Calkins v. BlumCalkins v. Blum
MEMORANDUM — DECISION AND ORDER
The named plaintiffs, plaintiff-intervenors,
1
and absent proposed class members are aged, blind, or disabled adults, their spouses, and any dependent children. All named plaintiffs have sought medical assistance [medicaid] as medically needy persons. In this action for declaratory, injunctive, and monetary relief, the plaintiffs
2
aver,
inter alia,
that the defendants, administrators of the medicaid program for the State of New York, have determined the medicaid eligibility of medically needy persons in a manner different from, and less generous than, the methods used to compute the medicaid eligibility of categorically needy persons. This disparate treatment, the plaintiffs alleged, has violated certain provisions of the Social Security Act, various regulations promulgated by the Department of Health and Human Services [HHS],
3
the Equal Protection Clause of the Fourteenth Amendment, the Supremacy Clause, and
Presently before the Court are motions by the plaintiffs for class certifications and for summary judgment, and by the defendants for dismissal of the complaint and for cross-summary judgment.
I.
A.
Title XIX of the Social Security Act of 1965,
With respect to these requirements, the federal program distinguishes two groups of medicaid recipients. Pursuant to
The State of New York is one state that participates in the cooperative medicaid program.
See
N.Y.Soc.Serv.Law §§ 363-369. In this regard, the State of New York also operates under a state constitutional mandate to affirmatively aid the needy.
Since the commencement of this action, the State of New York has converted to a different medical assistance plan, effective August 29, 1980. Under the new “209b” plan, as set forth in
B.
At dispute in this action are the budgeting procedures used by the defendants in ascertaining the eligibility for and amount of, medical assistance for the medically needy.
For purposes of clarity, the plaintiffs fall into four groups. The first group of plaintiffs is comprised of several aged, blind, or disabled, SSI medically needy persons: Kenneth Calkins, a blind resident of Onondaga County; Gerald Makin, a disabled resident of Steuben County; Mary Toomey, a disabled resident of Monroe County; Curtis and Addie Williams, disabled residents of Orleans County; Jane Kliss, a disabled resident of Monroe County; Isahiah and Louise Floyd, disabled residents of Genesee County; and Connie Hodeker, a disabled resident of Monroe County. The second group of plaintiffs represent the spouses of these aged, blind, or disabled, SSI medically needy persons, who join this action because they bear the financial responsibility for the medical and non-medical care of their medically needy spouses: Martin E. Toomey, Sr., a resident of Monroe County; Alexander Kliss, a resident of Monroe County; and David Hodeker, a resident of Monroe County. The third group of plaintiffs includes individuals who reside with SSI medically needy persons and who are AFDC medically needy by virtue of their children’s deprivation of parental support, which stems from the disabilities of the parents: Yvonne Cal-kins, a resident of Onondaga County and a caretaker relative of two minor children; Curtis and Addie Williams, residents of Orleans County and caretaker relatives of three minor children; Isahiah and Louise Floyd, residents of Genesee County and caretaker relatives of one minor child; and Helen Makin, a resident of Steuben County and a caretaker relative of four minor children. The final group of plaintiffs consists of aged, blind, or disabled SSI medically needy persons who reside with AFDC medically needy persons, and who thus qualify as both SSI and AFDC medically needy: *1081 Kenneth Calkins, Gerald Makin, Curtis and Addie Williams, and Isahiah and Louise Floyd.
The defendants are administrators of the New York medicaid program. The defendant Blum, Commissioner of the New York State Department of Social Services, is the chief administrator of that Department, and is responsible for exercising general supervision over all local welfare authorities, pursuant to N.Y.Soc.Serv.Law § 34. The defendants Lascaris, Commissioner of the Onondaga County Department of Social Services; Curtis, Commissioner of the Steuben County Department of Social Services; Richardson, Commissioner of the Monroe County Department of Social Services; Klapper, Commissioner of the Orleans County Department of Social Services; and Crabb, Commissioner of the Genesee County Department of Social Services, are responsible for the general operations of their respective departments, pursuant to
Those plaintiffs who are aged, blind, or disabled, SSI medically needy, and those plaintiffs who are AFDC medically needy and reside with SSI medically needy persons, sought medical assistance from their local county departments of social services. In each case, these plaintiffs were informed that because of excess income, they or their spouses would have to incur varying amounts of medical expenses before satisfying the eligibility requirements of the medicaid program. None of the aged, blind, or disabled, SSI medically needy plaintiffs had the earned income of their spouses computed according to the income disregard provisions of the SSI program.
Cf:
After receiving their medicaid determinations from the county departments of social services, the plaintiffs sought and secured administrative fair hearings before the New York State Department of Social Services. The decisions after fair hearing affirmed the county determinations of each plaintiff’s medicaid eligibility.
Alleging no adequate remedy at law, the plaintiffs raise two basic claims before this Court in regard to the defendants pre-August 29, 1980 practices. Firstly, the plaintiffs who are SSI or AFDC medically needy, and the spouses of such persons, contend that, among other requirements under the federal medicaid program, the defendants should have evaluated the income of SSI medically needy persons on the basis of the SSI budgeting methodology, and the income of AFDC medically needy persons on the basis of the AFDC budgeting methodology —or, in short, that the defendants use comparable standards in computing the eligibility of categorically and medically needy persons. Secondly, the plaintiffs who are both SSI and AFDC medically needy maintain that, pursuant to
In regard to the post-conversion period, only one group of plaintiffs seeks injunctive *1082 relief in addition to declaratory judgment and monetary relief against these same allegedly unlawful practices: the plaintiffs who are AFDC medically needy and reside with SSI medically needy persons. These plaintiffs contend that under the “209b” plan their claims remain alive, and that, accordingly, they are entitled to relief. 6
Before addressing these claims, it is necessary to turn to various preliminary issues that the parties have raised.
II.
A.
The plaintiffs have alleged that jurisdiction over this action lies under
One argument raised by the defendants is that this Court should not assume jurisdiction over this case because it “would be to accept a federal court review power over almost every ruling of the [commissioners] in the day-to-day operations of the state welfare laws .. . . ”
McCall v. Shapiro,
In addition, the defendants argue that pursuant to the decision of the Second Circuit in
Andrews v. Maher,
In view of the
Chapman
decision, then, this Court concludes that in this action the Social Security Act and, by themselves, the Supremacy Clause and
The plaintiffs, however, have not argued that the Supremacy Clause and
In response to these arguments, the defendants maintain that the Equal Protection Claims lack substantiality because, in actuality, there is no disparity of treatment between the categorically and medically needy; because the defendants have merely followed the requirements under the federal statutes and regulations, and because the plaintiffs’ claims fall under a rational basis standard of review. Given the insubstantiality of the Equal Protection Claims, the defendants contend, this Court consequently lacks jurisdiction to consider the pendent statutory claims raised by the plaintiffs.
With respect to the arguments asserted by the parties, the Supreme Court catalogued the various tests for insubstantiality in its seminal decision in
Hagans v. Lavine,
“so attenuated and unsubstantial as to be absolutely devoid of merit,” . . .; “wholly insubstantial,” ...; “obviously frivolous,” ...; “plainly unsubstantial,” ...; or “no longer open to discussion: . ... Id. at 536-37,94 S.Ct. at 1378-79 (citations omitted)
“so insubstantial, implausible, foreclosed by prior decisions of this Court and otherwise completely devoid of merit as not to involve a federal controversy within the jurisdiction of the District Court, whatever may be the ultimate resolution of the federal issues on the merits.” Id. at 543,94 S.Ct. at 1382 (quoting Oneida Indian Nation v. County of Oneida,414 U.S. 661 , *1084 666-67,94 S.Ct. 772 , 777,39 L.Ed.2d 73 (1974)).
After examining the Equal Protection issues raised in
Hagans
in light of these tests, the Court found that it was not so “immediately obvious ... from the face of the complaint” that the challenged practices were “so patently rational as to require no meaningful consideration.”
Id.
at 541,
Applying the
Hagans
substantiality tests to the plaintiffs’ complaints, this Court similarly concludes that the allegations of disparate treatment between categorically and medically needy persons are not insubstantial.
See Greklek v. Toia,
Since jurisdiction exists under
The county defendants urge dismissal of the complaint under
C.
Several defendants allege, as a further ground for dismissal of the complaint for failure to state a claim, that the plaintiffs, in asserting a claim under
In this regard, it is now settled that a plaintiff need only allege two elements for recovery under
Here the plaintiffs have averred that the defendants have “refusefd] to determine the eligibility for and amount of medical assistance” for the SSI and AFDC medically needy in accordance with federal requirements, and have “refuse[d] to advise persons who are both SSI and AFDC medically needy of their alleged right to have their medicaid eligibility computed under the category of their choice, all in violation of various alleged constitutional and statutory rights enjoyed by the plaintiffs. Examining these challenges to the personal actions of the defendants, and accepting as true these claims that the defendants, in effect, knowingly and intentionally disregarded certain asserted federal rights of the plaintiffs, this Court finds that the plaintiffs have stated a claim for relief under
D.
The defense is also raised that the plaintiffs Gerald and Helen Makin are time-barred under
In making this argument, however, the defendants have plainly ignored the rule in this Circuit that the three year statute of limitations contained in
Finally, the defendants contend that this Court should invoke the doctrine of abstention, and refuse to entertain the action. In order to address properly the arguments raised by the defendants, it is useful to consider initially the Supreme Court’s decision in
Colorado River Conservation District v. United States,
Firstly,
abstention may be proper “ ‘in cases presenting a federal constitutional issue which might be mooted or presented in a different posture by a state court determination of pertinent state law.’ ”
Id.
[1] the state statute [must] be unclear or the issue of state law [must] be uncertain . . .; [2] the resolution of the federal issue [must] depend upon the interpretation to be given to the state law, . . . and ... [3] the state law [must] be susceptible of an interpretation that would avoid or modify the federal constitutional issue.
McRedmond v. Wilson,
With respect to the pre-August 29, 1980 period, these three conditions have not been met. First, here there is no state law claim, separate and distinct from the federal claims, that, “if resolved in favor of [these plaintiffs], ‘would make it wholly unnecessary to consider the [constitutional] claim[s].’ ”
Id.
at 484-85 (citation omitted). As the plaintiffs note, the State, as well as federal, statutory schemes mandate that state and county officials follow federal requirements in determining what income and resources to consider in the computation of medicaid eligibility.
See
N.Y.Soc. Serv.Law § 366(2)(b). Thus, the issues in this action rest upon
federal
statutory and regulatory law and the defendants’ interpretation thereof.
See Moore v. Sims,
With respect to the post-conversion claims of the AFDC medically needy plaintiffs who reside with SSI medically needy persons, the implementation of the “209(b)” plan has not completely displaced the paramount role of federal law in this area. Specifically, the conversion to a “209(b)” plan does not diminish the supremacy of federal law in the computation of medicaid eligibility for AFDC recipients.
See
42 C.R.F.
Secondly,
abstention may be proper in cases that present “difficult questions of state law bearing policy problems of substantial public import whose importance transcends the result in the case then at bar.”
Colorado River,
In the instant action, although the State has certainly adopted a regulatory scheme of incalculable importance to its people, the difficult questions of law involve primarily federal statutes and regulations, as interpreted by the defendants. Application of the Burford rule thus seems unwarranted.
Thirdly,
abstention may be appropriate if there is a pending state action.
Colorado River,
The defendants forcefully argue, however, that this Court should dismiss this action because the plaintiffs have not availed themselves of state judicial remedies. While not argued by the plaintiffs, clearly there is no exhaustion of state judicial remedies requirement under
Accordingly, this Court shall not dismiss any of the plaintiffs’ claims under the doctrine of abstention.
III.
The plaintiffs Kenneth and Yvonne Cal-kins, Gerald and Helen Makin, Martin and Mary Toomey, Sr., Curtis and Addie Williams, and Isahiah and Louise Floyd, individually and on behalf of their minor children residing with them, have moved to certify this suit as a class action under
All persons who are now or may in the future be recipients of or eligible for medicaid benefits for the medically needy in the State of New York who reside with their spouses and/or minor children and are aged, blind, or disabled; their spouses who reside with them; and their minor children who reside with them.
The plaintiffs Alexander and Jane Kliss, and David and Connie Hodeker, seek to represent a subclass of this larger class:
All persons who have been, are now or may in the future be recipients of medicaid benefits for the medically needy in the State of New York who are aged, blind, or disabled and reside with their spouses who have earned income, and their spouses.
*1088
In order to proceed as class actions, the plaintiffs must first establish that their proposed classes satisfy the numerosity, commonality, typicality, and adequacy of representation requirements of
Pursuant to
Turning to the commonality requirement of
Whether federal law and regulations and the Constitution require the defendants to apply to aged, blind, or disabled, SSI medically needy persons and AFDC medically needy persons living with them at least as beneficial a methodology for computing income as is applied for other medicaid recipients actually receiving SSI or AFDC.
In view of the facts and issues presented by both the plaintiffs Calkins et al. and the defendants, commonality appears to exist.
Under
As a final requirement of
Having satisfied the requirements of
[defendants have acted or refuse to act on grounds generally applicable to the class, namely, they have refused to conform to federal requirements for computing plaintiffs’ eligibility for and amount of medicaid benefits, thereby making appropriate final injunctive or corresponding declaratory relief with respect to the class as a whole.
Cf: Greklek v. Toia,
Certainly, civil rights actions can be regarded as the “paradigmatic 23(b)(2) class
*1089
suits, for they seek classwide structural relief that would redound equally to the benefit of each class member.”
Marcera v. Chinlund,
Noting that retroactive monetary relief is in fact at issue in this action, the plaintiffs Calkins
et al.
go on to assert, as “additional reasons”, that class certification is necessary to avoid problems of mootness, enforcement, and class identification, and to effect a suggested mechanism for providing relief to persons affected by a judgment in favor of the named plaintiffs, namely, notice to class members. With respect to the particular concern for mootness, the aged, blind, or disabled status of many of these plaintiffs indisputably creates problems of mootness.
10
Thus, in order to “avert the substantial possibility” of mootness,
Greklek v. Toia,
The defendants maintain, however, that class action certification is nonetheless superfluous because this Court should assume that the defendants would apply any determination in favor of the plaintiffs to all individuals similarly situated, and because any judgment entered by this Court would fall within the scope of the doctrine of res judicata. Relying on
Domingo v. Toia and Fahey,
77-CV-217 (N.D.N.Y. August 24, 1977) (Foley, J.) (citing
Wells v. Malloy,
In regard to these arguments by the defendants, plainly neither the doctrine of res judicata, nor the doctrine of collateral estoppel can, by themselves, defeat class action certification; to hold otherwise would render nugatory the provisions of
*1090
Here, the defendants have given no definite assurances that they would apply a determination of this Court in favor of the named plaintiffs to all individuals similarly situated.
See Lucas
v.
Wasser,
Accordingly, this Court concludes that the plaintiffs Calkins et al. have established the propriety of class action certification, and hereby certifies a class consisting of all persons who are, as of the date of the commencement of this action, or who may in the future be recipients of or eligible for medicaid benefits for the medically needy in the State of New York who reside with their spouses and/or minor children and are aged, blind or disabled, and hereby certifies a class consisting of:
1. All persons who are, as of the date of the commencement of this action, or who may in the future be recipients of or eligible for medicaid benefits for the medically needy in the State of New York who reside with their spouses and/or minor children and are aged, blind or disabled.
2. Their spouses who reside with them.
3. Their children who reside with them.
Inasmuch as the plaintiffs Alexander and Jane Kliss, David and Connie Hodeker, and their proposed class fall within this class definition, it is unnecessary to address their motions for class action certification.
IV.
Because the papers reflect no genuine triable issue as to any material fact, this Court shall now consider the substantive claims urged by the parties in their motions for summary judgment and for cross-summary judgment. In this regard, the Court is mindful of its duty to address any “dis-positive issues of statutory . .. law . . . before reaching constitutional issues.”
Wolston v. Reader’s Digest Association, Inc.,
A.
The threshold inquiry here concerns the general requirements of the federal statutes and regulations with respect to the treatment of the medically and categorically needy.
The plaintiffs contend that two provisions of the Social Security Act, namely,
Turning to the language of the statutory provisions relied upon by the plaintiffs,
see, e. g., Consumer Product Safety Commission v. G.T.E. Sylvania, Inc.,
(a) A State plan for medical assistance must—
(10) provide—
(C) if medical assistance is included for any group of individuals who are [not recipients of, e. g., AFDC or SSI] and who do not meet the income and resources requirements of the appropriate State plan, or the supplemental security income program, . ..
(i) for making medical assistance available to all individuals who would, except for income and resources, be eligible for aid or assistance under any such State plan or to have paid with respect to them [SSI], and who have insufficient (as determined in accordance with comparable standards) income and resources to meet the costs of necessary medical and remedial care and services, ... (emphasis supplied).
Certainly the regulations promulgated by HHS, as interpreted by the Second Circuit, have contemplated that this provision mandates comparable eligibility requirements as between the categorically and medically needy.
See Caldwell v. Blum,
must not use requirements for determining eligibility for optional coverage groups [e. g., the medically needy] that are—
(1) For families and children, more restrictive than those used under the State’s AFDC plan; and (2) For aged, blind and disabled individuals, more restrictive than those used under SSI.. . (emphasis supplied).
Furthermore, various decisions of federal courts have held that
(17) include reasonable standards (which shall be comparable for all groups .. .) for determining eligibility for and the extent of medical assistance under the plan which ... (B) provide for taking into account only such income and resources as are, as determined in accord *1092 anee with standards prescribed by the Secretary, available to the applicant or recipient and (in the case of an applicant who would, except for income and resources, be eligible [to receive AFDC or SSI money payments]) as would not be disregarded ... in determining his eligibility for such aid, assistance, or benefits, (emphasis supplied).
See
In view of this statutory and judicial authority, it seems clear that the medicaid federal scheme, in general, mandates comparable treatment between categorically and medically needy individuals. Moreover, as this Court has recently held, the State’s conversion to a “209(b)” plan has no preemptory effect upon the applicability of the principle of comparability to the determination of medicaid eligibility for aged, blind, disabled, or AFDC medically needy persons. See Caldwell v. Blum, 78-CV-569 (N.D.N.Y. November 4, 1980).
B.
Relying upon this federal scheme, the aged, blind, or disabled medically needy plaintiffs and their ineligible spouses raise the question of whether, during the preconversion period, the principle of comparability, and the regulations that embody this principle, require medicaid agencies to apply to aged, blind, or disabled medically needy persons the SSI budgeting methodology applied to categorically needy individuals who receive SSI. For example, the plaintiffs argue that the defendants should apply the SSI income disregards to the earned income of ineligible spouses of aged, blind, or disabled medically needy persons.
11
Additionally, the plaintiffs contend that the defendants should apply the SSI eligibility scheme set forth in
In response to these arguments, the defendants contend that the principle of comparability set forth in
Notwithstanding the force of the defendants’ arguments, this Court concludes, for the following reasons, that the principle of comparability contemplates application of the SSI budgeting methodology in the determination of eligibility of SSI medically needy persons during the pre-conversion period.
It is of some interest that the defendants have relied only upon one provision of the Social Security Act, namely,
[Wjhile a state might use more generous maintenance amounts in determining financial eligibility (i. e. — medically needy level. .., disregards, or asset exemptions) all other SSI eligibility criteria are to be used. .. . [A]ll aged, blind and disabled persons ... must have their eligibility determined using all SSI eligibility rules except or — and only except for — higher dollar amounts for income and resource eligibility levels ...
42 Fed.Reg. 2685 (1977) (emphasis supplied).
See Fabula v. Buck,
*1094
The reasonableness of HHS’s interpretation is buttressed by the observation that, contrary to the allegations of the defendants, the medicaid program recognizes not only households, but also individuals. As set forth in its opening section, the Medicaid Act provides medical assistance to “families with dependent children”
and
to “aged, blind or disabled
individuals.”
Other arguments by the defendants are similarly without merit. Clearly, for example, if an agency deems the income of an ineligible spouse to an SSI medically needy person, then that income becomes the income of the medically needy person. 13 Hence, in applying the SSI income disregards, the agency indeed exempts income of the SSI medically needy individual, and not of the ineligible spouse. Furthermore, with respect to the defendants’ comparative construction of the former agency regulations and of the recodified CFR provisions, HHS has emphasized that “[n]o substantive changes have been made” in the recodified sections of the regulations. 43 Fed.Reg. 45176 (1978). Finally, HHS’s approval of New York’s medicaid plan surely does not obviate the need for a judicial determination of the legality of that plan.
Accordingly, inasmuch as the medically needy budgeting procedures used by the defendants during the pre-conversion period failed to include relevant SSI eligibility rules, as required by the principle of comparability, the defendants have violated the Social Security Act and the applicable federal regulations.
The plaintiff AFDC medically needy individuals raise the further question of whether the federal principle of comparability requires New York medicaid administrators, in determining the medicaid eligibility of AFDC medically needy persons, to regard as invisible the income and presence of any SSI medically needy spouse or parent who resides with the AFDC medically needy persons. Inasmuch as the conversion to a “209(b)” plan appears to have no direct effect upon the determination of an AFDC medically needy person’s eligibility, as evidenced by the absence of any reference to the AFDC medically needy subprogram in
Pursuant to
(a) A State Plan for aid and services to needy families with children must .. . (24) provide that if an individual is receiving benefits under [the SSI program], then, for the period for which such benefits are received, such individuals shall not be regarded as a member of a family for purposes of determining the amount of the benefits of the family under this subchapter and his income and resources shall not be counted as income and resources of a family under this subchapter.
Cases certainly follow the literal language of this provision.
See Martinez v. Maher,
The plaintiffs contend that the requirement of comparable treatment between categorically and medically needy persons requires that this invisibility feature of the AFDC budgeting methodology be applied to the AFDC medically needy person who resides with an SSI medically needy spouse or parent. For example, the plaintiffs assert that it would be illogical to regard an SSI medically needy person as an actual SSI recipient for the purpose of budgeting his medicaid benefits, and yet not regard this person as an SSI recipient for the purpose of budgeting his family’s medicaid benefits. Furthermore, the failure to carry through the fiction that medically needy persons are categorically needy, the plaintiffs argue, results in medically needy persons being left worse off, in actual dollars, than if everyone in the family were receiving SSI and AFDC, because the inclusion of the SSI medically needy person’s presence and income leads to a diminished allocation of medical assistance to the AFDC medically needy family members. Such a result, it is argued, contradicts the very purpose of the medically needy program.
In response to these arguments, the defendants first maintain that the principle of comparability requires only that AFDC medically needy persons receive the same income disregards as AFDC categorically needy persons. Also, because
As noted above, the principle of comparability mandates that conditions for the medicaid eligibility of AFDC medically needy persons must not be more restrictive than standards for the medicaid eligibility of actual AFDC recipients. Hence, if the income and presence of an SSI medically needy person were disregarded in the computation of medical assistance for the categorically needy, and not disregarded for the computation of medical assistance for the medically needy, such a practice would probably contravene the principle of comparability. In fact, as the defendants note, the language of
In this regard, the legislative history surrounding
Both plaintiffs and defendants place extensive reliance upon patently contradictory, informal positions of HHS with respect to the application of
Aside from the application of an “invisibility” rule, a more fundamental question raised by the plaintiffs is whether the principle of comparability requires that medically needy persons not be left financially worse off, in terms of their non-medical needs, than if everyone in the family were categorically needy, and thus recipients of federal assistance. They are not contending that in computing their medicaid eligibility, the defendants reduced their income below the level determined by the State of New York as necessary for their maintenance. See S.Rep.No.404, 89th Cong., 1st Sess.,
reprinted in
1965 U.S.Code and Cong, and Admin.News 1943, 2019;
This Court concludes, however, that the principle of comparability does not support such a position. The notion of comparability appears to embrace only the requirements for medicaid eligibility and the extent of medical assistance. See IV A(a) supra at 25. Hence, because the plaintiffs’ *1097 argument addresses an incident of medicaid determinations, as opposed to' the manner of making such determinations, it necessarily seems to fall beyond the scope of the principle of comparability. This is true even though the family of a marginally employed, income generating aged, blind, or disabled person may be effectively penalized for the labors of such a person.
Accordingly, inasmuch as the defendants include the SSI medically needy spouse or parent in determining the medicaid eligibility of an actual AFDC family unit, the defendants’ scheme for computing the medicaid budgets of AFDC medically needy persons who reside with SSI medically needy persons does not run afoul of the federal principle of comparability.
D.
Finally, relying on
The defendants, however, contend that any choice belongs to the applicant as a household, arguing that there is no federal requirement that a family applying for medical assistance be divided into separate households for purposes of determining medicaid eligibility. Moreover, the defendants argue further, to create separate households would both contravene the federal requirements that families of the same size be treated similarly,
see
Turning to the language of
§ 435.404 . Applicant’s choice of category-
The agency must allow an individual who would be eligible under more than one category to have his eligibility determined for the category he selects, (emphasis supplied).
Plainly, this regulation addresses the determination of medicaid eligibility for an individual, and not for the family of such an individual. Also plainly, this provision requires that an individual with dual eligibility be permitted to select the category under which he wishes to have his, not his family’s, medicaid eligibility computed. Thus, in the absence of any indication from the language of
Accordingly, the defendants’ practices of interpreting individual to mean family directly conflicts with the simple, unambiguous language of
*1098 V.
Having found in favor of certain plaintiffs on two claims, namely, the application of the SSI budgeting methodology to SSI medically needy persons, and the choice of category election available to individuals who are both SSI and AFDC medically needy, it is unnecessary to consider the plaintiffs’ equal protection claims in regard to these issues. Hence, this Court need only assess the equal protection question raised by the AFDC medically needy plaintiffs concerning the allegedly discriminatory classification between families comprised of AFDC and SSI categorically needy persons on the one hand, and families comprised of AFDC and SSI medically needy persons on the other hand, a classification that arises by virtue of the defendants’ practices to include the presence and income of the SSI medically needy person in determining the medicaid eligibility of his AFDC medically needy family.
The parties do not appear to disagree that the proper standard of review is whether any reasonable basis exists for the defendants’ method of computing the medicaid budgets of AFDC medically needy persons who reside with SSI medically needy persons.
See, e. g., Dandridge v. Williams,
Notwithstanding the force of plaintiffs’ arguments regarding the diminished amount of income retained by medically needy persons, as compared to that income retained by categorically needy persons, it is reasonable for the defendants to require the income of SSI medically needy persons, who are not recipients of SSI federal assistance, to be made available to AFDC medically needy families. As noted above, spousal and parental support appears to be the general rule under the medicaid program. Thus, given the absence of any clear statutory or regulatory language requiring the exclusion of SSI medically needy persons, the defendants have a reasonable basis for concluding that the income of SSI medically needy' persons should be applied to AFDC medically needy family members. Moreover, the double-counting problems attendant to determining benefits for AFDC and SSI recipients who reside in one household, as well as the desire that AFDC individuals should not have to rely upon the federal assistance benefits received by SSI beneficiaries, represent reasonable justifications for creating the classification in the first instance.
In short, although the plaintiffs urge this Court to adopt at least a narrow rule that would require administrators to disregard the presence and income of an SSI medically needy person when inclusion would reduce the non-medically related income of an AFDC medically needy person, the Equal Protection Clause does not mandate such a holding. Irrespective of the inequities created under the present scheme used by the defendants, the plaintiffs’ claim does not amount to constitutional stature under the Equal Protection Clause of the Fourteenth Amendment.
VI.
The next issue concerns the scope of relief that this Court shall award those successful plaintiffs in this action. In this regard, the plaintiffs seek declaratory and 'monetary relief against the defendants, whom the plaintiffs have sued in their individual and official capacities. The monetary relief sought by the plaintiffs is, for the named plaintiffs, restitution of all amounts wrongfully paid by them for medical care, and, for the absent class members, recomputation for the three month period prior to the month of the conversion. As an alternative request for relief for the named plaintiffs, these persons request restitution of wrongfully paid sums from the date of the commencement of this action.
None of the defendants challenge the power of this Court to award declaratory relief in this action against the defendants in their official capacities.
See, e. g., Scheuer v. Rhodes,
A.
Turning first to the question of monetary relief, it is clear that the Eleventh Amendment bars any direct restitution by the State Commissioner, in her official capacity, of medical expenditures wrongfully paid by the named plaintiffs. As the Supreme Court has unequivocally held, such an award would amount to expenditures from the State treasury, and hence would be prohibited under the Court’s interpretation of the Eleventh Amendment.
See, e. g., Edelman v. Jordan,
Examining the situation of the county defendants, the general rule is that the Eleventh Amendment is not applicable to suits for monetary damages against the county.
See, e. g., Lake Country Estate v. Tahoe Planning Agency,
Thus, the County Commissioners are not protected under the Eleventh Amendment against a judgment of monetary relief in favor of the successful named plaintiffs. Moreover, in the absence of any Congressional intent to the contrary,
Finally, in view of the absence of any constitutional or statutory bar to an award of retroactive monetary relief, the County Commissioners cannot succeed on their claims that this Court lacks the power to order the relief requested for absent class members under
*1100 (a) A State plan for medical assistance must—
* * * * sje *
(34) provide that in the case of any individual who has been determined to be eligible for medical assistance under the plan, such assistance will be made available to him for care and services included under the plan and furnished in or after the third month before the month in which he made application . . . for such assistance if such individual was . .. eligible for such assistance at the time such care and services were furnished.
Inasmuch as certain absent class members have wrongfully been compelled to expend funds for their medical care,
In view of this disposition, it is unnecessary to consider the named plaintiffs’ alternative request for relief.
B.
.Turning to the arguments raised by the County Commissioners, these defendants first aver that they were not personally involved in the determination of the plaintiffs’ eligibility for and amount of medical assistance. Relying on
Rizzo v. Goode,
Certainly a showing of personal participation is a prerequisite to recovery of monetary or other relief under
Given this causal relationship between the defendants’ conduct and the plaintiffs’ deprivation, the next question turns upon whether the County Commissioners can prevail upon their affirmative defenses of good faith against an award of monetary relief.
Under certain circumstances, a public official can assert a defense of good faith, or qualified immunity.
See, e. g., Procunier v. Navarette,
Even if the County Commissioners could assert defenses of good faith, these contentions would not prevail.
As originally set forth in
Scheuer v. Rhodes,
[I]n varying scope, a qualified immunity is available to officers of the executive branch of government, the variations being dependent upon the scope of discretion and responsibilities of the office and all the circumstances as they reasonably appeared at the time of the action on which liability is sought to be based. It is the existence of reasonable grounds for the belief formed at the time and in light of these circumstances, coupled with good-faith belief, that affords a basis for qualified immunity of executive officers for actions performed in the course of official conduct.
See Procunier v. Navarette,
[An official] is not immune from liability for damages under§ 1983 if he knew or reasonably should have known that the action he took within his sphere of official responsibility would violate the constitutional rights of the [person] affected, or if he took the action with the malicious intention to cause a deprivation of constitutional rights or other injury to the [person].
See Procunier v. Navarette,
Assessing the Commissioners’ actions under these criteria, these defendants fall short of establishing a defense of qualified immunity. At the time of the plaintiffs’ medicaid determinations, federal law and HHS policy statements required that SSI financial eligibility criteria be used applied to SSI medically needy persons and that qualified individuals be provided a choice of categories. Because the actions of the County Commissioners ran directly contrary to this federal law, of which the defendants were obliged to know and follow, their behavior cannot support a claim of good faith or of qualified immunity.
C.
For the foregoing reasons, the County Commissioners are liable to the named and absent class members. In this regard, inasmuch as the counties are payors in the first instance of medicaid benefits, it seems ap
*1102
propriate that they bear the costs of meeting the plaintiffs’ claims for restitution and relief under
VII.
Finally, the plaintiffs have requested an award of attorneys’ fees under the Civil Rights Attorney’s Fees Act of 1976,
[1] whether a person in the plaintiff’s position would have been deterred or inhibited from seeking to enforce civil rights without an assurance that his attorneys’ fees would be paid if he were successful . . .;
[2] the nature and extent of the right and interests at stake ...
[3] the size of the benefits conferred by the suit on the public or on others;
[4] the amount of any fund created by the litigation (and its adequacy to cover the plaintiffs’ costs and compensate him for actual damages);
[5] the presence or absence of any bad faith or obdurate conduct on the part of either party; and
[6] any unjust hardship that a grant or denial of fee-shifting might impose.
Zarcone v. Perry,
Plainly, certain plaintiffs have “prevailed]” upon two claims. Moreover, the defendants are not, and indeed can not, argue that the size of any likely benefits conferred upon the public would be de minimis, or that the nature and extent of the interest at stake are insignificant, or that all of the prevailing plaintiffs would have vigorously pursued this litigation by investing their meager funds in privately retained counsel.
The defendants instead contest an award of attorneys’ fees on other grounds. The defendant Blum, for example, argues that this suit is not a
Aside from these arguments by the State Commissioner, the County Commissioners also raise various arguments in opposition to an award of fees against them. It is unnecessary, however, to address these arguments. In the judgment of this Court, the defendant Blum, in her capacity as Commissioner of the New York State Department of Social Services, should bear such expenses because she is the chief administrator of the State medicaid program and it was her policies that the County Commissioners were effecting.
Accordingly the plaintiffs’ motion for attorneys’ fees is granted against the defendant Barbara Blum in her official capacity, in an amount to be set by this Court upon the submission of papers, and is denied against the County Commissioners.
VIII.
The plaintiffs’ motions for class action certification and for summary judgment are therefore granted to the extent set forth in the above opinion. The defendants’ motions for dismissal of the complaints are denied, and for cross-summary judgment are granted to the extent set forth in this decision.
A separate Order will follow.
Notes
. The Kliss and Floyd intervention motions were granted earlier by this Court. To the extent that the remaining motions to intervene appear unopposed, they are now granted.
. Unless otherwise denominated, the term “plaintiffs” refers to both the plaintiffs and intervening plaintiffs.
. Since the commencement of this action, the governing regulations have been substantially rewritten. Inasmuch as HHS has stated, however, that the new regulations reflect no substantive changes, the parties’ contentions are affected only to the extent discussed in this opinion. See 43 Fed.Reg. 45176 (September 29, 1978).
.
(N)o State not eligible to participate in the State plan program established under sub-chapter XVI of this chapter shall be required to provide medical assistance to any aged, blind, or disabled individual (within the meaning of subchapter XVI of this chapter) for any month unless such State would be (or would have been) required to provide medical assistance to such individual for such month had its plan for medical assistance approved under this subchapter and in effect on January 1, 1972, been in effect in such month. . ..
. On September 1, 1979, the plaintiff Mary Toomey became categorically needy and eligible for SSI benefits. Thus, her claim for damages and declaratory judgment relief seems alive only for the period ending August, 1979.
. The remaining groups of plaintiffs have requested that this Court not review their claims for injunctive relief at this time, in view of alleged uncertainties surrounding the budgeting of their income under the new plan. In the absence of any opposition by the defendants, this Court shall thus dismiss these claims without prejudice.
.
(a) The district courts shall have original jurisdiction of any civil action authorized by law to be commenced by any person:
is) To redress the deprivation, under color of any State law, statute, ordinance, regulation, custom or usage, of any right, privilege or immunity secured by the Constitution of the United States or by any Act of Congress providing for equal rights of citizens or of all persons within the jurisdiction of the United States;
(4) To recover damages or to secure equitable or other relief under any Act of Congress providing for the protection of civil rights, including the right to vote.
. Since the writing of this opinion, Congress enacted P.L. 96-486, eliminating the $10,000 amount in controversy requirement for actions under
. The plaintiffs object that the Commissioner of the Monroe County Department of Social Services is collaterally estopped from raising an Eleventh Amendment objection, by virtue of the litigation in
Holley v. Lavine,
. Indeed, the plaintiff Mary Toomey, a victim of the degenerative disease of multiple sclerosis, already has moved into a skilled nursing facility.
. With regard to the income disregards, under the SSI program the income of an ineligible spouse is designated as either earned or unearned income.
. With respect to the SSI budgeting scheme contained in
. See note 11 supra.
. The Court has been informed that the plaintiffs Kenneth and Yvonne Calkins have separated. Accordingly, while their claim for injunctive relief may be moot, their claim for declaratory relief and restitution remains alive during the period they were residing together.