to bear

[L]egislation taking effect on January 1 of that year exempted the Hampshire has two systems of public welfare: ‘categorical assistance See RSA 1 p. 6 67:20 (1977). . . . evaluating the plaintiff’s eligibility for the requested local assistance. “New Prior to 1986, the towns, cities, counties, and State all contributed synonymous with the NH-APTD financial assistance program for the purpose of children (AFDC), and [NH-]APTD.” Baker, 916 F.2d at 745. assistance (OAA), aid to the needy blind (ANB), aid to families with dependent Hampshire administers various public assistance programs, including old age IV, V, or VI of this section.

that is, she is “disabled as defined in the federal Social Security Act, Titles II 1134, 1137 (D.N.H. 197 p. 6 6). “The categorical assistance programs are federally

recognizes the qualification criteria for Medicaid in New Hampshire. We next turn to the question of whether the Medicaid-APTD program is

not be otherwise eligible to receive assistance under paragraph I, under RSA 541-A, but who does not receive assistance or would health and human services in accordance with rules adopted meets the categorical, age, and technical requirements under RSA 1 p. 6 67:6, VI; “medically needy.” Specifically, she is “eligible as medically needy” because she The parties agree that the plaintiff has qualified for Medicaid-APTD as

Thus, New Hampshire’s statutory treatment of “medical assistance” implicitly

regulation and defined by the commissioner of the department of to optional state coverage groups which are allowed by federal and old age assistance, in contrast to any other type of state relief.

p. 7 assistance] obligation of counties and towns under RSA chs. 165 and 166.”

financial obligation of local government to those receiving such aid.” 167:27, explicitly provides that medical assistance is compatible with NH-APTD contribution provided by the cities and towns to [NH-]APTD met the ‘fair share’ State Medicaid program (RSA ch. 167) did not repeal or amend the [local

differences stemming from the likely persistency of need,” specifically, the

which is compatible with all four programs). The section at issue here, RSA partially funded by the cities and towns,” specifically, NH-APTD, because “the NH-APTD — which are all mutually exclusive, and for medical assistance, is compatible with local aid. We have previously held, “The enactment of the assistance, aid to the needy blind, aid to families with dependent children, and whether the plaintiff’s Medicaid coverage through the Medicaid-APTD program same as NH-APTD. Based upon this analytical framework, we now address 167:27 as a constitutional legislative prioritization of welfare programs.

APTD. aid in conjunction with old age assistance or NH-APTD based upon “durational The court also pointed out the reasonableness of disallowing short-term local

restricted so as to exclude individuals already receiving relief from programs could reasonably have concluded that town welfare [under RSA 165:1] be (delimiting eligibility criteria for each of the chapter’s aid programs — old age 916 F.2d at 755. The court reasoned that “the New Hampshire legislature APTD program, provides medical assistance; and (3) Medicaid-APTD is not the Baker, APTD is incompatible with local aid under RSA 167:27, and upheld RSA We note that the First Circuit Court of Appeals held in Baker that NHassistance differently from New Hampshire’s other aid programs, including NH-

and defining medical assistance separately); RSA 167:6 (2002 & Supp. 2009) programs” to include old age assistance, aid to the needy blind, and NH-APTD, does not include medical assistance; (2) Medicaid, including the Medicaid- apply to the administration of medical assistance.”); RSA 167:5 (defining “adult See RSA 167:3-b (2002) (“The provisions of [preceding sections] do not

supported by the language of RSA chapter 167, which treats medical Hall v. County of Hillsborough, 122 N.H. 448, 452 (1982). This holding is level by [the New Hampshire Department of Health and Human Services].” United States Department of Health and Human Services, and on the state

the State and its counties.”

Our analysis to this point has established the following: (1) NH-APTD

are two separate entities, funded from different sources. The NH-APTD program and Medicaid, including the Medicaid-APTD program,

level by the Centers for Medicare and Medicaid Services, an agency within the

program receives half of its funding from the federal government and half from Supp. 200 p. 8 8).” Bel Air, 158 N.H. at 105. “In New Hampshire, the Medicaid individuals. See 42 U.S.C. §§ 1396a et seq. (2000); RSA ch. 151-E (2005 & state program that provides health care services to certain low-income 8

the Medicaid-APTD program. 167:27 does not bar receipt of local aid based upon receipt of Medicaid through

administered to promote its humanitarian purpose.”

City for evaluation of the plaintiff’s application for local assistance.

Precedent and the statutory scheme therefore lead us to conclude that RSA

municipal funds thus have not been burdened. this broadly worded statute, we have held “that the statute is to be welfare of such town, whether or not he has residence there.” In interpreting BRODERICK, C.J., and DALIANIS, DUGGAN and HICKS, JJ., concurred. support himself, he shall be relieved and maintained by the overseers of public

instance, we remand to the superior court with instructions to remand to the these are factual determinations, which we decline to address in the first the sole criteria for eligibility.” Baker-Chaput, 406 F. Supp. at 1137. Because of discrete ailments, rather than on-going payments for long-term support. (quotation omitted). “Financial need and an inability to support one’s self are

the state and federal entities in the case of Medicaid, and county and

165:1, I, which provides, “Whenever a person in any town is poor and unable to Accordingly, the plaintiff may apply for financial aid pursuant to RSA

duration of need, medical payments are often limited to payments for treatment

varying degrees by federal, state, and local agencies” is equally divided between assistance. The public funding burden that has historically “been shared in assistance, including Medicaid, is compatible with other forms of state These two rationales support the legislature’s determination that medical

children (who “grow up and cease being dependent”). Id. at 750-51. develop skills in order to support themselves”) or aid to families with dependent [NH-]APTD welfare as contrasted to aid to the blind (who “have the potential to generally longer duration of recipients’ need for old age assistance or