Medicaid recipients are not entitled to have guardianship fees deducted from their income for the purposes of determining the amount of income available to pay the nursing home, a U.S. district court has ruled. Williams v. Shah (E.D.N.Y., No. 12–CV–3953 (RRM)(RML), March 30, 2014).
Medicaid recipients in New York who live in nursing homes and whose income exceeds the thresholds are required to contribute to their care. The state deducts certain expenses – including a personal needs allowance -- from their income in order to calculate their net available monthly income (NAMI). The NAMI is the amount the recipient is required to pay toward the cost of care.
A group of Medicaid recipients who have guardians filed a class action against the state, arguing that guardianship-related fees and expenses should be deducted from their income when calculating the NAMI. The recipients contended that the funds used to pay the guardians must be drawn from assets allocated to the NAMI, which causes the recipients to incur potential liability for nursing home charges. The state filed a motion to dismiss.
The U.S. District Court, Eastern District of New York, grants the motion to dismiss, ruling that the recipients lack standing and even if they had standing, guardianship expenses are not a part of the personal needs allowance. According to the court, the recipients have not shown they were injured by the state because "any financial liabilities plaintiffs may incur as a result of not paying the NAMI are the result of an independent economic choice to pay their guardians instead, an obligation that is neither imposed by, nor attributable to, the Medicaid Act, the state's implementing regulations, or any other provision of federal law."
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