Perry v. Dowling

95 F.3d 231, 1996 U.S. App. LEXIS 23471, 1996 WL 509653
Court of Appeals for the Second Circuit·Decided September 10, 1996·No. Nos. 1535, 1659, Dockets 95-9084(L), 95-9132(CON)·Published·Cited by 34 cases

Opinion

ALTIMARI, Circuit Judge.

The defendants-appellants, the Commissioner of the New York State Department of Social Services (“DSS”) and the Commissioner of the Allegany County Department of Social Services (“ACDSS”), appeal from a judgment of the United States District Court for the Western District of New York (Cur-tin, /.), granting the plaintiff-appellee’s motion for summary judgment. The district court concluded that DSS’s policy requiring women who received prenatal and postpartum medical assistance under section 1902(a)(10)(A)(i)(IV) of the Social Security Act (“Act”), 42 U.S.C. § 1396a(a)(10)(A)(i)(IV) (1994), to cooperate in efforts at retroactively recouping the costs of such medical assistance from the unwed fathers of their children upon recertification for continued Medicaid coverage, is an unreasonable interpretation of the exemption from paternity cooperation extended to poverty level pregnant women under section 1912(a)(1)(B) of the Act, 42 U.S.C. § 1396k(a)(1)(B). See Perry v. Dowling, 888 F.Supp. 485, 492-93 (W.D.N.Y.1995). We hold that DSS’s policy is a permissible interpretation of the statute, and, therefore, reverse.

BACKGROUND

1. Statutory and Regulatory Framework

The present case concerns the provisions of the Social Security Act extending Medicaid coverage to indigent pregnant women. We have elsewhere described the general nature of the Act’s Medicaid provisions, see New York Dep’t of Social Servs. v. Shalala, 21 F.3d 485, 487 (2d Cir.1994); Lewis v. Grinker, 965 F.2d 1206, 1208-09 (2d Cir.1992), as well as the historical development of prenatal services for indigent, pregnant women, see id. at 1209-11, and, consequently, limit our discussion of the regulatory framework to the particular statutory provisions and regulations at issue.

Under Medicaid’s “Medical Assistance” provisions, state Medicaid plans must offer a range of prenatal, delivery, and postpartum benefits to pregnant women who do not otherwise qualify for Medicaid, but whose income falls within (i) 133% of the federal poverty income level, or (ii) at the state’s option, 185% of the federal poverty income level. See 42 U.S.C. § 1396a(a)(10)(A)(i)(IV). Eligible women meeting the above income requirements must be “women during pregnancy (and during the 60-day period beginning on the last day of the pregnancy).” 42 U.S.C. § 1396a(i)(1)(A) (incorporated by reference into section 1396a(a)(10)(A)(i)(IV)). The Health Care Financing Administration (“HCFA”), the division of the United States Department of Health and Human Services (“HHS”) charged with overseeing Medicaid, refers to such women as “poverty level pregnant women”. See 58 Fed.Reg. 4904, 4905 (1993). New York State has exercised its option under the statute to provide such prenatal and postpartum medical assistance to women whose incomes fall within 185% of the federal poverty income level. See New York [234] Social Services Law § 366.4(o) (McKinney 1992).

In order to help defray the costs incurred by the state, section 1396k(a)(l) requires that as a condition of eligibility for general Medicaid assistance a state Medicaid plan must require individuals applying or receiving such assistance to do three things: (1) assign to the state any rights they have, on behalf of themselves or their child, to support, and payment for medical care from any third party (the “assignment provision”), (2) cooperate with the state in (i) establishing the paternity of their child, if it is born out of wedlock, and (ii) obtaining support and payments for themselves and/or their child (the “paternity cooperation provision”), and (3) cooperate with the state in identifying and pursuing any third party, such as an insurer, who may be liable for care and services available under the statute (the “third party cooperation provision”). See 42 U.S.C. § 1396k(a)(1)(A)-(C); 42 C.F.R. §§ 433.145-147 (1994).

Only under two circumstances will an applicant not be required to comply with the cooperation provisions above. The first exception provides that individuals having “good cause” — as determined by the state agency implementing Medicaid — need not comply with the requirements of the paternity or third party cooperation provisions. See 42 U.S.C. § 1396k(a)(1)(B) and (C). The second exception provides that individuals described by section 1396a(i)(1)(A), namely “women during pregnancy (and during the 60-day period beginning on the last day of the pregnancy),” need not comply with the requirements of the paternity cooperation provision. See 42 U.S.C. § 1396k(a)(1)(B); 42 C.F.R. §§ 433.145(a)(2), 147(a)(1). The present controversy concerns the breadth of this second exception.

2. The Present Action

A Underlying Events

In October 1991, plaintiff-appellee Jodi Perry (“Perry”) became pregnant. At the time, she was unmarried and living with the father of the child, Thomas A. English II (“English”). Because of her modest income, Perry did not qualify for full Medicaid benefits. She did, however, qualify for pregnancy-related medical assistance under the Act as a poverty level pregnant woman, and on February 5, 1992 ACDSS approved such medical coverage. In accordance with the requirements of the assignment provision of section 1396k(a)(1)(A), Perry’s application for medical assistance included a clause assigning to the state her rights to any support and payment for the medical assistance from any other person.

Perry’s son was bom on July 29,1992. On October 20,1992, Perry applied for continued medical coverage of her son, and recertified for conventional Medicaid coverage of herself, since she no longer qualified for medical assistance as a poverty level pregnant woman. Like her original application for medical assistance, her recertification application contained an assignment to the state of her rights to support and payment. Two days later ACDSS approved continued coverage for her son and Medicaid coverage for Perry.

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Perry v. Dowling, 95 F.3d 231, 1996 U.S. App. LEXIS 23471, 1996 WL 509653 (2d Cir. 1996).

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