Matter of J.T.
Annotate this CaseDecided on December 16, 2013
Supreme Court, Bronx County
In the Matter of the Application for the Appointment of a Guardian for J.T., A Person Alleged To Be Incapacitated.
916XX/13
Counsel: Laura E. Remick, Esq., Of Counsel to Roy A. Esnard, Esq., Special Corporation Counsel to Michael A. Cardozo, Esq., Corporation Counsel of the City of New York.
Alexander W. Hunter Jr., J.
The application of the Commissioner of the New York City Human Resources Administration ("HRA") by order to show cause, to vacate a portion of the Order and Judgment Appointing a Guardian for J.T., dated July 23, 2013 (the "Order and Judgment"), is granted.
On or about January 29, 2013, petitioner Rebekah Rehab and Extended Care Center ("Rebekah Rehab") commenced a proceeding for the appointment of guardian of the person and property of J.T. The petition was granted and this court appointed Mr. T.'s daughters, M.C. and A.T., as the co-guardians of the person and Bronx Community Guardianship Network ("BCGN") as the guardian of the property.
The Order and Judgment reads in pertinent part as follows: "ORDERED AND ADJUDGED, that the Guardian of the Property shall be compensated $450.00 per month, which sum shall be deducted from the Incapacitated Person's income, and shall be deemed excluded from the Incapacitated Person's income for purposes of Medicaid calculation of Net Available Monthly Income (NAMI), because such an expenditure for the administrative costs of this proceeding is necessary to insure the medical and physical well-being of the Incapacitated Person."
HRA seeks to vacate the portion of the Order and Judgment directing the compensation of the guardian of the property to be deemed excluded from the calculation of NAMI on the ground that as the local social services district, HRA has the sole authority to determine Medicaid eligibility pursuant to Social Services Law §§ 34, 366 and Matter of Deanna W. (Rosenblut), 76 AD3d 1096 (2nd Dept. 2010). In Matter of Deanna W. (Rosenblut), the Second Department held that the lower court exceeded its authority by directing the Nassau County Department of Social Services ("NCDSS") to disregard certain sums used to pay expenses associated with the guardianship when calculating NAMI for Deanna W. The Second [*2]Department further determined that the interpretation of the Medicaid eligibility regulations by NCDSS was reasonable and entitled to deference.
According to HRA policy, incapacitated individuals who only have assignable income, e.g., Social Security benefits, are not entitled to a deduction for ongoing guardianship fees since their income can be assigned directly to the nursing home. As such, HRA argues that a guardian is not necessary to ensure that the income of the incapacitated person is available to pay for ongoing care at the nursing home. For incapacitated individuals with non-assignable income, e.g., a pension or an annuity, a guardian would be required to access the income and make it available for NAMI payments for the cost of their care. In those cases, HRA may exclude such guardianship fees from the calculation of NAMI. HRA also asserts that the local social services agency may deduct fees associated with establishing the guardianship from the incapacitated person's NAMI if that individual lacks the resources to pay such fees.
Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., was enacted for the purpose of providing necessary health care to the elderly, indigent, and disabled. S. Rep. No. 89-404 1965. The federal statute grants participating states with broad discretion to determine reasonable income eligibility standards so long as they are consistent with the objectives of the Social Security Act. 42 U.S.C. § 1396a(a)(17). The Medicaid program is implemented in this state under Article 5, Title 11 of the Social Services Law and 18 NYCRR 360-4. The New York State Department of Health ("NYSDOH") replaced the former New York State Department of Social Services ("NYSDSS") as the agency responsible for administering the Medicaid program, effective October 1, 1996. See, L. 1996, ch. 474 §§ 233-248. Social Services Law § 364(2)(g) provides that "[t]he department of health shall be responsible for establishing the standards of eligibility for medical assistance, consistent with the provisions of this title." Social Services Law § 364(1)(a) provides that "[t]he department of social services shall be responsible for determining eligibility for care and services pursuant to this title and consistent with standards established by the commissioner of the department of health and, as authorized by such commissioner, for hearing appeals and making findings and recommendations relating thereto."
In sum, the NYSDOH is the agency responsible for the administration of the Medicaid program in accordance with federal mandates. In furtherance of those duties, NYSDOH supervises the local social services districts in each county. See, Jennings v. Commissioner, NYS Department of Health, 71 AD3d 98 (2nd Dept. 2010).
NAMI equals the recipient's monthly income less certain deductions or disregards. See, Matter of New York Assn. of Homes & Servs. for the Aging, Inc. v. Novello, 13 AD3d 958 (3rd Dept. 2004).Nursing home residents are subject to chronic care budgeting and "all income must be applied toward the cost of care in the facility, including income disregarded or considered unavailable for the purpose of determining [Medical Assistance] eligibility." 18 NYCRR 360-4.9. There are 29 types of income disregards which are not counted when calculating NAMI and Medicaid eligibility. 18 NYCRR 360-4.6.Guardianship fees are not included on this exhaustive list. However, 18 NYCRR 360-4.9(a)(4) mandates deductions "to [*3]cover any expenses incurred for medical care, services, supplies, or remedial care for the institutionalized individual not subject to payment under this Title or by a third party."
By clear and convincing evidence, this court determined that Mr. T. is incapacitated within the meaning of Mental Hygiene Law § 81.02(b). Thus, Mr. T. is incapable of, among other things, marshaling his assets and/or income. At the time of commencement of the guardianship proceeding, Mr. T. was not a Medicaid recipient. Rebekah Rehab filed a Medicaid application on his behalf to preserve the earliest possible Medicaid eligibility date. Due to his cognitive deficits and functional limitations, Mr. T. was unable to provide the necessary documentation and information to complete his Medicaid application. Without the assistance of the guardian of the property, Mr. T. would be unable to obtain and/or retain his Medicaid benefits. Without Medicaid, Mr. T. will not be able to cover the cost of the skilled nursing care and services he requires. The functional limitations of Mr. T. necessitate his continued stay at a skilled nursing facility. Therefore, this court finds that guardianship fees, including compensation for BCGN in the amount of $450.00 per month, are medical expenses because they are necessary for Mr. T. to access medical care.
Nonetheless, this court is constrained to follow the holding in Matter of Deanna W. (Rosenblut).This court is cognizant of the fact that an administrative agency's interpretation of the regulation it is charged with enforcing is entitled considerable deference. See, Golf v. New York State Dept. of Social Services, 91 NY2d 656 (1998); Matter of Gaines v. New York State Div. & Community Renewal, 90 NY2d 545 (1997); Howard v. Wyman, 28 NY2d 434 (1971); Curry v. Wing, 277 AD2d 37 (1st Dept. 2010). The Second Department based its decision upon giving considerable deference to the interpretation by NCDSS of its own regulations when determining that the lower court had exceeded its authority. However, this court notes that the regulations at issue herein and in Matter of Deanna W. (Rosenblut) were issued and promulgated by the NYSDSS and not the local social services district. As such, deference is to be given to the interpretation of the regulations by the NYSDOH. Although this court deems guardianship fees to be medical expenses pursuant to 18 NYCRR 360-4.9(a)(4), the NYSDOH is the agency vested with the authority to determine whether such fees are to be deducted from the calculation of NAMI for any given recipient. Holding otherwise and directing HRA and ultimately the NYSDOH to exclude certain sums from the calculation of NAMI would be in excess of this court's authority.
Accordingly, the application of HRA to vacate the portion of the Order and Judgment directing the compensation of $450.00 per month for the guardian of the property to be deemed excluded from the calculation of NAMI for J.T., is granted.
This court hereby amends the Order and Judgment Appointing a Guardian for J.T., dated July 23, 2013, to the extent that the Guardian of the Property shall be compensated $450.00 per month, which sum shall be deducted from the Incapacitated Person's income.
This constitutes the decision and order of this court.
[*4]
Dated: December 16, 2013
ENTER:
________________________
J.S.C.
Some case metadata and case summaries were written with the help of AI, which can produce inaccuracies. You should read the full case before relying on it for legal research purposes.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
