SSR 79-5c: Rescinded 1982

20 CFR 416.231(b)(3)

SSR 79-5c

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.

alysis 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.

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.

d

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

n'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.