Citation Numbers: 167 Misc. 2d 633, 640 NYS2d 712
Judges: Buckley
Filed Date: 12/15/1995
Status: Precedential
Modified Date: 2/5/2022
OPINION OF THE COURT
This is a CPLR article 78 proceeding in which petitioner seeks an order vacating a decision after fair hearing which
The essential question for this court is to whom the discontinuation notice should have been mailed. The court finds that the notice was defectively issued because it was not sent to the recognized representative of the medical assistance beneficiary. This matter should, as a matter of fairness to the local agency, be remanded for any further proceedings, if necessary, consistent with this opinion.
The essential facts underlying the present controversy are not in dispute. Ms. Isabelle Watts was a recipient of medical assistance which paid for her care in the Oneida City Hospital Extended Care Facility (ECF) from 1986 until November of 1991. Ms. Watts had been eligible during that five-year period for medical assistance. There is no claim that Ms. Watts’ financial condition had changed with respect to income or resources as of November 1991 or subsequently Ms. Watts’ original application in 1986 had been submitted by a personal
The State regulation which permits a personal friend to become an applicant or recertify for one who claims to need medical assistance specifically conditions that ability to act for a person "because of physical incapabilities, or mental incompetency.” (18 NYCRR 350.4 [c] [4].) The regulations also require that the local agency investigate and verify all aspects of eligibility. (18 NYCRR 351.1 [a], [c].) The court can only assume, since the local agency accepted the original application and certified Ms. Watts as an eligible recipient of medical assistance for five years, that Ms. Carpenter was found to be an appropriate individual to apply on behalf of Ms. Watts because she was incapable of doing so for herself. Having once demonstrated to the agency’s satisfaction that Ms. Watts required the assistance of another individual, it was not logical to presume that Ms. Watts had no need for such help at a point in time when her medical assistance eligibility was at issue. It would be only reasonable to assume that if Ms. Watts could not apply or recertify for herself, she similarly could not be expected to do whatever was necessary to either accept or contest a discontinuation of the only evident source of payment for her institutional care. It is, however, also undisputed that no discontinuance notice was sent to anyone other than Ms. Watts.
From the foregoing, it is evident to this court that the 60-day Statute of Limitations did not begin to run since the notice was not issued properly. Bad notice is no notice. In order to afford an individual entitled to receive adequate notice a meaningful opportunity to contest adverse agency action, it must be issued to an individual with the capacity to respond. It is clear from the record before this court that Ms. Watts as early as 1986 was unable to manage her own affairs and that the local agency recognized this as an operative fact by accepting the signature of a personal friend in lieu of Ms. Watts’ on her original application. The local agency also accepted the recertification application without objection to the same personal friend’s signature. Aside from the regulation which conditions the ability of a person to have another apply for them, the court also notes that application and recertification forms purport to bind the signatory to a range of obligations. Having undertaken those obligations, Ms. Carpenter was entitled, as an applicant, to notification of any adverse action by the agency. (18 NYCRR 358-2.15, 358-3.3.) While the agency may have also dealt with other individuals at the Oneida City Hospital ECF in connection with Ms. Watts’ eligibility, Barbara Carpenter had become, through the local agency’s acceptance of the original application, Ms. Watts’ "designated” representative. As such, she was entitled to notification of any adverse action by the agency. (Matter of Zellweger v New York State Dept. of Social Servs., 74 NY2d 404 [1989], supra.) There is simply no other way to view the undisputed facts on this record.
To ensure that Ms. Watts was afforded her opportunity to avail herself of a "fair hearing” as one method of resolving her dispute with the local agency, Barbara Carpenter was an indispensable person to be noticed. Having failed to provide her with adequate notice, the local agency was without any authority apparent to this court to discontinue medical assistance to Ms. Watts. Having failed to provide her with adequate notice,
Having reviewed the written submissions identified in Appendix A and due deliberation having been had, it is hereby ordered that petitioner’s application is granted on the first cause of action and to the extent that the decision after fair hearing is annulled and this matter is remanded to respondent Commissioner of Social Services of the New York State Department of Social Services for further proceedings consistent with this opinion, and it is hereby ordered that this court retains jurisdiction of this matter for any further application by petitioner for ancillary relief.