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Gold v. United Health Services Hospitals12/9/1999
de that OMRDD and BCDSS may recoup the liens in full from the settlement proceeds.
As a condition of Medicaid eligibility, recipients are required to assign to the appropriate social services district the right to seek reimbursement from a responsible third party (see, Social Services Law § 366 ). Social Services Law § 367-a (2)(b) provides that "the local social services district or the department shall be subrogated, to the extent of the expenditures by such district or department for medical care furnished, to any rights such person may have to * * * third party reimbursement". As an alternative to commencing a direct cause of action for such reimbursement, a local social services agency may enforce its rights by placing a lien on the proceeds of a personal injury lawsuit instituted against a liable third party (see, Social Services Law § 104-b; Calvanese v. Calvanese, 93 NY2d 111, 117).
The Court of Appeals in Calvanese v. Calvanese (supra, at 118-119) determined that a Medicaid lien filed pursuant to Social Services Law § 104- b may be satisfied out of the entire proceeds of a Medicaid recipient's personal injury settlement. Specifically rejecting the argument that recoupment is limited to that portion of the settlement allocated to past medical expenses, the court held that a Medicaid lien was recoverable despite the absence of any specific amount attributed to repayment of the lien (see, id.). Reasoning that Social Services Law § 366(4)(h)(1) and § 367-a (2)(b) were enacted to ensure that Medicaid would be the "payor of last resort", the Court of Appeals determined that State and local lienholders are entitled to pursue repayment to the extent of " ' * * * any rights such person may have to * * * third-party reimbursement' " (id., at 118-119, quoting Social Services Law § 367-a [emphasis in original] ).
On the heels of the Calvanese decision, the case before us seeks to establish a limitation on lien recoupment by contending that the settlement at issue is distinguishable from Calvanese because the injured party is an infant. Plaintiffs rely upon Social Services Law § 104(2) and the Court of Appeals' decision in Baker v. Sterling (39 NY2d 397) in urging that the right of lien recovery is limited for infant Medicaid recipients.
Pursuant to Social Services Law § 104(1), a public welfare official is authorized to commence an "action or proceeding against a person discovered to have real or personal property * * * and shall be entitled to recover up to the value of such property the cost of such assistance or care". These recovery rights are limited with respect to recipients under the age of 21, unless the infant "was possessed of money and property in excess of his [or her] reasonable requirements" at the time the infant received aid from the State (see, Social Services Law § 104 ). Finding the local agency to be subrogated to the recipient's rights, the Court of Appeals in Baker found that the Social Services Law § 104(2) limitation applied to that portion of an infant's settlement attributable to compensation for pain and suffering because such funds were intended to meet the anticipated needs of the infant as a result of the injury sustained (see, Baker v. Sterling, supra, at 405- 406). Hence, awards compensating an infant for his or her loss were not "excess property" within the meaning of the statute. As a consequence of this distinction, the court found that the "portion of the settlement which represents a compromise of the claim for medical expenses is subject to lien and recovery by the Department. That portion representing a compromise of the infant's claim for personal injury is beyond the Department's reach" (id., at 406).
Notably, B
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