Calkins v. Blum

511 F. Supp. 1073
CourtDistrict Court, N.D. New York
DecidedApril 15, 1981
Docket78-IV-145
StatusPublished
Cited by36 cases

This text of 511 F. Supp. 1073 (Calkins v. Blum) is published on Counsel Stack Legal Research, covering District Court, N.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Calkins v. Blum, 511 F. Supp. 1073 (N.D.N.Y. 1981).

Opinion

MEMORANDUM — DECISION AND ORDER

MUNSON, Chief Judge.

The named plaintiffs, plaintiff-intervenors, 1 and absent proposed class members are aged, blind, or disabled adults, their spouses, and any dependent children. All named plaintiffs have sought medical assistance [medicaid] as medically needy persons. In this action for declaratory, injunctive, and monetary relief, the plaintiffs 2 aver, inter alia, that the defendants, administrators of the medicaid program for the State of New York, have determined the medicaid eligibility of medically needy persons in a manner different from, and less generous than, the methods used to compute the medicaid eligibility of categorically needy persons. This disparate treatment, the plaintiffs alleged, has violated certain provisions of the Social Security Act, various regulations promulgated by the Department of Health and Human Services [HHS], 3 the Equal Protection Clause of the Fourteenth Amendment, the Supremacy Clause, and 42 U.S.C. § 1983.

Presently before the Court are motions by the plaintiffs for class certifications and for summary judgment, and by the defendants for dismissal of the complaint and for cross-summary judgment.

I.

A.

Title XIX of the Social Security Act of 1965, 42 U.S.C. §§ 1396-1396k, has created a cooperative federal-state medical assistanee [medicaid] program designed to enable each State, “as far as practicable under the conditions of each State, to furnish (1) medical assistance on behalf of families with dependent children and of aged, blind, or disabled individuals whose income and resources are insufficient to meet the costs of necessary medical services, . .. . ” 42 U.S.C. § 1396(1). If a state chooses to participate in the medicaid program, it must submit to the Department of Health and Human Services [HHS], the administrator of the federal medicaid program, see 42 C.F.R. §§ 435.1-.1011, a medical assistance plan that comports with the requirements of the Social Security Act and of the regulations promulgated by HHS. 42 U.S.C. §§ 1396, 1396a; 42 C.F.R. § 435.10.

With respect to these requirements, the federal program distinguishes two groups of medicaid recipients. Pursuant to 42 U.S.C. § 1396a(a)(10)(A), a participating State must provide medical assistance to the “categorically needy,” those aged, blind, or disabled individuals, and families and children, whose levels of income and resources are low enough to qualify them for federal cash assistance under the Supplementary Security Income [SSI] program, 42 U.S.C. §§ 1381-1383c, or under the Aid to Families with Dependent Children [AFDC] program, 42 U.S.C. §§ 601-644. See 42 C.F.R. § 435.4 (amended 45 Fed.Reg. 24883, April 11, 1980). Pursuant to 42 U.S.C. § 1396a(a)(10)(C), a participating State may provide medicaid benefits to the “medically needy”, those aged, blind, or disabled individuals, and families and children, whose levels of income and resources are too low to cover the costs of medical care, but too high to qualify them for cash grants under the SSI or AFDC programs. See 42 C.F.R. § 435.4. This class of medically needy may *1080 thus be divided into two subgroups: the SSI medically needy, those aged, blind, or disabled individuals in need of medical assistance who are ineligible for SSI, and the AFDC medically needy, those families and children in need of medical assistance who are ineligible for AFDC.

The State of New York is one state that participates in the cooperative medicaid program. See N.Y.Soc.Serv.Law §§ 363-369. In this regard, the State of New York also operates under a state constitutional mandate to affirmatively aid the needy. N.Y.Const. Art. XVII, § 1. See Lee v. Smith, 43 N.Y.2d 453, 373 N.E.2d 247, 402 N.Y.S.2d 351 (1977); Tucker v. Toia, 43 N.Y.2d 1, 371 N.E.2d 449, 400 N.Y.S.2d 728 (1977). Under the New York medicaid scheme, which is administered by the departments of social services of the State, counties, and of the City of New York, the State furnishes medical assistance to both the categorically and medically needy. N.Y.Soc.Serv.Law §§ 366(l)(a)(l), (2) & (5).

Since the commencement of this action, the State of New York has converted to a different medical assistance plan, effective August 29, 1980. Under the new “209b” plan, as set forth in 42 U.S.C. § 1396a(f), 4 the State, instead of HHS, determines SSI eligibility, and may apply to aged, blind, or disabled individuals medicaid eligibility criteria that are more restrictive than the criteria utilized under the SSI program. See 42 C.F.R. § 435.121 (amended 45 Fed. Reg. 24883, April 11,1980). Thus, this opinion must address two separate time frames, the pre- and post-conversion periods.

B.

At dispute in this action are the budgeting procedures used by the defendants in ascertaining the eligibility for and amount of, medical assistance for the medically needy.

For purposes of clarity, the plaintiffs fall into four groups. The first group of plaintiffs is comprised of several aged, blind, or disabled, SSI medically needy persons: Kenneth Calkins, a blind resident of Onondaga County; Gerald Makin, a disabled resident of Steuben County; Mary Toomey, a disabled resident of Monroe County; Curtis and Addie Williams, disabled residents of Orleans County; Jane Kliss, a disabled resident of Monroe County; Isahiah and Louise Floyd, disabled residents of Genesee County; and Connie Hodeker, a disabled resident of Monroe County. The second group of plaintiffs represent the spouses of these aged, blind, or disabled, SSI medically needy persons, who join this action because they bear the financial responsibility for the medical and non-medical care of their medically needy spouses: Martin E.

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Bluebook (online)
511 F. Supp. 1073, Counsel Stack Legal Research, https://law.counselstack.com/opinion/calkins-v-blum-nynd-1981.