Backer Ex Rel. Freedman v. Shah, 788 F.3d 341

Appellant Mindy Backer, incapacitated, resides in a NY nursing home and receives Medicaid benefits.
Guardian Gay Lee Freedman was appointed by NY courts to manage Backer’s personal and/or property needs; the guardian’s income would be treated as unavailable income for NAMI calculations.
DOH determined that guardianship fees could not be deducted from Backer’s NAMI, requiring payment of about $1,800 per month from available funds.
Backer challenged DOH’s decision in state court; the outcome noted a lack of statutory authorization for deduction of guardianship fees.
Backer filed a putative class action under 42 U.S.C. § 1983 alleging DOH violated the Medicaid Act by refusing to deduct guardianship expenses; the district court dismissed for lack of standing and, alternatively, failure to state a claim.
The Court holds that Backer has standing but fails to state a valid § 1983 claim, affirming the dismissal.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether Backer has standing to sue.	Backer’s injury was caused by DOH’s rule, not solely by her own actions.	DOH’s ruling did not create an injury traceable to the defendant.	Backer has standing to sue.
Whether § 1983 claims based on 1396a(a)(19) or 1396a(q)(1)(A) create a private right of action.	§ 1396a(a)(19) or § 1396a(q)(1)(A) confer federal rights enforceable under § 1983.	Those provisions are too vague or narrow to create a private right of action.	No private right of action under either provision.
Whether DOH was unambiguously obligated to deduct guardianship fees from NAMI under § 1396a(q)(1)(A).	The guardianship fees should be deductible as part of personal needs.	The statute’s provision is limited to basic needs and does not authorize such deductions.	DOH was not obligated to permit deduction of guardianship fees.

Blessing v. Freestone, 520 U.S. 329 (1997) (private right of action requires a federal right and workable standard)
NextG Networks of NY, Inc. v. City of New York, 513 F.3d 49 (2d Cir. 2008) (factors for recognizing a statutory private right of action)
Singer v. Fulton Cnty. Sheriff, 63 F.3d 110 (2d Cir. 1995) (private rights depend on source of substantive right)
Wong v. Doar, 571 F.3d 247 (2d Cir. 2009) (NAMI and guardianship context; guardianship fees analyze under Medicaid)
Bruggeman v. Blagojevich, 324 F.3d 906 (7th Cir. 2003) (1396a(a)(19) considered too vague for private right of action)
Harris v. James, 127 F.3d 993 (11th Cir. 1997) (collects cases on vagueness of § 1396a(a)(19) private rights)
St. Pierre v. Dyer, 208 F.3d 394 (2d Cir. 2000) (injury must not be wholly self-inflicted to support standing)