New York Law Review

Tag: Medical Assistance

  • Denton v. Perales, 72 N.Y.2d 943 (1988): Medical Assistance Includes Prescribed Diet

    Denton v. Perales, 72 N.Y.2d 943 (1988)

    A prescribed diet necessary to treat a medical condition can constitute “medical assistance” under Social Services Law § 365-a (2), even if the food can be purchased at a grocery store.

    Summary

    The New York Court of Appeals held that a special high-protein, low-carbohydrate diet prescribed for a woman with severe hypoglycemia could be considered “medical assistance” under the Social Services Law. The petitioner, who had a long history of debilitating symptoms due to hypoglycemia, experienced significant improvement only after being placed on the diet. The court rejected the respondent’s restrictive interpretation of the statute, stating that food prescribed to treat a medical condition is not automatically excluded from being medical assistance simply because it can be bought at a grocery store. The court found the respondent’s interpretation irrational and inconsistent with the legislative purpose of providing humane assistance.

    Facts

    The petitioner, a woman in her late sixties, had a history of hypoglycemia since childhood, which caused severe symptoms like nightmares, depression, suicide attempts, and repeated hospitalizations. She was eventually diagnosed with hypoglycemia and prescribed a special high-protein, low-carbohydrate diet. This diet significantly improved her condition. The cost of the diet was calculable. The Social Services agency denied funding for the diet, arguing it was not covered under Social Services Law § 365-a (2).

    Procedural History

    This was the second time the petitioner’s claim had been litigated through the appellate courts. The prior case was Matter of Denton v. Blum, 95 A.D.2d 854. The lower courts presumably ruled in favor of the petitioner, as the Court of Appeals affirmed the Appellate Division’s order.

    Issue(s)

    Whether the cost of a special diet prescribed for a medical condition, hypoglycemia, can be considered “medical assistance” under Social Services Law § 365-a (2), if the food required for the diet is generally available for purchase at a grocery store.

    Holding

    Yes, because the respondent’s restrictive reading of the statute, which effectively excludes all food purchased at a grocery store from being considered “medical assistance,” is irrational, inhumane, and not in accordance with the legislative purpose.

    Court’s Reasoning

    The court relied on the principle that courts generally defer to the interpretation of a statute by the agency responsible for its administration, provided that the interpretation is not irrational or unreasonable. However, the court found the respondent’s interpretation of Social Services Law § 365-a (2) to be irrational. The court reasoned that excluding all food purchased at a grocery store from being considered “medical assistance” regardless of its medicinal purpose was too restrictive and not in line with the law’s intent. The court cited Matter of Sabot v. Lavine, 42 N.Y.2d 1068, 1069. The court stated the interpretation was not humane or in accordance with the legislative purpose. The Court found that the specific facts of the case, where the diet was medically necessary to treat a specific condition and had demonstrably improved the petitioner’s health, warranted considering the cost of the diet as “medical assistance.” There were no dissenting or concurring opinions noted.

  • Matter of Corr v. Westchester County Dept. of Social Services, 33 N.Y.2d 111 (1973): Establishing Residency for Medical Assistance

    33 N.Y.2d 111 (1973)

    An out-of-state resident who enters New York and is immediately hospitalized or placed in a nursing home can establish residency for medical assistance purposes if they demonstrate a genuine intent to remain in New York, regardless of the duration of their stay or the location of their residence.

    Summary

    Jessie Corr, an elderly widow with a long history of living in New York, moved from New Jersey back to New York to be closer to her family and entered a nursing home. She applied for medical assistance, but the Westchester County Department of Social Services denied her application based on her short residency in the state. The New York Court of Appeals reversed the denial, holding that Corr had established residency in New York despite being in a nursing home, and that the state could not impose a minimum residency requirement for medical assistance. The court emphasized Corr’s intent to remain in New York and her deep-rooted connections to the state.

    Facts

    Jessie Corr, born and raised in New York, lived in Westchester County from 1915 to 1962. After selling her home in 1962, she moved to New Jersey to live with her son. Following her son’s death in 1969, Corr, suffering from arteriosclerosis and unable to care for herself, lived alone in New Jersey. With limited income and most of her family in Westchester, she moved back to New York in November 1971 and was admitted to a private hospital, then transferred to a nursing home in Westchester a week later. She registered to vote in Westchester in February 1972, listing the nursing home as her address.

    Procedural History

    Corr applied for medical assistance in January 1972. The Westchester County Department of Social Services denied her application. Special Term reversed the Department’s decision, finding that Corr had established residency in New York. The Appellate Division reversed Special Term’s decision, reinstating the denial of medical assistance. Corr appealed to the New York Court of Appeals.

    Issue(s)

    Whether an individual who moves to New York from out-of-state and is immediately placed in a hospital or nursing home can establish residency in New York for the purpose of qualifying for medical assistance payments, despite not residing outside of an institution.

    Holding

    Yes, because Corr demonstrated a genuine intent to establish residency in New York, supported by her lifelong connections to the state and her desire to be closer to her family, regardless of the fact that she resided in a nursing home.

    Court’s Reasoning

    The court reasoned that while generally an inmate of an institution does not gain or lose residency, an exception exists when the individual pays their own way, is free to come and go, and has no other place of abode, demonstrating an intent to establish the institution as their permanent home. The court emphasized Corr’s 78 years of life in New York, her family in Westchester, her abandonment of her New Jersey home, and her registration to vote in Westchester. The court cited Shapiro v. Thompson, stating that states cannot impose minimum residency requirements for public assistance, as such requirements violate the Equal Protection Clause and the right to travel. The court distinguished this case from situations where someone enters a state solely for medical care. The court found that Corr’s primary motivation was to be closer to family and re-establish her life in New York, not simply to obtain medical assistance. The court held that once residence is established, New York cannot deny assistance based on the short duration of the renewed residence. As the court noted, the petitioner established “bona fides of her residence in New York.”