In the Matter of Raymond Marzec,
&c.,
Respondent,
v.
Barbara A. DeBuono, as
Commissioner of New York State
Department of Health, et al.,
Appellants,
et al.,
Respondent.
2000 NY Int. 110
This opinion is uncorrected and subject to revision before
publication in the New York Reports.
The issue here is whether Medicaid regulations
governing eligibility for benefits authorized a reduction in the
applicant's income in an amount necessary to meet the needs of
his ineligible spouse. The Appellate Division answered in the
affirmative. For reasons stated in this Opinion, we now reverse.
On October 1, 1996, petitioner Raymond Marzec applied for Medicaid benefits to the Erie County Department of Social Services ("DSS"). At that time petitioner's gross income, derived solely from Social Security, was $717 per month. Thereafter, petitioner was hospitalized from October 8 until October 16, 1996 .
In November 1996, DSS notified petitioner that his hospitalization would be covered by Medicaid. DSS calculated petitioner's costs based on a six month period beginning October 1, 1996 and ending March 31, 1997 (see, 42 CFR [1]). After taking into account all available income and resources, DSS concluded that petitioner had excess income of $138 per month, which he was required to spend on medical expenses before Medicaid would pay his medical bills (see, 42 USC 1369[a][17]; 18 NYCRR 360-4.8[c][1]). Thus, DSS required petitioner to spend down a total of $828 (six months times $138) before receiving benefits, leaving him with $711 in medical bills. DSS determined further that 18 NYCRR 360-4.6 did not entitle petitioner to an "income disregard" -- a deduction in the amount of income and resources deemed available to the applicant -- for the care of his ineligible spouse.
Petitioner requested a hearing to review the
determination, arguing that inasmuch as his spouse was entirely
dependent upon him for financial support, DSS should have made a
dependent family member deduction from his income pursuant to 18
The procedure for determining Medicaid eligibility, set
out in 18 NYCRR 360-4.1, requires (1) a determination of the size
of a household, (2) a determination of all income and resources
The applicable regulation, 18 NYCRR 1), enumerates the disregards for all applicants and recipients of medical assistance. Subdivision 2 of that regulation itself explicitly requires that DSS and the Department of Health look to "Federal guidelines" in order to determine the amount of the income disregard, if any, to which petitioner is entitled, in order to meet the needs of certain family members (see 18 NYCRR 360-4.6[a][2][i]).
Significantly, there are no Federal guidelines
supporting the deduction petitioner seeks. Federal regulations
DSS determined that there should be no disregard for the support of petitioner's wife. An agency's interpretation of its regulations must be upheld unless the determination is "irrational and unreasonable" (Seittelman v Sabol, , 91 NY2d 618, 625; Matter of Cortlandt Nursing Care Center v Whalen, , 46 NY2d 979, 980; Matter of Sigety v Ingraham, , 29 NY2d 110, 114). Appellants' interpretation of the regulation is not irrational or unreasonable and should be sustained.
Given this disposition, we need not and do not reach the question of class action certification.
Accordingly, the order of the Appellate Division should be reversed, without costs, and the petition dismissed.
1 In the words of the regulation, 18 NYCRR 360-4.6: Not all of the income and resources available to an applicant/recipient is counted in determining his/her financial eligibility for MA [medical assistance]. Certain types and amounts of income and resources are disregarded. After these disregards have been applied, what remains is the applicant'/recipient' (sic) net available income and resources.