Jennings v. Commissioner

71 A.D.3d 98, 893 N.Y.S.2d 103
Appellate Division of the Supreme Court of the State of New York·Decided January 5, 2010·Published·Cited by 26 cases

Opinions

OPINION OF THE COURT

Balkin, J.

In New York, the concept of a supplemental needs trust originated in 1978,1 establishing a vehicle for parents and guard[100]*100ians of adult children with severe and chronic disabilities to provide for their children’s future by transferring their funds to a trust, created to pay for items that will enhance their children’s quality of life without jeopardizing their children’s eligibility for government benefits, such as Supplemental Security Income (hereinafter SSI), pursuant to 42 USC § 1382 et seq., and Medicaid, pursuant to 42 USC § 1396 et seq. and Social Services Law § 363 et seq.

The issues of first impression at the appellate level are whether the transfer of a settlor/parent’s recurring income into a supplemental needs trust created for his or her disabled child must be counted toward (a) the settlor/parent’s net available monthly income for calculation of the amount of the Medicaid benefits to which the settlor/parent is entitled after he or she is determined to be eligible for Medicaid (hereinafter post-eligibility benefits) and (b) the obligation of the estate of a deceased settlor/parent for the reimbursement of a certain portion of those benefits. We hold that, in the instant matter, there was a rational basis to include this income in the calculations.

I

The following facts essentially are undisputed. On September 15, 2004 the petitioner’s decedent, Mattie Lou Hammond (hereinafter Hammond), who was then 85 years old, established an irrevocable supplemental needs trust (hereinafter SNT) for the benefit of her 52-year-old son, Frediland Hammond (hereinafter Frediland), who is disabled due to mental retardation and developmental disabilities. Frediland is a recipient of Social Security disability insurance (hereinafter SSDI) (see 42 USC § 423) and Medicare benefits (see 42 USC § 401 et seq.), but not Medicaid benefits. Hammond, whose only income consisted of Social Security retirement benefits and a small widow’s pension, created the trust by executing a special needs trust agreement (hereinafter the SNT agreement), which designated her cousin, the petitioner, William Jennings, as trustee, with the discretion to use the SNT income and/or principal to insure that Frediland enjoyed the “benefits of education, recreation, hobbies, vacation, modes of transportation, entertainment, and any other need and/or comforts [he] may require to maximize [his] [101]*101life and to keep [him] in the general community for so long as medically possible and safe.”

The SNT agreement, which initially funded the trust with the sum of $250, provided that “any person may, at any time, by Court order, assignment, gift, transfer, deed, or will, provide income or add to the principal of the Trust.” The SNT agreement also authorized the trustee to use the income for Frediland’s necessary medical care, equipment, and supplies that were not paid for by private insurance or Medicaid. Finally, in accordance with statutory requirements, the SNT agreement provided for the termination of the SNT upon Frediland’s death, with the trustee using any remaining principal and accumulated interest to reimburse or “pay back” the New York State Department of Social Services (hereinafter NYS DSS), the nonparty appellant, Commissioner, New York State Department of Health (hereinafter the DOH), or any other appropriate “Medicaid entity,” for the medical assistance provided to Frediland during his lifetime, before distributing any remaining trust assets to his estate. Coincident with the execution of the SNT agreement, on September 15, 2004 Hammond moved into a residential health care facility or nursing home in Hempstead, New York. On January 14, 2005 Hammond applied to the Nassau County Department of Social Services (hereinafter the NCDSS) for medical assistance benefits under the Medicaid program, to cover the costs of her own nursing home and medical care, retroactive to October 6, 2004. In her application, Hammond indicated that she had a total gross income in the sum of $1,780.84 per month, consisting of her Social Security retirement benefits in the monthly sum of $1,173, and a monthly pension benefit in the sum of $607.84; she informed the NCDSS, however, that she had been depositing all of her income into the SNT for Frediland’s benefit.

On January 27, 2005 the NCDSS issued a notice of intent to establish liability toward chronic care, which informed Hammond that she was eligible to receive Medicaid benefits. This determination of entitlement to post-eligibility benefits by the NCDSS is part of a process known as “chronic care budgeting” (18 NYCRR 360-4.9). Although the NCDSS determined that Hammond was eligible for Medicaid since the funds she deposited in Frediland’s SNT could be excluded from her income for the purpose of determining her Medicaid eligibility, it simultaneously treated those same funds as income available to her for the purpose of calculating her required contribution for [102]*102her own post-eligibility monthly cost of care. Specifically, the NCDSS determined that Hammond would have to contribute her net available monthly income (hereinafter NAMI)2 in the sum of $1,731 per month toward the cost of her post-eligibility Medicaid services, calculated by subtracting, from her gross monthly income of $1,847, a monthly personal needs allowance in the amount of $50 and a monthly Medicare deduction in the amount of $66.

Hammond challenged the determination of the NCDSS, and asked for an administrative fair hearing in connection with the challenge. On May 26, 2006 an administrative fair hearing was conducted by the New York State Office of Temporary and Disability Assistance, which is part of the DOH, the agency responsible for the administration and interpretation of Medicaid laws in New York (see Kuppersmith v Dowling, 93 NY2d 90, 97 [1999]). Although Hammond did not testify at the hearing, Jennings testified and introduced evidence of the existence and nature of the SNT agreement, Hammond’s application to the NCDSS, and the expenses actually paid from the SNT on Frediland’s behalf. According to Hammond, her NAMI should have been “zero” because she deposited all of her monthly income into Frediland’s SNT, relying on the rulings of Matter of Kaiser v Commissioner of N.Y.S. Dept. of Health (13 Misc 3d 1211[A], 2006 NY Slip Op 51786[U] [2006]) and Matter of Correri v Commissioner of N.Y. State Dept. of Health (Sup Ct, Nassau County, May 19, 2005, index No. 17372/04). The NCDSS disagreed, holding that, while the income placed in the SNT would not render Hammond ineligible for Medicaid, that income was countable for post-eligibility purposes in order to calculate Hammond’s required contribution toward her own cost of care.

Following the administrative fair hearing, the Commissioner of the DOH (hereinafter the Commissioner) confirmed the NCDSS’s determination in a decision dated June 7, 2006, relying upon past guidance letters and interpretative regulations contained in the State Medicaid Manual (hereinafter the SMM) issued by the United States Department of Health and Human Services’ Centers for Medicare and Medicaid Services (hereinafter the CMS). The Commissioner reasoned, in part:

“[Ms. Hammond] submitted documentation into the [103]*103hearing record that [her] income is being deposited monthly into the supplemental needs trust.

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Jennings v. Commissioner, 71 A.D.3d 98, 893 N.Y.S.2d 103 (N.Y. Ct. App. 2010).

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