Mathias, J.
This case requires us to once again delve into what we have previously referred to as the “unfortunately convoluted and complex” and “Byzantine” Medicaid system. Legacy Healthcare, Inc. v. Barnes & Thornburg, 837 N.E.2d 619, 622 & n.2 (Ind. Ct. App. 2005), trans. denied; see also Schweiker v. Gray Panthers, 453 U.S. 34, 43 (1981) (referring to the Social Security Act, of which the Medicaid system is a part, as having a “Byzantine construction” that “makes the Act ‘almost unintelligible to the uninitiated.’”) (quoting Friedman v. Berger, 547 F.2d 724, 727, n. 7 (2d Cir. 1976)).
At issue here is how to determine the portion of nursing home costs required to be paid by Lance Patterson (“Patterson”), a Medicaid recipient whose limited income is subject to a garnishment order due to a rather substantial child support arrearage. The Indiana Family and Social Services Administration (“the FSSA”) determined that the garnished portion of Patterson’s income should be included when determining Patterson’s portion of the cost of his care. Patterson challenged this decision by filing a claim for judicial review in Henry Circuit Court. The trial court entered judgment in favor of Patterson, determining that the garnished portion of Patterson’s income should be excluded when determining Patterson’s share of nursing home costs because Patterson did not actually receive this income. The FSSA appeals the trial court’s decision, arguing that the trial court erred in granting Patterson’s petition because the FSSA’s decision was consistent with federal and state law and was neither arbitrary nor capricious. Because we agree with the FSSA, we reverse.
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In Indiana, 405 I.A.C. 2-1.1-7(a) addresses the portion of costs that a Medicaid recipient, such as Patterson, must pay toward the costs of his or her care. The FSSA first determines the “recipient’s total income that is not excluded by federal statute.” 405 I.A.C. 2-1.1-7(a)(2). It then makes five deductions: (1) a statutory-minimum personal-needs allowance; (2) an increased personal-needs allowance; (3) an amount for health insurance premiums; (4) certain medical expenses for necessary or remedial care; and (5) federal, state, and local income taxes. 405 I.A.C. 2-1.1-7(a)(3)–(7). “The resulting amount is the amount by which the Medicaid payment to the facility shall be reduced,” and which must be covered by the Medicaid recipient. 405 I.A.C. 2-1.1-7(a). The parties refer to this as the recipient’s “liability,” i.e., the portion of the costs of care that must be borne by the recipient. It is this amount, and its calculation, that is at issue here.
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As noted above, the parties do not dispute that Patterson is eligible for Medicaid; both agree that he is. Patterson also does not deny that, when determining eligibility for Medicaid, the FSSA is required to include all of his income, including the portion thereof subject to garnishment. Instead, Patterson notes that there are two, discrete income calculations at issue here. The first one is used in determining Medicaid eligibility; the second, post-eligibility determination is used in determining the Medicaid recipient’s liability for a portion of his or her care.
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We agree that the references to “total income” in subsection 435.725(a) and “total income received” in subsection 435.725(e) render this section ambiguous. That is, they are subject to two different, reasonable interpretations: one includes all income, the other only income that is “received.” But this is all the more reason for us to defer to the FSSA’s interpretation of this rule.
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In short, the FSSA’s interpretation of the applicable statutes and regulations is reasonable. Because the FSSA’s interpretation of the regulations is reasonable, “we must stop our analysis and need not move forward with any other proposed interpretation.” Jay Classroom Teachers Ass’n, 55 N.E.3d at 816 (citing West, 54 N.E.3d at 353). Accordingly, the trial court erred in determining that the FSSA’s interpretation was arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with the law.
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Patterson makes a sound policy argument that the FSSA’s decision leaves him in the lurch. That is, even though he qualifies for Medicaid, the FSSA’s inclusion of the garnished portion of his income in determining his liability means that he is stuck owing the nursing home more money than he has access to. This means that either the nursing home must continue to care for him at a loss, or he must come up with another source of income, which is unlikely. Hopefully, Patterson can find care at a less expensive facility, or at least one that is willing to accept that portion of his care that Medicaid is willing to pay for.
Despite the merits of Patterson’s argument, it is not the role of this court to determine Medicaid policy. That role belongs to the FSSA and the HHS. The only question before us is whether the FSSA’s interpretation of the relevant state and federal regulations is reasonable, and we cannot say that the FSSA’s interpretation is unreasonable.
Conclusion
Because the FSSA is responsible for implementing the cooperative state-federal Medicaid system in Indiana, we give its interpretation of these statutes and regulations great weight. And since the FSSA’s interpretation is reasonable, our analysis stops there. The trial court’s analysis should have stopped there too. We therefore reverse the judgment of the trial court.
Reversed.
Bailey, J., concurs with opinion.
Bradford, J., concurs.
Bailey, Judge, concurring.
I agree that the trial court erred, although I do so reluctantly…
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I do not condone a voluntary decision not to pay child support. Yet I find it ironic that, were Patterson imprisoned for felony non-support, he would be provided with the care he desperately needs. In the convergence of circumstances present here – total disability requiring institutionalization, impoverishment, and a state-enforced action for child support arrearage – there is no optimal outcome with equity for all concerned. I understand the trial court’s attempt to exercise compassion. However, because the trial court found invalidity of agency action where there was none, I concur in the reversal.