Frerks ex rel. Frerks v. Shalala

848 F. Supp. 340, 1994 U.S. Dist. LEXIS 3874
CourtDistrict Court, E.D. New York
DecidedMarch 28, 1994
DocketNo. CV 91-1928
StatusPublished
Cited by1 cases

This text of 848 F. Supp. 340 (Frerks ex rel. Frerks v. Shalala) is published on Counsel Stack Legal Research, covering District Court, E.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Frerks ex rel. Frerks v. Shalala, 848 F. Supp. 340, 1994 U.S. Dist. LEXIS 3874 (E.D.N.Y. 1994).

Opinion

OPINION AND ORDER

SPATT, District Judge:

The plaintiff, David Frerks (“Frerks”), is a mentally handicapped twenty-four year old whose parents have been appointed as his guardians by the Nassau County Surrogate’s Court. In 1988. and 1990 respectively, Frerks was denied eligibility for Supplemental Security Income (“SSI”) by the United States Secretary of Health and Human Services (“Secretary”), and Medicaid by the New York State Commissioner of Social Services (“Commissioner”). The ground for the eligibility denials was that a medical malpractice settlement received by the plaintiff and held in a guardianship account ordered by the Surrogate’s Court was-determined by the agencies to be a “resource” available to the plaintiff. By counting the value of the settlement as a resource available to him, the plaintiff exceeded the resource limit for eligibility in these programs set by federal and state statutes. Accordingly, he was disqualified from receiving benefits.

As a result of these eligibility denials, the plaintiff initiated this action for judicial review of the Secretary’s actions pursuant to 42 U.S.C. § 405(g). The plaintiff also seeks relief against the Commissioner, based on the allegation that the New York State Department of Social Services (“NYDSS”) failed to follow federal and state laws when it denied the plaintiff Medicaid eligibility and additional state funds that supplement SSI payments.

The Secretary and Commissioner move to dismiss the Complaint. The defendant Secretary moves pursuant to Fed.R.Civ.P. 12(c) for a judgment on the pleadings, on the ground that the Secretary’s decision to deny the plaintiff SSI is supported by substantial evidence in the record. The defendant Commissioner moves to dismiss the complaint against him pursuant to Fed.R.Civ.P. 12(b), on the grounds of lack of subject matter jurisdiction, failure to state a claim, and failure to join a necessary party to the action, or in the alternative, for summary judgment.

STATUTORY AND REGULATORY FRAMEWORK

The federal Supplemental Security Income program, 42 U.S.C. § 1381 et seq., provides non-medical cash assistance to aged, blind or disabled persons. Under the statute, an aged, blind or disabled person is eligible for SSI if either their monthly income or overall available resources do not exceed certain [344]*344maximum amounts set forth in the statute and regulations. See 42 U.S.C. § 1382, and 20 C.F.R. § 416 subparts D and K (setting forth criteria for income limits) and 20 C.F.R. § 416.1205 (resource limits). In 1988, the year Frerks was denied eligibility, the maximum amount of resources a disabled individual not residing with a spouse could have available was $1,900. See 42 U.S.C. § 1382(a)(l)(B)(ii), and 20 C.F.R. § 416.1205. If the Department of Health and Human Services (“HHS”) determines that either of an individual’s available resources or monthly income exceed the prescribed limits, he or she is ineligible for SSI.

The statute does not define the terms “income” or “resource.” Instead, the definition of these terms is provided in the regulations promulgated under the statute. With respect to the definition of a “resource,” 42 C.F.R.- § 410.1201 discusses resources generally, and gives the following definition:

(a) Resources; ' defined. [RJesources means cash or other liquid assets ... that an individual ... owns and could convert to cash to be used for his or her support and maintenance.
(1) If the individual has the right, authority or power to liquidate the property or his or her share of the property, it is considered a resource.

The regulation goes on to specifically define liquid and nonliquid resources that an individual owns or could convert to cash in order to use for his or her support and maintenance:

(b) Liquid Resources. Liquid resources are cash or other property which can be converted to cash within 20 days.... Examples of resources that are ordinarily liquid are stocks, bonds, mutual funds shares, promissory notes, mortgages, life insurance policies, bank accounts (savings and checking), certificates of deposit and similar items.
(c) Nonliquid Resources. (1) Nonliquid resources are property which is not converted to cash within 20 days_ Examples of resources that are ordinarily nonli-quid are loan agreements, household goods, automobiles, trucks, tractors, boats, machinery, livestock, building and land.

42 C.F.R. § 410.1201(b) and (c).

The NYDSS provides Optional State Supplement (“OSS”) payments to SSI recipients as well. Through OSS, also known as “supplemental assistance” and “additional state payments,” a state provides additional aid to SSI recipients and to those who do not meet the eligibility standards for SSI. See 42 U.S.C. § 1382e, and New York State Social Services Law § 207 et seq. Although OSS assistance comes almost exclusively from state funds, the federal statute provides that, at a state’s request, the federal government will administer the OSS assistance. See generally Oklahoma v. Schweiker, 655 F.2d 401, 404 (D.C.Cir.1981).

New York State has entered into an agreement with the HHS, whereby HHS administers the OSS payments and determines the eligibility of individuals for such payments. See New York State Social Services Law § 211(1); Casey v. New York State Department of Social Services, 56 A.D.2d 72, 391 N.Y.S.2d 173, 176 (2d Dept.1977).

In addition to SSI, the federal Medicaid program, 42 U.S.C. § 1396 et seq., provides medical assistance to those who lack sufficient income and resources to pay for health care. Medicaid is also a joint federal-state program. In order for a state to participate in the Medicaid program, it must create a state plan that complies with the requirements of the federal statute and regulations. See Himes v. Sullivan, 779 F.Supp. 258, 259 (W.D.N.Y.1991), aff'd without opinion 956 F.2d 1159 (2d Cir.1992).

New York State’s Medicaid program is entitled the Medical Assistance Program, and is set forth in New York State Social Services Law § 366 et seq., and at 18 New York Code Rules and Regulations (“NYCRR”) part 360.

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Related

FRERKS BY FRERKS v. Shalala
848 F. Supp. 340 (E.D. New York, 1994)

Cite This Page — Counsel Stack

Bluebook (online)
848 F. Supp. 340, 1994 U.S. Dist. LEXIS 3874, Counsel Stack Legal Research, https://law.counselstack.com/opinion/frerks-ex-rel-frerks-v-shalala-nyed-1994.