In determining the Medicaid eligibility of a disabled applicant who is over age 65, New York State must disregard that portion of the applicant's income needed to meet the needs of his dependent, non-disabled wife.
Raymond Marzec, 67, applied for Medicaid after a brief hospitalization in October 1996. At the time his monthly income was $717. Because his wife was not 65, blind or disabled and had no income of her own, the Erie County Department of Social Services treated the household as a one-person household for eligibility purposes. The Department then disregarded only the first $20 of Mr. Marzec''s income pursuant to regulations, determing that the remainder of his income was available to be considered for Medicaid eligibility purposes. Mr. Marzec brought an action contending that a state regulaton requires the Department to also disregard that portion of his income necessary to meet the needs of his dependent wife. The pertinent regulation provides an income disregard for "MA applicants/recipients who are 65 years of age or older, certified blind or certified disabled" (18 NYCRR 360-4.6[a][2] ). This disregard is to be applied to "an amount of income determined in accordance with Federal guidelines to meet the needs of dependent family members who live with the applicant/recipient and who are not certified blind or certified disabled" (18 NYCRR 360-4.6[a][2][i] ).
The Commissioners of New York State Departments of Health and Social Services countered that Mr. Marzec is not entitled to an income disregard for the needs of his wife because her status had already been considered in determining household size for Medicaid eligibility. They further argued that there are no federal guidelines that permit a disregard for the needs of a dependent spouse who is not 65, blind or disabled. The state Supreme Court disagreed, concluding that the regulation plainly provides for an income disregard for a dependent spouse, and granted Mr. Marzec class action certification.
The Appellate Division sides with the lower court, ruling that the Commissioners'' interpretation violates the plain language of the regulation. The court concludes that the Commissioners'' focus on the method for determining the amount of the disregard (i.e., "in accordance with Federal guidelines"), "deprives petitioner of the benefit of the disregard. That interpretation renders the plain language of the regulation meaningless."
Subscribe to the Knowledge Bank.
