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DELUCA v. HAMMONS

June 7, 1996

FRANCES DeLUCA, IDA ROZENBERG PERCELL HICKS, PERCY BRIENZA, SEYMOUR YELOVICH, DAVID BORINSKY, BERTHA GOLDMAN, MARIA RIVERA, SYLVIA COHEN, ADELINA PONCE, and JEAN FREEDMAN, on behalf of themselves and all others similarly situated, --and-- BEN KAPLAN, MARY MEYERS, and ANNA D'ONOFRIO, on behalf of themselves and all others similarly situated, Plaintiffs, against MARVA LIVINGSTON HAMMONS, as Commissioner of the New York City Department of Social Services; and BRIAN J. WING, as Acting Commissioner of the New York State Department of Social Services, Defendants.


The opinion of the court was delivered by: MCKENNA

 McKENNA, D.J.

 I. Introduction

 This action is brought by Plaintiffs to challenge the legality of N.Y. Comp. Codes R. & Regs. tit. 18, ("18 N.Y.C.R.R.), § 505.14 (a)(6)(ii)(b) ("the Initial Cap Regulation"), a New York state regulation that limits the number of home-care attendant hours that can be allocated to Medicaid recipients who are initial applicants for home care. *fn1" The Plaintiffs, some of whom are subject to the Regulation, *fn2" are elderly and infirm residents of New York City who require personal care services for more than four hours per day (28 hours per week). Plaintiffs ask this Court to find the Initial Cap Regulation in violation of federal law and to enjoin permanently its application. *fn3"

 The regulation under review is applied by Defendants Marva Livingston Hammons, Commissioner of the New York City Department of Social Services, ("the City" or "HRA"), and overseen by Brian J. Wing, Acting Commissioner of the New York State Department of Social Services ("the State" or "DSS"). The State, but not the City, opposes Plaintiffs' motion regarding this regulation.

 The Court has jurisdiction over this dispute pursuant to 28 U.S.C. § 1331, granting original jurisdiction over all civil matters arising under the Constitution, laws, or treaties of the United States.

 II. Standard of Review

 The determination of whether the Initial Cap Regulation violates federal law is an "issue of law, subject to de novo review in federal court." Turner v. Perales, 869 F.2d 140, 141 (2d Cir. 1989). A state agency's interpretation of federal law requirements is not entitled to the same deference that would be accorded to a federal agency's interpretation. Id. (distinguishing "arbitrary and capricious" standard of review, see Chevron U.S.A., Inc. v. Natural Resources Defense Council, Inc., 467 U.S. 837, 843-44, 81 L. Ed. 2d 694, 104 S. Ct. 2778 (1984), which applies to federal agency interpretations of federal law, from standard of review appropriate for state agency interpretations of federal law). "In passing on the validity of a state Medicaid plan under federal law, the court must determine whether the plan is procedurally and substantively in compliance with the requirements of the Federal Medicaid Act and its implementing regulations." AMISUB (PSL), Inc. v. Colorado Dep't of Social Servs., 879 F.2d 789, 795 (10th Cir. 1989), cert. denied, 496 U.S. 935, 110 L. Ed. 2d 660, 110 S. Ct. 3212 (1990).

 III. Federal Medicaid Law Requirements

 Title XIX of the Social Security Act of 1965, 42 U.S.C. §§ 1396 et seq., ("the Medicaid Act"), establishes a joint federal-state funding program that provides medical assistance to persons whose income and resources are insufficient to meet the costs of medical care. The Federal Government approves a state plan for the funding of medical services for the needy and then subsidizes a significant portion of the financial obligations the State has agreed to assume. A state's participation is voluntary, but once a state chooses to participate in the program, it must comply with federal statutory and regulatory requirements. See Alexander v. Choate, 469 U.S. 287, 289 n.1, 83 L. Ed. 2d 661, 105 S. Ct. 712 (1985); 42 U.S.C. § 1396a.

 Federal Medicaid law sets minimum standards for the scope of services provided by a state, including services provided at the state's option such as personal care services. See Weaver v. Reagen, 886 F.2d 194, 197 (8th Cir. 1989). Since 1973, New York State has opted to provide personal care services as an integral component of its Medicaid program. See New York Soc. Serv. Law § 365-a(2)(e); 18 N.Y.C.R.R. § 505.14; Hallock Aff., pp. 2-3. A state has considerable, but not unbridled, discretion in fashioning its Medicaid program: "[A state] may not arbitrarily deny or reduce the amount, duration, or scope of a required service to an otherwise eligible recipient solely because of the diagnosis, type of illness or condition." 42 C.F.R. § 440.230(c). However, a state may place "appropriate limits on a service based on such criteria as medical necessity or utilization control procedures." 42 C.F.R. 440.230(d). A state's plan for determining eligibility for medical assistance must be "'reasonable' and 'consistent with the objectives' of the Act." Beal v. Doe, 432 U.S. 438, 53 L. Ed. 2d 464, 97 S. Ct. 2366 (1977) (quoting 42 U.S.C. § 1396a(a)(17)).

 IV. The Challenged Regulation

 The challenged regulation, 18 N.Y.C.R.R. § 505.14 (a)(6)(ii)(b), reads in relevant part:

 
The initial authorization for Level II [personal care home attendant] services shall not exceed four hours per day or 28 hours per week. ...

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