Gomez v. Blum, 61 N.Y.2d 664 (1984)

When determining Medicaid eligibility, the income exemption is calculated based only on the applicant, their spouse, or the person legally responsible for their support; other individuals in the household cannot be considered when calculating the exemption.

Summary

This case addresses how the income exemption for Medicaid applicants should be calculated, specifically focusing on who should be considered part of the applicant’s household. The New York Court of Appeals held that the Commissioner of Social Services improperly calculated the income exemption by including individuals other than the spouse, parent, or legal guardian of the applicant as household members. The court reasoned that federal and state law only allow the income and resources of a spouse or parent to be considered available to the applicant, and including other individuals effectively considers their financial resources as available, which is impermissible.

Facts

Medicaid applicants’ income exemption was calculated by the Commissioner of Social Services by counting individuals other than the spouse, parent or person legally responsible for supporting the applicants as household members. The applicants challenged this calculation, arguing it violated federal and state law.

Procedural History

The Appellate Division upheld the Commissioner’s determination. The New York Court of Appeals reversed the Appellate Division’s order and annulled the Commissioner’s determination.

Issue(s)

Whether the Commissioner of Social Services can calculate the income exemption of Medicaid applicants by including individuals other than the spouse, parent, or person legally responsible for supporting the applicants as members of the household.

Holding

No, because federal and state law expressly provide that only the income and resources of a spouse or a parent may be deemed available to the applicant.

Court’s Reasoning

The court reasoned that while the federal regulation (42 CFR 448.3[c][1]) bases the amount of the income exemption upon the ADC maintenance level, it does not dictate how household size should be calculated. The court emphasized that both federal and state laws (42 CFR 435.602; Social Services Law, § 366, subd 2, par [b]) explicitly state that only the income and resources of a spouse or a parent can be considered available to the applicant. To include other individuals as household members effectively considers their financial resources as available to the applicant, which is not permitted under the law. The court referenced Genin v. Toia, 47 N.Y.2d 959, 960, to support the principle that including an individual as a member of the applicant’s household is tantamount to considering that individual’s financial resources as available to the applicant. The court stated: “Indeed, Federal and State law expressly provide that only the income and resources of a spouse or a parent may be deemed available to the applicant (42 CFR 435.602; Social Services Law, § 366, subd 2, par [b]). To include an individual as a member of the applicant’s household is to consider that individual’s financial resources as available to the applicant”.