Greenery Rehabilitation Group, Inc. v. Hammon

• Decision Date: 28 July 1998
• Docket Number: 97-6238,Docket Nos. 97-6236
• Citation: 150 F.3d 226
• Parties: The GREENERY REHABILITATION GROUP, INC., Plaintiff-Appellee, v. Marva L. HAMMON, as Commissioner of the New York City Human Resources Administration, City of New York, Brian J. Wing, as Acting Commissioner of the New York State Department of Social Services, and Barbara A. DeBuono, as Commissioner of the New York State Department of Health, Defendants-Third-Party-Plaintiffs-Appellants, Donna E. Shalala, as Secretary of the United States Department of Health and Human Services, Third-Party-Defendant-Appellant.
• Court: U.S. Court of Appeals — Second Circuit

Page 226

150 F.3d 226

57 Soc.Sec.Rep.Ser. 537

The GREENERY REHABILITATION GROUP, INC., Plaintiff-Appellee, v. Marva L. HAMMON, as Commissioner of the New York City Human Resources Administration, City of New York, Brian J. Wing as Acting Commissioner of the New York State Department of Social Services, and Barbara A. DeBuono, as Commissioner of the New York State Department of Health Defendants-Third-Party-Plaintiffs-Appellants Donna E. Shalala, as Secretary of the United States Department of Health and Human Services Third-Party-Defendant-Appellant.

Docket Nos. 97-6236, 97-6238

United States Court of Appeals, Second Circuit.

Argued April 13, 1998.

Decided July 28, 1998.

Hermes A. Fernandez, Bond, Schoeneck & King, LLP, Albany, NY, (Gregory J. Champion, of counsel), for Plaintiff-Appellee.

Jeffrey D. Friedlander, Acting Corporation Counsel of the City of New York, New York City (Stephen J. McGrath, Ellen Ravitch, of counsel), for Defendants-ThirdParty-Plaintiffs-Appellants Marva L. Hammon and the City of New York.

Victor Paladino, Assistant Attorney General of the State of New York, Albany, NY (Dennis C. Vacco, Attorney General of the State of New York, Albany, NY, Peter G. Crary, Assistant Attorney General of the State of New York, Peter H. Schiff, Deputy Solicitor General of the State of New York, Albany, NY, of counsel), for Defendants-ThirdParty-Plaintiffs-Appellants Brian J. Wing and Barbara DeBuono.

Sushma Soni, United States Department of Justice, Civil Division, Appellate Staff, Washington, DC, (Barbara C. Biddle, United States Department of Justice, Civil Division, Appellate Staff, Washington, DC, Frank W. Hunger, Assistant United States Attorney General, United States Department of Justice, Washington, DC, Thomas J. Maroney, United States Attorney for the Northern District of New York, Syracuse, NY, of counsel), for Third-Party-Defendant-Appellant.

Before: KEARSE, MINER, Circuit Judges, and KEENAN, District Judge. ^*

MINER, Circuit Judge:

Defendants - third - party - plaintiffs - appellants the City of New York, Marva L. Hammon, Commissioner of the New York City Human Resources Administration, Brian J. Wing, former Acting Commissioner of the New York State Department of Social Services, Barbara DeBuono, Commissioner of the New York State Department of Health, and third-party-defendant-appellant Donna E. Shalala, Secretary of the United States Department of Health and Human Services, appeal from a declaratory judgment entered in favor of plaintiff-appellee The Greenery Rehabilitation Group, Inc., in the United States District Court for the Northern District of New York (McAvoy, C.J.) after a bench trial. The district court determined that undocumented aliens who suffered serious traumatic head injuries were suffering from "emergency medical condition[s]" within the meaning of 42 U.S.C. § 1396b(v)(3), 42 C.F.R. § 440.255(b)(1) and corresponding New York State regulations, after initial treatment of the injuries. The patients were stable but had chronic debilitating conditions requiring continuous daily care, following initial treatment. Accordingly, the court ordered payment to plaintiff-appellee The Greenery Rehabilitation Group, Inc., a health care provider, pursuant to the Medicaid scheme.

For the reasons that follow, we reverse.

BACKGROUND

The underlying facts are carefully set out in the comprehensive opinion of the district court in The Greenery Rehabilitation Group, Inc. v. Hammon, 893 F.Supp. 1195, 1197-99 (N.D.N.Y.1995). We highlight here only the facts most relevant to this appeal, which centers on the interpretation of "emergency medical condition" as set forth in 42 U.S.C. § 1396b(v)(3).

Medicaid is a federal program that provides health care funding for needy persons through cost-sharing with states electing to participate in the program. See 42 U.S.C. §§ 1396-1396a; see generally Atkins v. Rivera, 477 U.S. 154, 156-57, 106 S.Ct. 2456, 91 L.Ed.2d 131 (1986); Schweiker v. Hogan, 457 U.S. 569, 571, 102 S.Ct. 2597, 73 L.Ed.2d 227 (1982). Undocumented aliens or aliens not otherwise permanently residing in the United States under color of law generally are not entitled to full Medicaid coverage. See 42 U.S.C. § 1396b(v)(1) ("no payment may be made to a State under this section for medical assistance furnished to an alien who is not lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law"); 42 C.F.R § 435.406. The only exception to this exclusion is payment for medical assistance that is "necessary for the treatment of an emergency medical condition." 42 U.S.C. § 1396b(v)(2)(A). An "emergency medical condition " is a medical condition (including emergency labor and delivery) manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in--

(A) placing the patient's health in serious jeopardy,

(B) serious impairment to bodily functions, or

(C) serious dysfunction of any bodily organ or part.

42 U.S.C. § 1396b(v)(3). The corresponding regulation is found at 42 C.F.R. § 440.255(b)(1), which provides that aliens are entitled to Medicaid coverage for

[e]mergency services required after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in:

(i) Placing the patient's health in serious

jeopardy;

(ii) Serious impairment to bodily functions; or

(iii) Serious dysfunction of any bodily organ or part.

A state Medicaid plan must conform with these requirements. See 42 U.S.C. § 1396a(a). New York has chosen to participate in the Medicaid program and has enacted regulations that are substantially the same as those found in 42 U.S.C. § 1396b(v) and 42 C.F.R. § 440.255(b)(1). See N.Y. Comp.Codes R. & Regs. tit. 18, § 360-3.2(f)(2).

Plaintiff-appellee The Greenery Rehabilitation Group, Inc., ("GRG") operates nursing homes and rehabilitation facilities where specialized programs are offered for the care of individuals who have suffered brain injuries. GRG operates facilities in several states. Care was and is being provided to the patients involved in this case, following their initial treatment, stabilization and transfer, at facilities located in Brighton, Middleboro, and Hyannis, Massachusetts.

GRG has entered into agreements with defendant-third-party-plaintiff New York City Human Resources Administration ("NYCHRA") to admit into GRG's specialized brain injury care programs New York City residents who are in need of its services and are eligible for Medicaid. GRG admitted into its Massachusetts facilities three New York City residents who were in need of such services, but for whom NYCHRA has refused payment because of their alien status. Two of the three patients, Izeta Ugljanin and Leon Casimir, are undocumented aliens. The third, Yik Kan, was granted legal residency in the United States but had not yet met the residency requirements necessary to qualify for Medicaid benefits.

All three patients suffered sudden and serious head injuries that necessitated immediate treatment and ultimately left the patients with long-term debilitating conditions requiring ongoing care and daily attention. On June 16, 1991, nineteen-year-old Ugljanin was thrown from a vehicle during an automobile accident and sustained head injuries that caused severe brain damage. Due to her injuries, Ugljanin required immediate care for which she was admitted to Nassau County Medical Center. After being stabilized, Ugljanin was transferred to GRG's Brighton facility in 1991, and was subsequently transferred to GRG's Middleboro facility. Bed-ridden and quadriplegic, she continues to require a feeding tube, continual monitoring and extensive nursing care. At the time this litigation arose, Ugljanin, an immigrant from what is now known as the Republic of Macedonia, fulfilled the criteria for Medicaid coverage but for her alien status.

On March 9, 1990, thirty-eight-year-old Casimir, an immigrant from Trinidad, was shot in the head and suffered brain damage. He was initially treated at Goldwater Memorial Hospital in New York City and, after being stabilized, was transferred to GRG's Brighton facility in 1991 and is currently receiving care at GRG's Hyannis facility. Casimir is unable to walk, requires monitoring and medication for seizures and behavioral problems related to his injury and needs assistance with daily tasks such as bathing, dressing, eating and toileting. Casimir was also eligible for Medicaid coverage but for his alien status.

In October of 1990, forty-six-year-old Yik Kan, an immigrant from Hong Kong, was attacked and beaten, resulting in cerebral contusions and a hematoma to his right eye. Yik Kan initially received treatment at Harlem Hospital in New York City and was later transferred to GRG's Middleboro facility and has been receiving care at GRG's Hyannis facility since May of 1993. Although he is legally blind as a result of his injuries, he is ambulatory and can function if instructed to accomplish a given task. For example, he can feed himself if instructed to eat and is able to dress or use the toilet if directed to do so. He also suffers from behavioral and psychiatric problems that require medication and monitoring. Like the others, Yik Kan was eligible for Medicaid coverage but for his alien status.

Defendant - third - party - plaintiff - appellant Marva L. Hammon served as Commissioner of the NYCHRA at all times relevant to this appeal. As Commissioner, Hammon was responsible for administering the Medicaid program within the five boroughs of the City of New York in accordance with the rules and regulations of the State of New York. Defendant-third-party-plaintiff-appellant City of New York (the "City"), employs Hammon, and is a social services...