IN RE: Estate of Gerhardt WISE (2026)

DECISION & JUDGMENT

Proceeding pursuant to CPLR article 78 to review a determination of the New York State Department of Health dated June 30, 2023.  The determination, after a fair hearing pursuant to Social Services Law § 22, upheld a determination of the Rockland County Department of Social Services dated December 17, 2019, denying an application for Medicaid benefits made on behalf of Gerhardt Wise.

ADJUDGED that the determination dated June 30, 2023, is confirmed, the petition is denied, and the proceeding is dismissed on the merits, with costs.

The petitioners commenced this proceeding to annul a determination of the New York State Department of Health (hereinafter the DOH) made after a fair hearing pursuant to Social Services Law § 22.  The determination upheld a determination of the Rockland County Department of Social Services (hereinafter DSS) denying an application for Medicaid benefits made on behalf of Gerhardt Wise due to the failure to timely submit proper documentation.  The Supreme Court transferred the proceeding to this Court pursuant to CPLR 7804(g).

In reviewing a Medicaid eligibility determination made after a fair hearing, the court must review the record, as a whole, to determine if the agency's decisions are supported by substantial evidence (see Matter of Pagnani v. Suffolk County Dept. of Social Servs., 152 A.D.3d 696, 696, 55 N.Y.S.3d 912;  Matter of Bosco v. McGuire, 111 A.D.3d 931, 932, 975 N.Y.S.2d 687).  “Substantial evidence means such relevant proof as a reasonable mind may accept as adequate to support a conclusion or ultimate fact.  The petitioner bears the burden of demonstrating eligibility” (Matter of Loiacono v. Demarzo, 72 A.D.3d 969, 970, 898 N.Y.S.2d 513 [citations and internal quotation marks omitted];  see Matter of Pagnani v. Suffolk County Dept. of Social Servs., 152 A.D.3d at 696, 55 N.Y.S.3d 912, 55 N.Y.S.3d).

Here, the DOH's determination to uphold the denial of the application for Medicaid benefits made on behalf of Wise was supported by substantial evidence.  The evidence demonstrated that documentation concerning a life insurance policy was not provided for the processing of the application in a timely manner (see Matter of Pagnani v. Suffolk County Dept. of Social Servs., 152 A.D.3d at 696, 55 N.Y.S.3d 912, 55 N.Y.S.3d;  Matter of Bosco v. McGuire, 111 A.D.3d at 932, 975 N.Y.S.2d 687).  The petitioners failed to establish good cause for the failure to timely provide that documentation (see Matter of Mangels v. Zucker, 168 A.D.3d 1060, 1061–1062, 92 N.Y.S.3d 377;  Matter of Schaffer v. Zucker, 165 A.D.3d 1266, 1267, 85 N.Y.S.3d 556).

The petitioners’ remaining contentions are without merit.

DUFFY, J.P., BRATHWAITE NELSON, WARHIT and TAYLOR, JJ., concur.