In re Elizabeth

55 A.D.3d 257, 863 N.Y.S.2d 789
Appellate Division of the Supreme Court of the State of New York·Decided September 16, 2008·Published·Cited by 1 cases

Opinion

OPINION OF THE COURT

Angiolillo, J.

The issue presented on this appeal is the scope of entitlement of the Department of Social Services of the City of New York (hereinafter the DSS) to recovery, from the trust corpus of a supplemental needs trust, for the medical assistance provided by Medicaid to Ruben N., the beneficiary of the supplemental needs trust, over the course of his lifetime. The DSS claims that it was entitled, pursuant to the statutorily-required language of the supplemental needs trust, to recovery of the total medical assistance provided to Ruben N. over the course of his lifetime and not just the medical assistance provided to him after the creation of the supplemental needs trust.

We agree with the Supreme Court that the DSS is not entitled to recovery for medical assistance provided to Ruben N. prior to August 24, 2002 for reasons other than those stated by the Supreme Court. However, the DSS is entitled to recovery for medical assistance provided on or after August 24, 2002 through September 22, 2003.

[259]*259Ruben N. was born with Down syndrome in 1964 and began receiving medical assistance under the State Medicaid plan on July 1, 1992. On July 14, 1997, he suffered an injury during corrective spinal surgery, which resulted in his partial paralysis such that he was no longer able to ambulate. A medical malpractice action was commenced by Ruben N.’s sister on his behalf against the hospital where the surgery was performed and several doctors. Ruben N. continued to receive medical assistance from the DSS, and the DSS filed a lien pursuant to Social Services Law § 104-b (hereinafter the Medicaid lien) for recovery from any award made in the medical malpractice action, for such assistance for which the third-party tortfeasor was found to be liable.

The parties to the medical malpractice action reached a settlement. Based upon the proposed settlement, the DSS agreed to accept the sum of $102,423.56 to settle the Medicaid lien. The amount necessary to settle the Medicaid lien was premised on a letter from the DSS stating that it would accept that amount on the Medicaid lien against the proceeds of the personal injury lawsuit, based on the proposed settlement of the lawsuit for the sum of $1,600,000. The letter further provided that the DSS reserved the right to collect any unpaid balance of the Medicaid lien if Ruben reached a further settlement that provided additional proceeds or if he should receive funds from another source such as the lottery; neither of those circumstances eventuated.

The settlement of the medical malpractice action was approved by the Supreme Court, Kings County (Patterson, J.), in an amended order dated August 23, 2002, with the direction that payment be made to the DSS in the amount of $102,423.56, in full satisfaction of the Medicaid lien to the date of the order. Pursuant to regulation, the Medicaid lien was required to be satisfied or otherwise resolved in order for the remaining funds received by Ruben N. to be disregarded, for purposes of eligibility to continue receiving Medicaid benefits, by placement in a supplemental needs trust (see 18 NYCRR 360-4.5 [b] [5] [ii]). As will be discussed herein, the Medicaid lien was limited to the medical assistance Ruben N. received as a result of the third-party tortfeasor’s negligence. The lien was not and could not have been asserted in connection with any medical assistance provided to Ruben N. as a result of his Down syndrome condition; whether such assistance was provided prior to or subsequent to the medical malpractice. The settlement of the medical [260]*260malpractice action and settlement of the lien did not in any way address the other assistance that had been correctly paid to Ruben N.

In accordance with a further direction of the Supreme Court, Ruben N.’s sister petitioned for appointment as guardian of the person and property of Ruben N. and for approval of the creation of a supplemental needs trust. Ruben N. was declared to be an incapacitated person, and by order and judgment (one paper) dated January 15, 2003, Ruben N.’s sister was appointed as his guardian and a supplemental needs trust was created, with the sister as trustee.

Until the Supreme Court approved the settlement of the medical malpractice action, Ruben N. possessed a claim against a third party, but he did not have any present assets or resources to meet his needs. Once the settlement was approved, Ruben had assets and resources that ordinarily would have made him ineligible for continuing receipt of medical assistance. By placing those assets in a supplemental needs trust, his eligibility continued. The authorization for what have genetically been called exception trusts, including what has come to be known in New York as supplemental needs trusts, is contained in 42 USC § 1396p (d) (4) (A) and Social Services Law § 366 (2) (b) (2) (ii). Those trusts were the exception to the general tightening of fiscal responsibility contained in the Federal Omnibus Budget Reconciliation Act of 1993 (Pub L 103-66, 107 US Stat 312) and New York’s enactment of the present version of Social Services Law § 366.

The referenced sections are provisions which address an applicant’s eligibility and a recipient’s continuing eligibility to receive medical assistance. The federal provision, 42 USC § 1396p (d) (4) (A), deals with the treatment of trust amounts, both those that are considered as available resources and the exceptions; the state provision, Social Services Law § 366, is a general treatment of eligibility, with the trust exceptions addressed in the cited subparagraph.

New York adopted Estates, Powers and Trusts Law § 7-1.12 to allow for the creation of what have come to be called supplemental needs trusts. Those trusts were primarily intended to foster effective future care planning for disabled individuals whose basic needs were primarily met through government benefits or assistance programs (see Bill Jacket, L 1993, ch 433; see also Cricchio v Pennisi, 90 NY2d 296, 308-309 [1997]).

The supplemental needs trust created for Ruben N. contained a provision, as required by federal and state law (see 42 USC [261]*261§ 1396p [d] [4] [A]; Social Services Law § 366 [2] [b] [2] [iii]), that upon Ruben N.’s death, the State would receive all amounts remaining in the trust up to the total value of “all medical assistance” provided to Ruben N. On September 22, 2003, Ruben N. died.

The medical assistance provided to Ruben N. during his lifetime may be viewed in three different segments. Those are: the period from July 1, 1992 to July 13, 1997, when Ruben received medical assistance as a result of his Down syndrome; the period from July 14, 1997 to August 23, 2002, when he received medical assistance as a consequence of the failed medical procedure that left him partially paralyzed, in addition to the continued receipt of assistance attributable to his Down syndrome; and the period from August 24, 2002 until his death on September 22, 2003, when he continued to receive medical assistance notwithstanding his receipt of assets from the settlement of the malpractice action.

In her amended final accounting, the trustee took the position that the State was only entitled to reimbursement of the amount of medical assistance provided to Ruben N. after the creation of the trust, January 15, 2003, until his death, the sum of $50,226.63.

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In re Elizabeth, 55 A.D.3d 257, 863 N.Y.S.2d 789 (N.Y. Ct. App. 2008).

55 A.D.3d 257 (In re Elizabeth) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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