The plaintiff was a Franklin resident who received Medicaid-APTD as well as social security benefits. She applied to the City for local assistance under RSA 165:1. The City denied assistance based on RSA 167:27, which provides that “[n]o person receiving old age assistance or aid to the permanently and totally disabled [APTD] under this chapter or RSA 161 shall at the same time receive any other relief from the state, or from any political subdivision thereof, except medical and surgical assistance, and the acceptance of such relief shall operate as a revocation of old age assistance or [APTD].” In other words, the law says that people who receive APTD benefits are not eligible for local welfare assistance from towns or cities.
The issue in this case was whether “Medicaid-APTD” was the same thing as “NH-APTD” (as the Court referred to it) under RSA 167:27. The Court reviewed the history of the development of Medicaid, including its Medicaid-APTD program, and the history of the funding of New Hampshire’s APTD program. It noted that NH-APTD is funded by a county-state funding source, but Medicaid-APTD is a federal-state program. It concluded that NH-APTD and Medicaid, including the Medicaid-APTD program, are two separate entities, funded from different sources.
The Court then considered whether Medicaid-APTD is compatible with local assistance. Referring to a 1990 decision of the Federal First Circuit Court of Appeals, the Court noted that the “New Hampshire legislature could reasonably have concluded that town welfare [under RSA 165:1] be restricted so as to exclude individuals already receiving relief from programs partially funded by the cities and towns … because the contribution provided by cities and towns to [NH-APTD] met the ‘fair share’ financial obligation of local government to those receiving such aid.” Baker v. Concord, 916 F.2d 744, 750 (1st Cir. 1990). However, since Medicaid-APTD is funded by a combination of federal, state and county money rather than directly by cities and towns, the Court held that the restriction against local assistance does not logically extend to Medicaid-APTD.
In addition, the Court noted another difference between old age assistance and NH-APTD on one hand and Medicaid-APTD on the other: the duration of need. Referring once again to the Baker decision, the Court found that it may be reasonable to disallow short-term local assistance in conjunction with old age assistance and NH-APTD because recipients of old age assistance and NH-APTD tend to have a longer-term need for that assistance than, for example, the blind (who “have the potential to develop skills in order to support themselves”) or aid to families with dependent children (who “grow up and cease being dependent”). Medical payments are “often limited to payments for treatments of discrete ailments, rather than ongoing payments for long-term support,” the Court reasoned, and, therefore, receipt of Medicaid-APTD is not something that should bar receipt of local assistance.