Case Information
*1 B е f o r e: WINTER, WALKER, and CABRANES, Circuit Judges. Appeal from a dismissal of a complaint by the United States District Court for the Eastern District of New York (Roslynn R. Mauskopf, Judge), on the alternative grounds that appellant lacked standing to bring, and failed to state, a claim that the Medicaid Act allows her to deduct guardianship fees from her Medicaid-required contributions to nursing home costs.
We hold that appellant has standing but failed to state a valid claim for relief. We therefore affirm.
JOSEPH P. GARLAND (Michael Korsinsky, on the brief), Korsinsky & Klein, LLP, Brooklyn, NY, for Plaintiff-Appellant. BETHANY A. DAVIS NOLL, Assistant Solicitor General (Barbara D. Underwood, Solicitor General, Anisha S. Dаsgupta, Deputy Solicitor General, on the brief), for Eric T. Schneiderman, Attorney General of the State of New York, New York, NY, for Defendant-Appellee.
WINTER, Circuit Judge:
Mindy Backer appeals from Judge Mauskopf’s Fed. R. Civ. P.
12(b)(1) and 12(b)(6) dismissal of her complaint alleging a Sеction 1983 violation. In that action, she claimed that the New York State Department of Health (“DOH”) violated the Medicaid Act, 42 U.S.C. § 1396 et seq. , when DOH determined that guardianship fees approved by a statе court could not be deducted from Backer’s Medicaid-required contributions to her nursing home costs. We conclude that Backer has standing but has nevertheless failed to state a valid Section 1983 claim. We therefore affirm.
BACKGROUND
Appellant is incapacitated and resides in a nursing home.
She receives Medicaid benefits. Medicaid covers part or all of
the costs of nursing home facility services for qualified
beneficiaries. 42 U.S.C. § 1396d(a)(4)(A). Such beneficiaries
are required to contribute their available income to the cost of
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their institutional care. See 42 U.S.C. § 1396a(q)(1)(A); see
also Wong v. Doar,
Under New York law, an incapacitated person is entitled to
have a guardian appointed to “act on [her] behalf . . . in
providing for personal neеds and/or for property management.”
N.Y. Mental Hygiene L. § 81.03(a). Pursuant to that law,
appellant’s sister, Gay Lee Freedman, was appointed by the New
York Supreme Court to be appellant’s guardiаn. The guardianship
order stated that the income appellant deposited in her
guardianship account would be considered unavailable income for
purposes of calculatiоn of her NAMI. See Matter of Freedman v.
Comm'r of State of New York Dep't of Health,
Relying on the terms of the guardianshiр order, Freedman challenged DOH’s decision in state court, but the court upheld DOH’s decision on the ground that it had a rational basis. Id. The court also noted that New York’s Medicaid regulations did not authorizе the deduction of guardianship fees and expenses from the amount required to be contributed toward nursing home costs. Id.
While her state court challenge was pending, Freedman filed the present аction, including a putative class action, in the Eastern District. The complaint sought declaratory and injunctive relief pursuant to 42 U.S.C. § 1983, alleging that DOH violated the Medicaid Act, 42 U.S.C. §§ 1396a(a)(19), 1396a(q)(1), 1396d, by refusing to deduct guаrdianship expenses from required Medicaid contributions. Backer alleged she was “being damaged because of the failure of DOH to permit the deduction of the guardianship fees from her avаilable assets.”
DOH successfully moved to dismiss the action. The district
court held that appellant lacked constitutional standing to bring
the claim, noting that the complaint “failed to allege any injury
‘fairly traсeable’ to defendant’s conduct or the provisions of
the Medicaid Act. Any financial liabilities plaintiff[] [has]
incur[red] as a result of not paying the NAMI [were] a result of
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an independent economiс choice to pay [the] guardian[] instead.”
Williams ex rel. United Guardianship Servs. v. Shah, No.
12-CV-3953 (RRM) (RML),
DISCUSSION
We review de novo a district court’s grant of a motion to dismiss (i) for lack of standing, and (ii) for failure to state a claim upon which relief can be granted. Rothstein v. UBS AG, 708 F.3d 82, 90 (2d Cir. 2013).
a) Standing
Before reaching the merits, we must first determine whether
appellant had standing to bring her claim. See Shearson Lehman
Hutton, Inc. v. Wagoner,
The district court held that appellant lacked standing
because her alleged injury was “solely attributable” to her own
actiоn in paying her guardian instead of her nursing home costs.
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Williams,
DOH determined that appellant was obligated to make NAMI payments for the costs of her nursing home residency before рaying the guardianship fees. This determination caused appellant to have insufficient funds to pay her guardianship obligations. She was thus exposed to potential liability either for the nursing facility chаrges or for guardianship services.
An injury is “self-inflicted” so as to defeat standing only
if “the injury is so completely due to the plaintiff’s own fault
as to break the causal chain.” St. Pierre v. Dyer,
Therefore, we hold that appellant had standing to bring the action.
b) Section 1983
We now turn to the merits of appellant’s Section 1983 claim.
To obtain redress through Sеction 1983, “a plaintiff must assert
the violation of a federal
right
, not merely a violation of
federal
law
.” Blessing v. Freestone,
“Section 1983 is only a grant of a right of action; the
substantive right giving rise to the actiоn must come from
another source.” Singer v. Fulton Cnty. Sheriff,
119 (2d Cir. 1995). One alleged source of appellant’s Section
1983 claim is 42 U.S.C. § 1396a(a)(19), which requires state
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Medicaid plans to “provide such safeguards as may be necessary to
assure that eligibility for care and services under the plan will
be determined . . . in a manner consistent with simplicity of
administration and the best interests of the recipients.” We
have yet to address the issue, but various other circuits have
held that Section 1396a(a)(19) is too vague and amorphous to
create a Section 1983 private right of action. See, e.g.,
Bruggeman v. Blagojevich,
Section 1396a(a)(19)’s direction to provide safeguards so that the determination of Medicaid eligibility will be consistent with both “simplicity of administration” and “the best interests of . . . recipients” provides no workable standard for judicial decision making. The terms used are amorphous and in some circumstances inconsistent, requiring an experimental balancing of perceived costs and benefits in a vast number of forseen and unforseen situations. Recognition of a private right of action to enforce such terms would truly strain judicial competence to a breаking point.
The only other source of a Section 1983 claim relied upon by appellant is 42 U.S.C. § 1396a(q)(1)(A), which requires state Medicaid plans to deduct a “monthly personal needs allowance -- (i) which is rеasonable in amount for clothing and other personal needs of the individual (or couple) while in an institution, and (ii) which is not less [than $30 for an institutionalized individual].” Id.; see also id. § 1396a(q)(2).
The language of this provision indicates that it is limited
to payment for comfort items, such as clothes, that are “not
supplied by [an individual’s] institution.” H.R. Rep. No. 92-231
at 150 (1971), reprinted in 1972 U.S.C.C.A.N. 4989, 5136.
Indeed, the paltry minimum sum allowed for such comfort items
could not havе been designed to encompass potentially high
guardianship fees. See Wong,
Appellant therefore has not stated a Section 1983 claim based on either Section 1396a(q)(19) or 1396a(q)(1)(A).
CONCLUSION
For the reasons stated, we affirm the dismissal pursuant to Rule 12(b)(6).