4 No. 102
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
October 24, 2000
This opinion is uncorrected and subject to revision before publication
in the New York Reports.
Victor Paladino, for appellants.
Anthony Szczygiel, for respondent Marzec.
_________________________________________________________________
SMITH, J.:
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
SNIPPETS:
Victor Paladino, for appellants.
The issue here is whether Medicaid regulations governing eligibility for benefits authorized
On October 1, 1996, petitioner Raymond Marzec applied for Medicaid benefits to the Erie
DSS calculated petitioner's costs based on a six month period beginning October 1, 1996 and
DSS determined further that 18 NYCRR 360-4.6 did not entitle petitioner to an "income
Petitioner requested a hearing to review the determination, arguing that inasmuch as his
At the hearing, the Administrative Law Judge disagreed, concluding the calculations were in
The Commissioner of Health upheld that determination.
Concluding that the administrative determination was "unreasonable and irrational," Supreme
Under 18 NYCRR 360-4.6, a Medicaid applicant is allowed a disregard, for the "amount of
Petitioner contends that this regulation authorizes an income disregard of an amount
Appellants, the Commissioner of Health and DSS Commissioner, argue that there should be no
There is no dispute that petitioner is considered a one person household for purposes of the
The absence of such a disregard is consistent with the efforts to assist only those who are
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