McMahon v. Novello

192 F. Supp. 2d 54, 2001 U.S. Dist. LEXIS 23813, 2001 WL 1822415
CourtDistrict Court, W.D. New York
DecidedDecember 20, 2001
Docket1:91-cv-00621
StatusPublished
Cited by4 cases

This text of 192 F. Supp. 2d 54 (McMahon v. Novello) is published on Counsel Stack Legal Research, covering District Court, W.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
McMahon v. Novello, 192 F. Supp. 2d 54, 2001 U.S. Dist. LEXIS 23813, 2001 WL 1822415 (W.D.N.Y. 2001).

Opinion

INTRODUCTION

CURTIN, District Judge.

This case was originally filed as a class action against the Commissioners of the New York State Department of Social Services (N.Y.SDSS) and the Erie County Department of Social Services (ECDSS) on September 23,1991. Item 1. The plaintiff class consisted of members who were typically mentally retarded and living with older parents who were eligible for but lost Medicaid coverage. By way of their complaint, plaintiffs sought to remedy “defendants’ policies and practices which have resulted in the failure to implement 42 USC § IBSScic), 1 which provides for continued Medicaid benefits for disabled adults who have had Supplemental Security Income (SSI) 2 benefits discontinued solely because of eligibility for or an increase in Social Security Child’s Insurance Benefits, also known as Disabled Adult Child’s (DAC) benefits.” Item 1, ¶ 1. Only plaintiffs’ motion for attorneys’ fees, Item 68, remains to be decided.

The complaint explained the plight of the class members: “When one of the parents, usually the father, dies, the adult son or daughter qualifies for DAC benefits on the earnings record of the father. Since the DAC benefits are more than the SSI check he or she had received until the father’s death, the SSI benefits are terminated.” Id., ¶ 2. Once a person’s SSI benefits are terminated, that person also often loses Medicaid 3 benefits, even though they are entitled to continued Medicaid eligibility under 42 U.S.C. § 1383e(c) 4 . Plaintiffs sought injunctive relief guaranteeing their statutory and constitutional 5 rights and requiring full implementation of 42 U.S.C. § 1383c(c); a declaratory judgment that these policies violate, inter alia, the Social Security Act; and reinstating the Medicaid benefits of members of the plaintiff class and reimbursement of medical expenses *57 they incurred from the date their Medicaid benefits were improperly terminated.

BACKGROUND

When this complaint was filed, plaintiffs held the State Department of Social Services and the Erie County Department of Social Services responsible for loss of their Medicaid benefits, pointing to NYSDSS as failing to provide timely and accurate information to ECDSS to identify individuals who were potentially eligible for Medicaid pursuant to 42 U.S.C. § 1383c(c). All six of plaintiffs’ causes of action against these two defendants were brought under 42 U.S.C. § 1983.

Within two months of filing the complaint, plaintiffs moved to amend, adding two claims for relief against the new defendant, the Secretary of Health and Human Services (HHS). Item 7. A Stipulation and Order was subsequently entered regarding class certification. Item 13. During 1993 and 1994, plaintiffs and defendants undertook settlement negotiations, which resulted in a Stipulation and Order of Partial Settlement (“Partial Settlement”) on January 31, 1995. Item 15. The Partial Settlement provided that the HHS Secretary would issue State Medicaid Manual instructions for the implementation of 42 U.S.C. § 1383c(c). The instructions would address the obligations of the State Medicaid Agencies to prospectively certify as Medicaid eligible those persons meeting the criteria of 42 U.S.C. § 1383c(c). Item 15, p. 3. In order' to implement the Partial Settlement, the Social Security Agency modified its computer systems 6 to insure that the State Data Exchange (SDX), 7 sent to the NYSDSS, contained a code in the Medicaid eligibility field that identified potential § 1383c(c) candidates whose SSI benefits had been terminated due to the amount of their DAC benefits. Item 15, ¶ 29. The NYSDSS was also required to implement the Partial Settlement by, inter alia, issuing various Administrative Directives and Regulations explaining criteria for Medicaid eligibility under 42 U.S.C. § 1383c(c), and providing for readjudication by potential class members regarding their eligibility for Medicaid. Item 15, ¶¶ 12-21.

In addition, the Partial Settlement identified a remaining problem confronting a subset of the plaintiff class: those “dually entitled” Social Security beneficiaries “who receive DAC benefits in addition to disability insurance benefits based on their own *58 earnings records, [who] may be eligible for Medicaid continuation pursuant to the provisions of 42 U.S.C. § 1383c(c).” Item 15, ¶ 28. 8 At the time of the Partial Settlement, the HHS Secretary could not state that their computer systems produced an identification code for these dually entitled Social Security beneficiaries. As a result, the Secretary was investigating whether their computer systems could be modified to indicate such a code. Id., ¶ 30. Plaintiffs reserved the right to seek future amendment of the Settlement Order with respect to those dually entitled individuals who had not been identified as potential class members. Id., ¶ 31.

Following entry of the Partial Settlement, plaintiffs made their first motion for attorneys’ fees on February 24, 1995, reflecting the hours their attorneys had expended on the case from 1991 through the first two months of 1995. Item 17. In an order dated September 3, 1996, the court withheld passing upon the application for attorneys’ fees until the conclusion of the action. Item 31.

In March 1995, the Social Security Administration (SSA) became an independent agency, and the Commissioner became a defendant in this case, joining the Commissioner of HHS (collectively, the “federal defendants”, or “the government”). Item 71, p. 2, n.l.

The court hosted a series of status conferences and meetings among the parties during 1995, 1996, 1997, 1998, 1999, and 2000. Often the topic of the meetings and correspondence concerned the preparation of the computer program that would identify the dually eligible class members. See Items 25 and 26. Because of the difficulties in creating such a program, the court ordered that it would hold a hearing to determine why the State and federal authorities could not resolve the matter more promptly. Item 27. Throughout 1996 and 1997, the defendants’ technical and computer staffs continued to work on the computer programs.

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Cite This Page — Counsel Stack

Bluebook (online)
192 F. Supp. 2d 54, 2001 U.S. Dist. LEXIS 23813, 2001 WL 1822415, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mcmahon-v-novello-nywd-2001.