DEAL v. VELEZ et al

Filing 81

OPINION. Signed by Judge Joseph H. Rodriguez on 2/20/2018. (tf, )

IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF NEW JERSEY
CAMDEN VICINAGE
PATRICE DEAL, EXECUTRIX OF THE :
ESTATE OF GRACE DEAL, DECEASED,
:
Plaintiff,
v.

:

JENNIFER VELEZ, et al.,

Hon. Joseph H. Rodriguez
Civil Action No. 14-6444
OPINION

:

Defendants.

:

This matter is before the Court on a motion for summary judgment
pursuant to Fed. R. Civ. P. 56 filed by the sole remaining Defendant,
Charles SanFilippo, Director of Burlington County Board of Social
Services.1 The Court has reviewed the submissions and decides the matter
based on the briefs pursuant to Fed. R. Civ. P. 78(b). For the reasons stated
here, Defendant SanFilippo’s motion will be granted.
Background
This case arises out of a series of applications for assisted living
benefits made by or on behalf of decedent Grace Deal, which were originally
denied by the State of New Jersey in conjunction with the Burlington

Defendants originally named but dismissed from the case are Jennifer
Velez, former Commissioner of New Jersey Department of Human Services
(“DHS”), Meghan Davey, Director of New Jersey DHS Division of Medical
Assistance and Health Services (“DMAHS”).
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County Board of Social Services (“BCBOSS”). Although the State eventually
granted Deal’s application, Plaintiff Patrice Deal, Executrix of the Estate of
Grace Deal, asserts that Defendants wrongly determined that Grace Deal
was not eligible for the Medicaid Waiver Program to cover assisted living
services of $63,411.28 for the period from July 1, 2014 to February 28,
2015. Detailed facts regarding the application process and determinations
of benefits are familiar to the parties and were outlined by the Court in its
March 20, 2017 Opinion dismissing all claims except those asserted against
Defendant SanFilippo.
Relevant to the instant motion is that on January 6, 2014, Grace Deal
applied for Medicaid benefits through the Global Options Assisted Living
Medicaid Waiver (“GO”) Program, the only Medicaid funded program in
New Jersey that covered benefits received for assisted living facilities. On
March 4, 2014, BCBOSS, the county welfare agency, denied Deal eligibility
for the GO Program because on December 13, 2013 she had entered into a
Consent Order reducing the amount of monthly spousal support to which
she was entitled pursuant to a March 17, 2010 settlement agreement which
accompanied her Limited Divorce from Bed and Board from $2055 to
$1,500. BCBOSS presumed that Deal’s request for the Order decreasing her
monthly support was improperly motivated to obtain Medicaid, which had

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a $2,163 monthly income limit, contrary to N.J. Admin. Code 10:714.10(b)3, which prohibits disposal of assets at less than fair market value
for five years prior to application for benefits.
Plaintiff timely filed an administrative appeal on March 12, 2014. On
June 20, 2014, following a state administrative hearing, the administrative
law judge issued an initial decision affirming the denial of Deal’s eligibility.
On August 1, 2014, the DMAHS issued a final agency decision affirming the
administrative law judge’s decision denying Deal GO Program eligibility.
Plaintiff did not appeal that decision to the Superior Court of New Jersey,
Appellate Division. Rather, on October 17, 2014, Plaintiff filed the
Complaint in this case. Deal filed a second Medicaid application January
20, 2015 and set up a Qualified Income Trust the next day. She alleges that
in processing this second application, Defendants required her to obtain
judicial modification of her monthly spousal support payment back to
$2055, which she did effective by court Order dated June 5, 2015. Deal
passed away June 28, 2015.
On or about July 22, 2015, Deal was determined eligible for the
Medicaid waiver program as of June 1, 2015, and based on undue hardship
while seeking legal action to reverse the “transfer of assets,” granted her
eligibility effective March 1, 2015.

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Plaintiff asserts violations of Deal’s statutory rights as granted by the
Federal Medicaid Act, enforceable under 42 U.S.C. § 1983. The Amended
Complaint asserts claims for: (1) failure to establish an appropriate date of
eligibility (July 1, 2014) in operation of a Medicaid Assisted Living Waiver
in violation of 42 U.S.C. § 1396a(a)(34); (2) denial of due process in
operation of the Medicaid AL Waiver in violation of 42 U.S.C. § 1396a(a)(3)
by failing to notify Deal that she was denied coverage for the time between
the effective date of eligibility (July 1, 2014) and the date in which she was
enrolled; (3) failure to provide medical assistance with reasonable
promptness in operation of the Medicaid AL Waiver in violation of 42
U.S.C. § 1396a(a)(8); (4) denial of due process in operation of the Medicaid
AL Waiver by failing to give full faith and credit to the December 13, 2013
Superior Court Order reducing Plaintiff’s spousal support; and (5)
declaratory relief directing Defendants to properly process Deal’s Medicaid
application and determine her to be eligible for Medicaid effective July 1,
2014.
Summary Judgment Standard
“Summary judgment is proper if there is no genuine issue of material
fact and if, viewing the facts in the light most favorable to the non-moving
party, the moving party is entitled to judgment as a matter of law.” Pearson

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v. Component Tech. Corp., 247 F.3d 471, 482 n.1 (3d Cir. 2001) (citing
Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986)); accord Fed. R. Civ. P. 56
(a). Thus, the Court will enter summary judgment in favor of a movant who
shows that it is entitled to judgment as a matter of law, and supports the
showing that there is no genuine dispute as to any material fact by “citing to
particular parts of materials in the record, including depositions,
documents, electronically stored information, affidavits or declarations,
stipulations . . . admissions, interrogatory answers, or other materials.”
Fed. R. Civ. P. 56 (c)(1)(A).
An issue is “genuine” if supported by evidence such that a reasonable
jury could return a verdict in the nonmoving party’s favor. Anderson v.
Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). A fact is “material” if, under
the governing substantive law, a dispute about the fact might affect the
outcome of the suit. Id. In determining whether a genuine issue of material
fact exists, the court must view the facts and all reasonable inferences
drawn from those facts in the light most favorable to the nonmoving party.
Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986).
Initially, the moving party has the burden of demonstrating the
absence of a genuine issue of material fact. Celotex Corp. v. Catrett, 477
U.S. 317, 323 (1986). Once the moving party has met this burden, the

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nonmoving party must identify, by affidavits or otherwise, specific facts
showing that there is a genuine issue for trial. Id.; Maidenbaum v. Bally’s
Park Place, Inc., 870 F. Supp. 1254, 1258 (D.N.J. 1994). Thus, to withstand
a properly supported motion for summary judgment, the nonmoving party
must identify specific facts and affirmative evidence that contradict those
offered by the moving party. Andersen, 477 U.S. at 256-57. “A nonmoving
party may not ‘rest upon mere allegations, general denials or . . . vague
statements . . . .’” Trap Rock Indus., Inc. v. Local 825, Int’l Union of
Operating Eng’rs, 982 F.2d 884, 890 (3d Cir. 1992) (quoting Quiroga v.
Hasbro, Inc., 934 F.2d 497, 500 (3d Cir. 1991)). Indeed,
the plain language of Rule 56(c) mandates the entry of
summary judgment, after adequate time for discovery and
upon motion, against a party who fails to make a showing
sufficient to establish the existence of an element essential
to that party’s case, and on which that party will bear the
burden of proof at trial.
Celotex, 477 U.S. at 322. That is, the movant can support the assertion that
a fact cannot be genuinely disputed by showing that “an adverse party
cannot produce admissible evidence to support the [alleged dispute of]
fact.” Fed. R. Civ. P. 56(c)(1)(B); accord Fed. R. Civ. P. 56(c)(2).
In deciding the merits of a party’s motion for summary judgment, the
court’s role is not to evaluate the evidence and decide the truth of the
matter, but to determine whether there is a genuine issue for trial.
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Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249 (1986). Credibility
determinations are the province of the factfinder. Big Apple BMW, Inc. v.
BMW of N. Am., Inc., 974 F.2d 1358, 1363 (3d Cir. 1992).
Discussion
Defendant SanFilippo argues that, on behalf of BCBOSS, he acts as an
arm of the State in the initial processing of Medicaid applications, and
therefore is entitled to Eleventh Amendment immunity. The Eleventh
Amendment incorporates a general principle of sovereign immunity that
bars citizens from bringing suits for damages against any State in federal
court. Pennhurst State Sch. & Hosp. v. Halderman, 465 U.S. 89, 100-01
(1984). Sovereign immunity extends to State agencies and State officers, “as
long as the state is the real party in interest.” Fitchik v. N.J. Transit Rail
Operations, 873 F.2d 655, 659 (3d Cir. 1989). It does not extend to counties
and municipalities, despite their status as political subdivision of a state.
Karns v. Shanahan, 879 F.3d 504, 513 (3d Cir. 2018) (citing Bolden v.
Southeastern Pa. Transp. Auth., 953 F.2d 807, 813-14 (3d Cir. 1991)). The
Court finds no precedent for Defendant’s position here and declines to
apply State law immunity to SanFilippo, a County Defendant.
Next, however, the Court finds that there are no facts in the record to
indicate that Defendant SanFilippo had any involvement in denying

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Plaintiff’s eligibility for Medicaid benefits. Instead, the record reflects that
Defendant SanFilippo was not involved in processing the two Medicaid
applications at issue and he was not named Acting Director of BCBOSS
until about March 2016. (Danks Cert. Ex. 1; SanFilippo Cert.) Vicarious
liability is inapplicable to § 1983 suits. Ashcroft v. Iqbal, 556 U.S. 662, 676
(2009). Accordingly, insofar as a claim has been asserted against him
individually, summary judgment will be granted in favor of Defendant
SanFilippo. Further, Plaintiff has produced no evidence at this summary
judgment stage to sustain any of her claims of violations of the Medicaid
Act or other legislation in denying coverage for assisted living services for
the period from December 1, 2014 through February 28, 2015.
Conclusion
For these reasons, Defendant SanFilippo’s motion for summary
judgment [73] will be granted. An appropriate Order will be entered.

Dated: February 20, 2018

/s/ Joseph H. Rodriguez
JOSEPH H. RODRIGUEZ
U.S.D.J.

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