The opinion of the court was delivered by: JOHN T. CURTIN
Plaintiff Jodi Perry brings suit on behalf of herself and all similarly situated persons against defendant Michael Dowling, individually and in his capacity as Commissioner of the New York State Department of Social Services, and defendant Joan Sinclair, individually and in her capacity as Commissioner of the Allegany County Department of Social Services ("DSS"). Plaintiff claims that the defendants violated 42 U.S.C. § 1396k(a)(1) and her Fourteenth Amendment right to due process by conditioning her receipt of Medicaid benefits after the birth of her child, Thomas English III, on her willingness to cooperate with the agencies in recouping the costs of the pregnancy-related medical services from the child's father, Thomas English, Jr. Perry now moves for class certification and summary judgment, seeking declaratory and injunctive relief.
Defendants Dowling and Sinclair initially moved for partial dismissal on the pleadings. After conducting a limited amount of discovery, the defendants filed a cross-motion for summary judgment on both causes of action. They claim that the legislative intent of Congress in exempting women such as the plaintiff from the cooperation requirement extends only to the time of pregnancy and 60 days postpartum. Since the plaintiff was not asked to cooperate in securing payment from Mr. English until she sought to continue Medicaid coverage for herself and her child after the 60-day postpartum period, no federal statutory, regulatory, or due process violation occurred.
In 1986, Congress expanded Medicaid coverage of pregnancy-related medical care to low-income women who did not otherwise qualify for Medicaid. Women during pregnancy and the 60-day postpartum period who are not eligible under any other Medicaid program and whose income is up to 133 percent of the federal poverty level or, at the State's option, up to 185 percent of the federal poverty level, can apply for limited prenatal and postpartum health care services. 42 U.S.C. §§ 1396a(l)(1)&(2); 1396a(a)(10)(A)(i)(IV). New York State has exercised the option to provide for coverage up to 185 percent of the federal poverty level.
Medical coverage in this program is different from that offered by conventional Medicaid, in that it is limited to prenatal, delivery, postpartum care, and family-planning services. 42 U.S.C. § 1396a(a)(10). There is no coverage for other kinds of medical care not related to pregnancy or childbirth. However, households which continue to meet the eligibility standards under the Act after the baby's birth may obtain continued health care under Medicaid's Infant Care Program until the infant is one year old. 42 U.S.C. § 1396a(l)(1)(B).
For conventional Medicaid coverage, eligible applicants must cooperate with the State Medicaid agency to obtain financial support from third parties who may be legally responsible to support them. Until 1990, applicants could be exempted from this requirement only "[if] the individual is found to have good cause for refusing to cooperate . . . ." 42 U.S.C. § 1396k(a)(1)(B) (1986). However, in 1990, Congress amended § 1396k to add another exemption to the "good-cause" exception. Recognizing that the cooperation requirement created a barrier for some pregnant women who seek prenatal care, Congress decided to exempt women who receive only the limited pregnancy-related medical care coverage, as described in § 1396a(a)(10)(A)(i)(IV). 42 U.S.C. § 1396k(a)(1)(B) (1990).
In October 1991, Jodi Perry applied for Medicaid benefits to cover the costs of her pregnancy-related medical care. She was told she was ineligible for comprehensive Medicaid coverage because of her income level, but could receive pregnancy-related benefits for the duration of her pregnancy, including 60 days postpartum.
After her baby was born, Perry sought and received "recertification" of Medicaid benefits for herself and Thomas III. She alleges that she was told at the time that the only way she could receive coverage was to sign over her right to third party funds and to agree to cooperate with DSS in securing such funds from the baby's father. Perry agreed to these conditions. DSS then commenced child support proceedings against Thomas English, Jr. It filed a modification petition which requested that English pay not only for Medicaid reimbursements made on behalf of Perry and Thomas III after the postpartum period, but also for Perry's pregnancy-related benefits.
I. Interpretation of Section 1396k(a)(1)
The facts are not in dispute for the purposes of plaintiff's first cause of action. Rather, the parties argue over the interpretation of statute.
Section 1396k(a)(1) states that a State medicaid plan must require an individual, as a condition of eligibility for medical assistance:
(A) to assign the State any rights, of the individual or of any other person who is eligible for medical assistance under this subchapter and on whose behalf the individual has the legal authority to execute an assignment of such rights, to support (specified as support for the purpose of medical care by a court or administrative order) and to payment for medical care from any third party;
(B) to cooperate with the State (i) in establishing the paternity of such person (referred to in subparagraph (A)) if the person is a child born out of wedlock, and (ii) in obtaining support and payments (described in subparagraph (A)) for himself and for such person, unless (in either case) the individual is described in section 1396a(l)(1)(A) of this title or the individual is found to have good cause for refusing to cooperate as determined by the State agency . . .; and
(C) to cooperate with the State in identifying, and providing information to assist the State in pursuing, any third party who may be liable to pay for care and services available under the plan, unless such individual has good cause for refusing to cooperate as determined by the State agency . . . .
The parties agree that the plaintiff was an individual described in § 1396a(l)(1)(A), which covers "women during pregnancy (and during the 60-day period beginning on the last day of the pregnancy)," when she applied for and began receiving benefits. They further agree that the plaintiff has ...