the Matter of County of Chemung, St. Lawrence, Chautauqua, Jefferson, Oneida, Genesee, Cayuga, Monroe v. Nirav R. Shah

66 N.E.3d 1044, 28 N.Y.3d 244
CourtNew York Court of Appeals
DecidedOctober 27, 2016
Docket136-143
StatusPublished
Cited by34 cases

This text of 66 N.E.3d 1044 (the Matter of County of Chemung, St. Lawrence, Chautauqua, Jefferson, Oneida, Genesee, Cayuga, Monroe v. Nirav R. Shah) is published on Counsel Stack Legal Research, covering New York Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
the Matter of County of Chemung, St. Lawrence, Chautauqua, Jefferson, Oneida, Genesee, Cayuga, Monroe v. Nirav R. Shah, 66 N.E.3d 1044, 28 N.Y.3d 244 (N.Y. 2016).

Opinion

*256 OPINION OF THE COURT

Rivera, J.

In these appeals, several counties challenge the constitutionality of the 2012 amendment (L 2012, ch 56, § 1, part D, § 61) (section 61) to the Medicaid Cap Statute (L 2005, ch 58, § 1, part C, § 1), which closes the door on reimbursement claims for a category of Medicaid disability expenses paid by the counties to the State prior to 2006. The current appeals are the latest round in a decade-long struggle between the counties and the State, during which the counties demanded payment after the state legislature restructured the Medicaid local-share payment system, and enacted a flat cap on total county Medicaid expenses. We are now faced with divergent departmental approaches to the resolution of the singular question underlying these proceedings: whether the State must consider and pay claims submitted after the effective date of the legislative deadline for pre-2006 reimbursement claims set forth in section 61. We conclude section 61 is constitutional, and that the State is under no further obligation to address outstanding county reimbursement claims filed after April 1, 2012, nor must the State initiate an administrative review of its records to identify and pay for any pre-2006 claims.

L

Medicaid is a federal program that provides medical services to low-income individuals with limited resources (see generally Matter of Visiting Nurse Serv. of N.Y. Home Care v New York State Dept. of Health, 5 NY3d 499, 503 [2005]; 42 USC § 1395 et seq.). The program is jointly funded by the federal government and the states (42 USC §§ 1396a, 1396b). In New York, the program is administered through the State Department of Health (DOH), and the State pays for covered medical services and, in turn, is partially reimbursed a specified percentage for these expenses by the federal government (id.). Unreimbursed expenses are shared between the State and 58 local social services districts, which are coterminous with the State’s counties (Social Services Law § 368-a [1] [d]). 1

From 1984 until 2006 the State directly billed the counties for their respective local shares, which included costs for a category of medical services for certain Medicaid recipients for which the counties bore no financial responsibility, and for *257 which they were entitled to repayment, known as “overburden reimbursements” (Social Services Law § 368-a [1] [h]). The State deposited the local share in a special escrow Medicaid fund maintained by the State Comptroller (Social Services Law § 367-b [14]). As required by Social Services Law § 368-a (1) (h) (i), upon review by DOH of the local share, the State was obligated to pay the county 100% of Medicaid services provided to recipients who were eligible for overburden reimbursement. 2

From 1984 to 2005, the State met its obligation to pay overburden reimbursements in two ways. First, DOH identified overburden reimbursement-eligible patients and paid the counties quarterly. Second, DOH instituted a process whereby counties could submit reimbursement claims for eligible patients overlooked by DOH (18 NYCRR 601.4; part 635). To assist with the claims process, DOH would send each county several reports that included the client identification number of each patient for which the county was entitled to reimbursement, the amount the county had originally paid for that patient’s Medicaid expenditures, and the reimbursement amount. The State also made the adjudicated claims history file available to the counties, and it included details from 1984 onward regarding all Medicaid claims that DOH’s fiscal agent paid for services provided to Medicaid recipients. Any county that believed it was owed a reimbursement based on its review of these reports could notify DOH in writing by letter or upon submission of a claim in accordance with DOH regulations.

In response to rising Medicaid costs and the fiscal burdens they imposed on the counties, in 2005 the legislature enacted the Medicaid Cap Statute (Cap Statute) to limit the counties’ financial responsibility for Medicaid expenditures. The Cap Statute replaced the counties’ fixed percentage of Medicaid *258 expenses (for example, roughly .25%), with a maximum individualized county cap, based on the Medicaid expenditures made by or on behalf of each county during the 2005 base year, after deducting any overburden reimbursement payments made to the county.

Thereafter, DOH interpreted the Cap Statute as imposing a specific annual contribution amount on the counties that they could not reduce by seeking payment for outstanding overburden reimbursements, and DOH denied overburden reimbursement claims submitted after the enactment of the Cap Statute. Niagara, Herkimer, and St. Lawrence Counties each brought CPLR article 78 proceedings challenging the denials. Supreme Court granted the Counties partial relief and, when DOH appealed, the Appellate Division held that DOH’s application of the Medicaid Cap Statute to the Counties’ claims “constituted an impermissible retroactive application of the statute” (Matter of County of St. Lawrence v Daines, 81 AD3d 212, 214 [3d Dept 2011], lv denied 17 NY3d 703 [2011]; see also Matter of County of Herkimer v Daines, 60 AD3d 1456, 1457 [4th Dept 2009], lv denied 13 NY3d 707 [2009]; Matter of County of Niagara v Daines, 60 AD3d 1460, 1461 [4th Dept 2009], lv denied 13 NY3d 708 [2009]).

On the heels of the Counties’ success in the courts, the legislature enacted an amendment in 2010 that DOH interpreted as barring the Counties from seeking past overburden reimbursements. Another round of litigation ensued, and the Appellate Division ultimately rejected the State’s statutory construction and annulled DOH’s denials of overburden claims, concluding that the 2010 amendment did not clearly and unambiguously extinguish the State’s obligation to pay the pre-2006 claims (see Matter of County of St. Lawrence v Shah, 95 AD3d 1548, 1548, 1551-1553 [3d Dept 2012]; Matter of County of Niagara v Daines, 91 AD3d 1288, 1290 [4th Dept 2012], lv denied 94 AD3d 1481 [2012]).

While these appeals were pending, the legislature enacted section 61 as part of the 2012-2013 executive budget, which expressly provides that “ [notwithstanding the provisions of section 368-a of the social services law or any other contrary provision of law, no reimbursement shall be made for social services districts’ claims submitted on and after the effective date of this paragraph, for district expenditures incurred prior to January 1, 2006” (L 2012, ch 56, § 1, part D, § 61). Section 61, which was proposed on January 17, 2012 and passed on *259 March 30, 2012, had an effective date of April 1, 2012. According to the State Executive Budget Memorandum, section 61 was intended:

“to clarify that local governments cannot claim for overburden expenses incurred prior to January 1, 2006, when the ‘local cap’ statute that limited local contributions to Medicaid expenditures took effect.

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Bluebook (online)
66 N.E.3d 1044, 28 N.Y.3d 244, Counsel Stack Legal Research, https://law.counselstack.com/opinion/the-matter-of-county-of-chemung-st-lawrence-chautauqua-jefferson-ny-2016.