In re the Estate of Abraham XX.

36 A.D.3d 1085, 827 N.Y.S.2d 769
CourtAppellate Division of the Supreme Court of the State of New York
DecidedJanuary 18, 2007
StatusPublished
Cited by5 cases

This text of 36 A.D.3d 1085 (In re the Estate of Abraham XX.) is published on Counsel Stack Legal Research, covering Appellate Division of the Supreme Court of the State of New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
In re the Estate of Abraham XX., 36 A.D.3d 1085, 827 N.Y.S.2d 769 (N.Y. Ct. App. 2007).

Opinion

Cardona, EJ.

(1) Cross appeals from an order of the Supreme Court (Feckman, J.), entered September 8, 2005 in Broome County, which, in a proceeding pursuant to Mental Hygiene Law § 43.11, partially granted petitioner’s motion for summary judgment seeking a refund of certain sums paid to respondent from the remainder of a supplemental needs trust, and (2) appeal from the judgment entered thereon.

In July 1992, Abraham XX. was born with spastic quadriplegic cerebral palsy. Litigation brought on Abraham’s behalf resulted in a malpractice verdict in excess of $100,000,000, which was reduced to $5,000,000 pursuant to a “high-low” settlement agreement entered into during jury deliberations.1 By order of December 22, 1998, $1,707,884.95 of the settlement proceeds was allocated to the Office of Mental Retardation and Developmental Disabilities (hereinafter OMRDD) to satisfy a Medicaid lien covering medical assistance provided to Abraham through March 23, 1998, the date of the verdict. An additional $336,334.71 was allocated to fund a supplemental needs trust (hereinafter SNT)2 for Abraham’s benefit, and $2,173,625.83 was set aside to pay Abraham’s postverdict medical expenses. The SNT was funded on September 13, 1999, and two days later Abraham received the amount allocated to postverdict medical expenses. Following the plaintiffs’ appeal of the order allocating the settlement proceeds, the latter amount was also placed in the SNT, retroactive to December 22, 1998, the date of the original order.

[1087]*1087Abraham died in June 2003. OMRDD thereafter asserted a verified supplemental claim against the SNT in the amount of $1,507,954.91 for Medicaid expenditures made during the period from March 24, 1998 through the end of October 2000. After the claim was paid, petitioner, Abraham’s mother, commenced this proceeding seeking a refund of all or part of the funds recouped by OMRDD. On her subsequent motion for summary judgment, petitioner limited her request for relief to two specific amounts: $961,810.89 for the period from March 24, 1998 (the day after the verdict) through September 12, 1999 (the day before the first funds were deposited in the SNT), and $34,633.64 for the 16 days from October 16, 2000 through October 31, 2000 when Abraham was not a resident of any OMRDD facility. Respondent opposed the motion.

Supreme Court partially granted the motion by refunding petitioner $472,167.12 for the period from March 24, 1998 through December 22, 1998. The court reasoned that because respondent failed to amend the original Medicaid lien or appeal any interim order allocating the settlement funds, res judicata bars recovery of any additional Medicaid amounts expended prior to the funding of the SNT on December 22, 1998. The court otherwise denied the motion, holding that petitioner is not entitled to a refund for the period from December 23, 1998 to September 12, 1999 because the SNT was in existence during that time, and she is not entitled to a refund for the period from October 16, 2000 through October 31, 2000 because services were not billed by OMRDD for that period.

Respondent appeals from that part of Supreme Court’s ruling which granted petitioner a partial refund; petitioner cross-appeals from the portions partially denying her motion. Applying both Federal and State Medicaid statutes, we now modify by granting summary judgment in respondent’s favor for the full amount reimbursed to OMRDD for the period from March 24, 1998 to September 12, 1999. We further find that questions of fact exist as to the period from October 16, 2000 to October 31, 2000 such that neither party is entitled to summary judgment with respect thereto.

Initially, we do not agree with Supreme Court’s conclusion that res judicata applies here. That doctrine forecloses litigation of “a claim where a judgment on the merits exists from a prior action between the same parties involving the same subject matter” (Matter of Hunter, 4 NY3d 260, 269 [2005]; see O’Brien v City of Syracuse, 54 NY2d 353, 357 [1981]). The prior litigation involving Abraham resolved only the allocation of the malpractice settlement proceeds in accordance with the jury verdict, [1088]*1088which included satisfaction of the preverdict Medicaid lien and an allowance for Abraham’s future medical and custodial care (Gold v United Health Servs. Hosps., 261 AD2d 67 [1999], mod 95 NY2d 683 [2001]). The December 22, 1998 order specifically acknowledged that postverdict Medicaid expenses were not included in the settlement because those charges would be payable out of the funds allocated to Abraham’s future medical care. Accordingly, although OMRDD raised the issue, the court never ruled on the merits of any claim for postverdict Medicaid expenses.

Turning now to the merits of that claim, petitioner accurately notes that 42 USC § 1396p (b) (1) provides that “medical assistance correctly paid on behalf of an individual” may not be recovered except in certain specified instances (see also Social Services Law § 369 [2] [b]). Contending that Medicaid benefits were correctly paid on Abraham’s behalf between the time of the verdict and the funding of the SNT, and that his circumstances do not fit any of the enumerated exceptions, petitioner argues that OMRDD is precluded from seeking reimbursement from the SNT for that period. Respondent counters that 42 USC § 1396p (d) (4) (A) creates a further exception to 42 USC § 1396p (b) (1) that permits a state to recover from the remainder of an SNT “the total medical assistance” paid on the beneficiary’s behalf (42 USC § 1396p [d] [4] [A]; see Social Services Law § 366 [2] [b] [2] [iii]). Respondent urges that to the extent those provisions conflict, the more recently enacted provision relating to SNTs should govern over the earlier enacted general provision regarding recovery of correctly paid Medicaid.

We hold that respondent is entitled to reimbursement of all Medicaid expended on Abraham’s behalf. However, we do so for different reasons than those argued by respondent. As explained below, we do not agree with respondent that 42 USC § 1396p (d) (4) (A) creates an exception to 42 USC § 1396p (b) (1), nor do we see a conflict between those provisions. Rather, we conclude that respondent’s right to reimbursement of all Medicaid expended on a beneficiary’s behalf flows from the terms of the SNT agreement itself — an agreement voluntarily entered into by the beneficiary or his or her agent in order to obtain the significant advantage of preserving Medicaid eligibility while at the same time benefitting from the funds contained in the trust (see 42 USC § 1396p [d] [4] [A]; Social Services Law § 366 [2] Db] [2] [Hi]; EPTL 7-1.12 [a] [5]).

By way of background, 42 USC § 1396p governs the broad areas of “Liens, adjustments and recoveries, and transfers of assets” as those subjects relate to Medicaid. Although housed [1089]*1089under one heading, these are distinct topics, treated in separate subsections of the statute. Subsection (b), relied on by petitioner, sets forth the rules on “Adjustment or recovery of medical assistance correctly paid under a State plan” from an individual’s estate (42 USC § 1396p [b]; see Social Services Law § 369 [2] [b]); thus, that subsection concerns only recovery of benefits already paid on the recipient’s behalf.

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In Re the Estate of Abraham XX.
900 N.E.2d 136 (New York Court of Appeals, 2008)
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44 A.D.3d 982 (Appellate Division of the Supreme Court of New York, 2007)
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42 A.D.3d 95 (Appellate Division of the Supreme Court of New York, 2007)

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Bluebook (online)
36 A.D.3d 1085, 827 N.Y.S.2d 769, Counsel Stack Legal Research, https://law.counselstack.com/opinion/in-re-the-estate-of-abraham-xx-nyappdiv-2007.