Wong v. Doar

Court of Appeals for the Second Circuit·Decided June 22, 2009·No. 08-4992-cv·Published

Opinion

08-4992-cv Wong v. Doar

UNITED STATES COURT OF APPEALS F OR THE S ECOND C IRCUIT

August Term, 2008

(Argued: February 23, 2009 Decided: June 22, 2009)

Docket No. 08-4992-cv

S AI K WAN W ONG, by his guardian K EVIN W ONG, individually and on behalf of a class of all others similarly situated,

Plaintiff-Appellant,

— v.—

R OBERT D OAR, in his official capacity as Commissioner, New York City Human Resource Administration, R ICHARD F. D AINES, M.D., in his official capacity as Commissioner of New York State Department of Health, K ATHLEEN S EBELIUS, in her official capacity as Secretary, United States Department of Health and Human Services,1

Defendants-Appellees.

B e f o r e:

C ABRANES, R AGGI, and H ALL, Circuit Judges.

1 Pursuant to Federal Rule of Appellate Procedure 43(c)(2), Kathleen Sebelius is substituted for Mike Leavitt as defendant-appellee.

Appeal from an award of summary judgment in favor of defendants on plaintiff’s challenge to State Medicaid Manual section 3259.7, an informal rule issued by the United States Department of Health and Human Services’ Centers for Medicare and Medicaid Services, which provides that income placed in a Special Needs Trust be considered in determining the extent of benefits to which a Medicaid-eligible person is entitled. We reject plaintiff’s argument that section 3259.7 conflicts with the plain language of 42 U.S.C. § 1396p(d), and we accord Skidmore deference to the enforcing agency’s issuance of section 3259.7 as a reasonable exercise of discretion to fill a gap in the statute on an issue about which Congress failed to express clearly its intent. We also reject plaintiff’s procedural challenge to 42 C.F.R. § 435.832 as time-barred.

A FFIRMED.

A YTAN Y EHOSHUA B ELLIN, White Plains, New York (Rene H. Reixach, Jr., Rochester, New York, on the brief), for Plaintiff-Appellant.

C AROLINA A. F ORNOS, Assistant United States Attorney (Elizabeth Wolstein, Assistant U.S. Attorney, on the brief), for Lev Dassin, Acting United States Attorney for the Southern District of New York, for Defendant-Appellee Kathleen Sebelius, Secretary, United States Department of Health and Human Services.

C AROL F ISCHER, Assistant Solicitor General (Michael Belohlavek, Senior Counsel, Division of Appeals & Opinions, on the brief), for Andrew M.

Cuomo, Attorney General of the State of New York, for Defendant-Appellee Richard F. Daines, M.D., Commissioner, New York State Department of Health.

J ANET Z. Z ALEON (Kristen M. Helmers and Marilyn Richter, on the brief), for Michael A. Cardozo, Corporation Counsel of the City of New York, for Defendant-Appellee Robert Doar, Commissioner, New York City Human Resources Administration.

R EENA R AGGI, Circuit Judge:

Plaintiff Sai Kwan Wong is a permanently disabled Medicaid recipient who resides in a nursing home. Through his guardian, Wong appeals an award of summary judgment in favor of the named city, state, and federal defendants, which was entered in the United States District Court for the Southern District of New York (Miriam Goldman Cedarbaum, Judge) on September 29, 2009. Wong asserts that the district court erred in rejecting his challenge to State Medicaid Manual (“SMM”) section 3259.7 (“section 3259.7” or “SMM 3259.7”), an informal rule issued by the Department of Health and Human Services’ (“HHS”) Centers for Medicare and Medicaid Services (“CMS”).2 SMM 3259.7 requires that, for purposes of determining the benefits due a Medicaid-eligible individual, states consider income placed in a Special Needs Trust for that individual’s benefit. See 42 U.S.C. § 1396p(d)(4)(A) (defining Special Needs Trust). The rule effectively prevents Medicaid recipients such as Wong from using Special Needs Trusts to shelter their monthly Social Security Disability Insurance (“SSDI”) income from certain Medicaid eligibility determinations. Wong asserts that the district court erred in accepting defendants’ reliance on SMM 3259.7 in calculating

2 In this opinion HHS and CMS are collectively referred to as “the agency.”

his benefits because the rule conflicts with the express language of 42 U.S.C. § 1396p(d), the provision of the Medicaid Act that sets forth Medicaid eligibility rules for trusts created with an individual’s assets.

We reject Wong’s reading of § 1396p(d) and instead conclude that Congress did not speak to the question presented by Wong’s claim. We apply Skidmore deference to SMM 3259.7, which was issued by the agency to fill the gap left by Congress. See Skidmore v. Swift & Co., 323 U.S. 134, 140 (1944) (holding that an agency’s “rulings, interpretations and opinions” of an act administered by the agency, “while not controlling upon the courts by reason of their authority, do constitute a body of experience and informed judgment to which courts and litigants may properly resort for guidance”). We conclude that SMM 3259.7 is an appropriate exercise of the agency’s authority and we therefore affirm the district court’s grant of summary judgment to defendants. I. Background A. Statutory Background Medicaid provides “joint federal and state funding of medical care for individuals who cannot afford to pay their own medical costs.” Arkansas Dep’t of Health & Human Servs. v. Ahlborn, 547 U.S. 268, 275 (2006); see also Rabin v. Wilson-Coker, 362 F.3d 190, 192 (2d Cir. 2004). At the federal level, Congress has entrusted the Secretary of HHS with administering Medicaid, and the Secretary, in turn, exercises that delegated authority through the CMS. See 42 U.S.C. §§ 1301(a)(6), 1396-1; Arkansas Dept. of Health & Human Servs.

v. Ahlborn, 547 U.S. at 275; Rabin v. Wilson-Coker, 362 F.3d at 192. In New York State, Medicaid is administered by the State Department of Health. See Rubin v. Garvin, 544 F.3d 461, 463 (2d Cir. 2008). At the local level, Wong’s Medicaid needs are addressed by a social services district operated by the New York City Human Resources Administration. See Reynolds v. Giuliani, 506 F.3d 183, 187 (2d Cir. 2007).

For a state to receive federal funding for its Medicaid program, CMS must determine that the state’s plan for granting assistance complies with the requirements of the Medicaid Act and its implementing regulations. See 42 U.S.C. § 1396a(a); Rabin v. Wilson-Coker, 362 F.3d at 192 (citing Wisconsin Dep’t of Health & Family Servs. v. Blumer, 534 U.S. 473, 479 (2002)). To comply with the Act, a state’s plan must include, inter alia, “reasonable standards . . . for determining eligibility for and the extent of medical assistance under the plan.” 42 U.S.C. § 1396a(a)(17). Section 1396a(a)(17) thus requires a state to make two separate determinations: (1) whether an individual is “eligib[le] for” Medicaid and, if so, (2) the “extent of” benefits to which he is entitled. Id. Both determinations are informed by an individual’s available “income” and “resources,” “as determined in accordance with standards prescribed by the Secretary.” Id. § 1396a(a)(17)(B); Himes v. Shalala, 999 F.2d 684, 686 (2d Cir. 1993); see also 42 U.S.C. § 1382a (defining income); id. § 1382b (defining resources).

The parties do not dispute that the first determination was properly made in Wong’s favor, i.e., he is eligible for Medicaid assistance. The sole issue on this appeal relates to the

second determination — referred to in the regulations and throughout this opinion as a “post- eligibility” determination. See, e.g., 42 C.F.R. § 435.832. Specifically, Wong submits that defendants erred as a matter of law when, in calculating his Medicaid benefits, they treated as income the monthly SSDI benefits that he places into a Special Needs Trust. To facilitate our discussion of this argument, we first review the statutory and regulatory provisions governing the post-eligibility treatment of income generally and of income placed in trusts specifically.

Free access — add to your briefcase to read the full text and ask questions with AI

Wong v. Doar, (2d Cir. 2009).

Wong v. Doar (Wong v. Doar) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

United States v. Connolly
552 F.3d 86 (Second Circuit, 2008)
S.D. Ex Rel. Dickson v. Hood
391 F.3d 581 (Fifth Circuit, 2004)
Skidmore v. Swift & Co.
323 U.S. 134 (Supreme Court, 1944)
Juidice v. Vail
430 U.S. 327 (Supreme Court, 1977)
Schweiker v. Gray Panthers
453 U.S. 34 (Supreme Court, 1981)
North Haven Board of Education v. Bell
456 U.S. 512 (Supreme Court, 1982)
Lowe v. Securities & Exchange Commission
472 U.S. 181 (Supreme Court, 1985)
Public Employees Retirement System of Ohio v. Betts
492 U.S. 158 (Supreme Court, 1989)
Lujan v. Defenders of Wildlife
504 U.S. 555 (Supreme Court, 1992)
Thomas Jefferson University v. Shalala
512 U.S. 504 (Supreme Court, 1994)
Blessing v. Freestone
520 U.S. 329 (Supreme Court, 1997)
Metropolitan Stevedore Co. v. Rambo
521 U.S. 121 (Supreme Court, 1997)
United States v. Mead Corp.
533 U.S. 218 (Supreme Court, 2001)
Nixon v. Missouri Municipal League
541 U.S. 125 (Supreme Court, 2004)
Central Virginia Community College v. Katz
546 U.S. 356 (Supreme Court, 2006)