MEMORANDUM, DECISION & ORDER
I. FACTUAL BACKGROUND
The Greenery Rehabilitation Group, Inc. ("the Greenery") specializes in the field of traumatic brain injury treatment and operates facilities in several states. The Greenery entered into an agreement with the New York City Human Resources Administration (HRA) which provided that the Greenery, with the approval of the New York State Department of Social Services (DSS), would admit into its specialized brain injury programs New York City residents who are in need of such services and who are eligible for Medicaid.
The Greenery admitted three New York City residents into its specialized brain injury programs who met the financial eligibility criteria, but for whom HRA has refused to pay. These three patients, Izeta Ugljanin, Yik Kan, and Leon Casimir, are aliens residing in the United States. Izeta Ugljanin, an immigrant from what is now the Republic of Macedonia residing in New York City, was thrown from a car in which she was riding and suffered severe injuries, including brain damage. Yik Kan, then a forty-six-year-old immigrant from Hong Kong legally residing in New York City, was beaten in Manhattan's Central Park in 1990 which resulted in severe injuries, including brain damage. And lastly, Leon Casimir, then a thirty-eight-year-old immigrant from Trinidad residing in New York City, was shot in the head in 1991. He also suffered serious brain damage. All three patients were initially taken to local hospitals in New York but were later transferred to Greenery facilities.
The Greenery alleges that all three patients had Medicaid numbers at the time of their admission.
Because of the high level of specialized care provided by the Greenery, the three named aliens could not be admitted without the prior approval of the New York State Department of Health (DOH). At trial, the issue of whether DOH did, in fact, approve the admission of these three aliens into the Greenery's specialized brain injury programs was litigated. Regardless, the Greenery has provided care to the three aliens, the cost of which, at the rates approved by the State of New York, amounted to $ 152,612.28, $ 213,916.10 and $ 181,604.76 respectively through November 30, 1992. The Greenery continues to provide such care today. Plaintiff Greenery now seeks a declaration which states that the care and services provided to the three aliens have been for the treatment of emergency medical conditions, thus entitling it to Medicaid reimbursement for the care provided.
II. STATUTORY BACKGROUND
Title XIX of the Social Security Act ("the Act") establishes a jointly funded, cooperative federal-state program known as Medicaid designed to enable each state to furnish medical assistance to eligible individuals. See Atkins v. Rivera, 477 U.S. 154, 156-57, 106 S. Ct. 2456, 2458, 91 L. Ed. 2d 131 (1986). The program, enacted in 1965, was established "for the purpose of providing federal financial assistance to States that choose to reimburse certain costs of medical treatment for needy persons." Schweiker v. Hogan, 457 U.S. 569, 571, 102 S. Ct. 2597, 2600, 73 L. Ed. 2d 227 (1982), quoting, Harris v. McRae, 448 U.S. 297, 301, 100 S. Ct. 2671, 2680, 65 L. Ed. 2d 784 (1980). If a state chooses to participate in the program, it must do so in accordance with the broad framework set by the federal government through the Act. If the state satisfies these requirements, it has wide discretion in administering its program "including the responsibility for determining the eligibility of recipients, enlisting medical service providers, and paying those providers for services rendered." DeGregorio v. O'Bannon, 500 F. Supp. 541, 545 (E.D.Pa. 1980).
New York State regulations provide that, in general, aliens lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law who meet Medicaid requirements are eligible to receive the full range of Medicaid benefits. N.Y. COMP. CODES R. & REGS. tit. 18, § 360-3.2(f). However, aliens who meet Medicaid program requirements but who are not lawfully admitted for permanent residence, or otherwise permanently residing in the United States under color of law, or who have not been granted lawful permanent resident status under the Federal Immigration Reform and Control Act of 1986, are not eligible to receive medical assistance unless the care and services are necessary for the treatment of an "emergency medical condition." N.Y. COMP. CODES R. & REGS. tit. 18, § 360-3.2(f)(2). The New York statutory language is substantially the same as the language of the Act. See 42 U.S.C. § 1396b(v).
It is the interpretation of the term "emergency medical condition" which is at the heart of the present litigation. The Greenery contends that the patients in question are receiving treatment for emergency medical conditions within the statutory and regulatory definitions. The State and City defendants contend otherwise and look to HHS for the correct interpretation of the section in question. HHS has argued unsuccessfully that it should not be part of this litigation at all.
The third-party plaintiffs allege that HHS' refusal to provide guidance to DSS resulted in the instant litigation. Prior to commencing this litigation, the Greenery's attorney contacted the State agency concerning the Greenery's claim that Medicaid should pay for the chronic care it was providing to the three patients in question. After receiving the inquiry, DSS referred the issue to HHS and requested that the federal agency evaluate the circumstances of the patients in question and give guidance concerning whether Medicaid should pay for their care. The third-party plaintiffs allege that HHS refused to give such guidance.
III. PROCEDURAL BACKGROUND
The State and City defendants removed the instant case to this Court and filed a third party complaint against defendant Shalala as the Secretary of the United States Department of Health and Human Services (HHS). HHS is the federal agency that administers the Medicaid program. The third party complaint asks that, should the Court determine that the state Medicaid program must pay for the cost of these patients' care (the finding sought in the initial complaint), the Court then determine that HHS must also bear part of that cost pursuant to federal statutes which provide that Medicaid costs are to be divided among the federal, state, and city governments. See 42 U.S.C. §§ 1396a, 1396b. After numerous motions from the parties, the court conducted a bench trial on the remaining issues on April 13, 1995. Only two issues remained at trial:
1. Did the Greenery receive the prior consent required by New York State Medicaid for the three patients in question in regard to their admission to Greenery facilities?
2. Has the Greenery provided emergency medical care to these patients within the meaning of the statute and corresponding regulations?