Lisnitzer v. Zucker

306 F. Supp. 3d 522
CourtDistrict Court, E.D. New York
DecidedJanuary 26, 2018
DocketCV 11–4641 (LDW) (ARL)
StatusPublished
Cited by1 cases

This text of 306 F. Supp. 3d 522 (Lisnitzer v. Zucker) 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
Lisnitzer v. Zucker, 306 F. Supp. 3d 522 (E.D.N.Y. 2018).

Opinion

WEXLER, District Judge

Plaintiff Leslie Lisnitzer ("Lisnitzer") brings this putative class action for declaratory and injunctive relief against officials of the New York State Department of Health ("DOH") and New York State Office of Temporary and Disability Assistance ("OTDA"), challenging the legality of an alleged statewide policy and practice in New York under which the state terminates fair hearing appeals of local agency decisions denying Medicaid benefits by reversing and remanding those matters back to local agencies rather than determining eligibility for Medicaid benefits by a definitive and final fair hearing decision within the required time limit. Having concluded a bench trial, the Court makes the following findings of fact and conclusions of law.

BACKGROUND AND FINDINGS OF FACT

A. Medicaid Program and Fair Hearing Process in New York

1. Medicaid is a cooperative federal-state program designed to assist needy individuals and families "whose income and resources are insufficient to meet the costs of necessary medical services." See 42 U.S.C. § 1396-1.

2. States participating in the Medicaid program must comply with the requirements imposed by Title XIX of the Social Security Act ("Medicaid Act"), see 42 U.S.C. §§ 1396 et seq. , and the regulations promulgated by the Secretary of the United States Department of Health and Human Services ("HHS"), see 42 C.F.R. pts. 430-456.

3. HHS disseminates a "State Medicaid Manual" to participating states providing guidance for implementing the Medicaid Act and regulations (the "Manual"). See Joint Pre-Trial Order ("JPTO") Exh. 6.

4. To qualify for federal funding, participating states must submit a "Medicaid State Plan" ("MSP") to HHS's Center for Medicare and Medicaid Services for approval. See 42 U.S.C. §§ 1396-1, 1396a(b), 1396b ; 42 C.F.R. pt. 430.

5. A participating state can either administer the Medicaid program itself or supervise its administration through local political subdivisions in the state. See 42 U.S.C. § 1396a(a)(5).

6. New York State administers the Medicaid program through local social services districts ("local agency"), namely the City of New York and the other 57 counties in the state. See N.Y. Soc. Serv. Law §§ 56, 61, 65, 365[1](a).

7. If a participating state decides to supervise the administration of the Medicaid program through political subdivisions, it must designate a single state agency with the authority to ensure local conformity with state rules, regulations, and policies. See 42 U.S.C. § 1396a(a)(1), (5) ; 42 C.F.R. § 431.10.

8. Under its MSP, New York designates its DOH as the single state agency charged with administering the Medicaid *525program in New York. See State Plan Under Title XIX of the Social Security Act, Medical Assistance Program ("New York Medicaid State Plan"), JPTO Exh. 1.

9. DOH is authorized to establish Medicaid eligibility standards, promulgate applicable regulations, maintain a system of administrative fair hearings, and make final administrative determinations and issue final decisions on such matters. See id. ; N.Y. Soc. Serv. Law §§ 363-a, 364[2].

10. A Medicaid applicant whose claim is denied by a local agency is entitled to an opportunity for "a fair hearing before the State agency." 42 U.S.C. § 1396a(a)(3).

11. DOH has established a fair hearing system, to provide "an opportunity for a fair hearing ... to any individual whose claim for medical assistance ... is denied or is not acted upon with reasonable promptness." Id. ; see N.Y. Soc. Serv. Law § 22.

12. Under its MSP, New York designates the OTDA to conduct Medicaid fair hearings and make findings and recommendations to DOH, as DOH remains "responsible for making final administrative determinations and issuing final decisions," N.Y. Soc. Serv. Law § 364(2)(h), and for ensuring the fair hearing system's compliance with federal law and regulations, see 42 C.F.R. § 431.205. Shakhnes v. Berlin , 689 F.3d 244, 248 (2d Cir. 2012) ; see JPTO Exh. 1.

13. The Office of Administrative Hearings ("OAH"), a division within OTDA, is responsible for providing administrative hearings and issuing fair hearing decisions upon review of local agency decisions. See http://otda.ny.gov/hearings.

14. When a local agency denies an individual's Medicaid application, it must issue a written notice informing the individual of the reasons for the adverse action and the right to request a fair hearing to contest the decision. See 42 C.F.R. §§ 431.206(b), 431.210(b) ; 18 N.Y.C.R.R.

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Bluebook (online)
306 F. Supp. 3d 522, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lisnitzer-v-zucker-nyed-2018.