P u rsu a n t to F e d e ra l R u le o f A p p e llate P ro c e d u r e 4 3 (c )(2 ), K a th lee n S e b e liu s is 1 s ubs t i tut ed forM i ke Leavi t tas defe ndant
- appel l ee. 08-4992 -cv W ongv . Do ar U N I TED STA TES C O U RT O F A PPEA LS F ORTH E S EC ON D C IR C U IT
A ugus tT erm , 2008 ( A r gued: February23, 2009 D eci ded: J une 22, 2009) D ocketN o. 08- 4992- cv
S A I K W AN W ON G , byhi s guar di an K EVIN W ON G , i ndi vi dual l yand on beha l f of a cl as s of a ll o th e rs s im ila rl ys itu a te d , P la in tif f-Ap p e lla n t,

— v . — R OB ER T D OA R , i n hi s offi ci al capa ci t yas C om m i s s i oner , N ew Y or k C i t yH um an R e s o u rc e A d m in is tr a tio n , R I C HA R D F. D AINES , M
. D
. , i n hi s offi ci al capa ci t yas C o m m is s io n e r o f

N e w Y o rk S ta te D e p a rt m e n t o f H e a lth , K ATH L EEN S EB EL I US , i n her off i ci al capac i t yas Secret ary , U nit ed S t at es D epart m ent of H eal t h an d H um an S ervi ces, 1 D ef end an t s-App el l ees.
B e f o re: C AB RAN ES , R AG GI , and H A LL , C i r cui tJudges
.

___________________2

A p p ea l from an aw ard o f su m m aryjud g m en t i n fa v o r of d ef en d an ts on p lai n ti ff ’s chal l enge t o St at e M edi cai d M anual s ect i on 3259. 7, an i nform al ru le issu ed bythe U ni t ed S tate s D e p a rtm e n t o f

H e a lth a n d H u m a n S e rv ice s’ C e n te r s f o r M e d ica re a n d M e d ica id S e rv ice s, w h ich p ro v id e s th a t in c o m e p la c e d in a S p e c ial N e e d s T ru st b e c o n sid e re d in det erm i ni ng t he ext entof bene fi t s t o w hi ch a M edi cai d- el i gi bl e per s on i s ent i t l ed. W e r ej ect p l a i n t i f f ’ s a r g u me n tt h a ts e c t i o n 3 2 5 9
. 7 c o n f l i c t s wi t h t h e p l a i n l a n g u a g e o f 4 2 U. S
. C. § 1396p( d) , and w e acc or d Ski dm or e defe r ence t o t he enfor ci ng agenc y ’ s i s s uance of s ect i on 3259. 7 as a r eas onabl e exe r ci s e of di s cr et i on t o fi l l a g ap in the s t atut e on an i s s ue about
w hi ch C ongr es s fai l ed t o expr es s cl ear l yi t s i nt ent . W e al s o r ej ectplai n ti ff’ s pr ocedur al
c h a lle n g e to 4 2 C .F .R . § 4 3 5 .8 3 2 a s tim e -b a rr e d
. A F F I R MED .

A YTAN Y EHO SH UA B E LLIN , W h it e P lai n s, N ew Y o rk (R en e H
. R eixa ch , J r., R o c h e s te r, N e w Y o rk , on the br i ef ), f orP l ai nt i f f

-Appel l ant . C AR OL INA A. F OR

NO S , A s s i s t antU ni t ed St at es A t t orney( E l i zabe t h W ol s t ei n, A s s is ta n t U .S . A tto rn e y , on the br i ef ), f or L ev D as s i n, A ct i ng U ni t ed St at es A tto rn e yf

o r t h e S o u th e rn D is tr ic t o f N e w Y o rk , f

orD efen d a nt -Appel l ee Kathl een Se bel i us , Secr etar y, U ni t ed Stat es D epar tm ent of Heal th and H

um an Ser vi ces . C A R O L F I SC HER , A s s i s t antSol i ci t orG ener al ( M i chae l B el ohl avek, Seni or C o u n s e l, D iv is io n o f A p p e a ls & O p in io n s , on the br i ef ), f or A n d r e w M. C u o m o , A tto rn e yG e n e ra l o f th e S ta te o f

N e w Y o rk , f

orD ef endant

-Appel l ee R i char d F
. D ai nes , M
. D
. , C om m is s i oner, N ew Y ork Stat e D ep a rtm en tof He a lth
.I n t hi s opi ni on H H S and C M S ar e col l ect i vel yr efe r r ed t o as “the age ncy . ” 2 3 J AN ET Z. Z AL EON (K ri s te n M . H e lm e rs a n d M a ri lyn R ic h te r, on the br i ef ), f or M ic h a e l A . C a rd o z o , C o rp o ra tio n C o u n s e l o f th e C ity o f

N e w Y o rk , f

or D ef e n da n t -Ap

p e l l e e Ro b e r tDoa r, Comm is s i o n e r, Ne w York Ci t y Hum an R e s o u r c e s A dm in is tr a tio n . R EEN A R AG GI , C i r cui tJudge : Pl ai nt i ff Sai K w an W ong i s a perm anent l ydi s abl ed M edi cai d r eci pi entw ho r es i des in a n u rsin g h o m e . T h ro u g h h is g u a rd ian , W o n g a p p e a ls a n a w a rd o f su m m a ryju d g m e n t in favorof t he named c i t y , s t at e, and fede r al defe ndant s , w hi ch w as ent er ed i n the U ni t ed St at es D i s t r i ctC our tfort he Sout hern D i s t r i ct of N ew Y or k ( M i r i am G ol dm an C edarbaum, J udge) on Sept ember 29, 2009. W ong as s ert s t hatt he di s t r i ctcour terr ed i n r ej ect i ng hi s chal l enge to S tat e M ed icaid M an u al (“ S M M ”) sec ti o n 3 2 5 9
. 7 (“se cti o n 3 2 5 9
. 7 ” o r “S M M 3 2 5 9
. 7 ”),
an inf o rm al rule issue d b ythe D ep artm en t of H ea lth an d H u m an S erv ices’ (“H H S ”) C en ters forM edi car e and M edi cai d Ser vi ces ( “C M S”)
. SM M 3259. 7 r equi r es that , forpurpos es of 2 det erm i ni ng t he benefi t s due a M edi cai d- el i gi bl e i ndi vi dual , s t at es cons i deri ncome pl ace d i n a S p e c i a l Ne e d s T ru s t f o r t h a ti n d i v i d u a l ’ s b e n e f i t . S e e 4 2 U. S
. C. § 1 3 9 6 p ( d ) ( 4 ) ( A) ( defi ni ng Speci al N eeds T rust). T he rul e ef fec t i vel ypr event s M edi cai d r eci pi ent s s uch as W o n g f ro m u sin g S p e c ial N e e d s T ru sts to s h e lt e r th e ir m o n th lyS o c ial S e c u rityD isa b ili ty In su ra n c e (“ S S D I” ) in c o m e f ro m c e rta in M e d ica id e lig ib ili tyd e ter m in a tio n s. W o n g a ss e rts t hatt he di s t r i ctcourterr ed i n acc ept i ng defe ndant s ’ r el i ance on SM M 3259. 7 i n cal cul at i ng4

hi s benef i t s beca us e t he rul e confl i ct s w i t h t he expr es s l anguage of 42 U
. S. C
. § 1396p( d) , t he p ro v isio n o f th e M e d ica id A c t th a t se ts fo rth M e d ica id e lig ib ili ty ru les f o r tru sts c re a ted w ith
a n in d iv id u a l’ s a s s e ts . W e r ej ectW ong’ s r eadi ng of § 1396p( d) and i ns t ead c oncl ude thatC ongr es s di d not
s pe a k t o the qu e s t i on pr e s e nt e d by W on g’ s c l a i m. W e a pp l y Ski dmor e de fe r e nc e t o SM M 32 5 9
. 7 , w hi ch w as i s s ued byt he age ncyt o fi l l the gap l eftbyC ongr es s . See Ski dm or e v. Sw i ft& C o. , 323 U
. S. 134, 140 ( 1944) ( hol di ng t hatan age ncy ’ s “rul i ngs , i nt erpr et at i ons and opi ni ons ” of a n actadmi ni s t er ed byt he age ncy , “w hi l e notcontr ol l i ng upon the court s by
r eas on of t hei r author i t y , do cons t i tut e a bodyof expe r i ence and i nform ed j udgm entt o w hi ch
c o u rts a n d lit ig a n ts m a y p ro p e rlyre so rt f o r g u id a n c e ” ). W e c o n c lu d e th a t S M M 3 2 5 9 .7 is
an ap p rop ri ate e x erc ise o f th e a g en cy ’s au tho ri tyan d w e the ref o re a ff irm the d istri ct co u rt ’s g ra n t o f s u m m a ry ju d g m e n t to d e f e n d a n ts . I . Backg r ound A
. St atut or y B ackgr ound M edi cai d p rov ides “join t fed era l and stat e f u n d ing o f m ed ical care fo r i n d ivi dual s w ho
cann ot afford t o pay t heir ow n m edical cost s. ” A rkansas D ep’tof H eal t h & H um an S ervs.
v. A hl bor n, 547 U
. S. 268, 275 ( 2006) ; s ee al s o R abi n v. W i l s on- C oker , 362 F. 3d 190, 192 (2 d C ir. 2 0 0 4 ). A t th e f e d e ra l lev e l, C o n g re ss h a s e n tru ste d th e S e c re tar yo f H H S w ith admi ni s t er i ng M edi cai d, and the Secr et ary , i n turn, exer ci s es thatdel eg a t e d author i t ythr ough t he C M S
. S ee 42 U
. S
. C
. §§ 13 01 (a) (6) , 13 96 -1; A rkansas D ept. of H eal t h & H um an S ervs.5

v. A hl bor n, 547 U
. S. at 275; R abi n v. W i l s on- C oker , 362 F. 3d at 192. I n N ew Y or k St at e, M edi cai d i s admi ni s t er ed by t he S t at e D epart m ent of H eal t h. See R ubi n v. G arvi n, 544 F. 3d 461, 463 ( 2d C i r . 2008)
. A t t he l ocal l evel , W ong’ s M edi cai d needs ar e addr es s ed bya s oci al
s ervi ces di s t r i ctoper at ed byt he N ew Y or k C i t yH um an R es our ces A d m ini s t r at i on. See R e yn o ld s v . G iu lia n i, 5 0 6 F .3 d 1 8 3 , 1 8 7 (2 d C ir . 2 0 0 7 ). Fora s t at e t o r ece i ve fe der al fundi ng fori t s M edi cai d pr ogr am, C M S m us tdet erm i ne th a t th e sta te’ s p lan f

o r gr a n tin g a ss ista n c e c o m p lies w ith th e re q u ire m e n ts o f th e M e d ica id A ct an d it s im p lem en ti n g reg u lat ion s. S ee 4 2 U
. S
. C
. § 1 3 9 6 a(a ); R ab in v
. W il so n -C o k er, 362 F. 3d at192 ( ci t i ng W i s cons i n D ep’ tof H eal t h & Fam i l y Ser vs . v. B l um er , 534 U
. S. 473, 4 7 9 ( 2 0 0 2 )). T o c o m p lyw ith th e A c t, a s tate ’s p lan m u st in c lu d e , inte r a lia, “ re a so n a b le
s t and a r d s . . . f

o rd e t e rmi n i n g e l i g i b i l i t yf o ra n d th e e x t e n to f

me d i c a l a s s i s t a n c e u n d e rt he p l a n . ” 4 2 U. S
. C. § 1 3 9 6 a ( a ) ( 1 7 )
. S e c t i o n 1 3 9 6 a ( a ) ( 1 7 ) t h u s r e q u i r e s a s t a t e t o ma k e t wo
s epar at e det erm i nat i ons : ( 1) w hetheran i ndi vi dual i s “el i gi b[l e] for ” M edi cai d and, i f s o, ( 2) t he “e xt entof” be nefi t s t o w hi ch he i s ent i t l ed. I d. B oth det erm i nat i ons ar e i nform ed byan in d iv id u a l’s a v a ilab le “ in c o m e ” a n d “ re so u rc e s,” “ a s d e ter m in e d in a c c o rd a n c e w ith
s t andar ds pr es cr i bed byt he S ecr et ary . ” I d. § 1396a( a) ( 17) ( B ) ; H i m es v. Shal al a, 999 F. 2d 684, 686 ( 2d C i r . 1993) ; s ee a l s o 42 U
. S. C
. § 1382a ( defi ni ng i ncome) ; i d. § 1382b ( defi ni ng
reso u rce s). T h e p arti es d o n o t d ispu te th at th e f ir st de term ination w as p rop erlym ad e in W o n g ’s favor , i
. e. , he i s el i gi bl e forM edi cai d as s i s t ance . T he s ol e i s s ue on thi s appea l r el at es t o t heW o n g d o e s n o tc h a l l e n g e d e f e n d a n t s ’ c a l c u l a t i o n o f th e a p p l i c a b l e i n c o me 3 deduct i ons , and w e ther efor e do notdi s cus s t hem in d etail
. W e not e, how ever , as an exampl e, t hata M edi cai d- el i gi bl e i ndi vi dual i s ent i t l ed t o a pos t - el i gi bi l i t y i ncome deduct i on of a “ per s onal needs al l ow ance . . . w hi ch i s r easo n ab l e i n amount forcl othi ng and other per s onal needs of the i ndi vi dual ( orcouple) w h i l e i n an i ns t i tut i on and .
. . w hi ch i s not le s s . . . th a n . . . $ 3 0 .” 4 2 U .S .C . § 1 3 9 6 a (q )( 1 )( A ), ( 2 ); 4 2 C .F .R . § 4 3 5 .8 3 2 (c )( 1 ). 6 se c o n d d e ter m in a tio n — re f e rre d to in th e re g u latio n s a n d th ro u g h o u t th is o p in io n a s a “ p o stel i gi bi l i t y ” det erm i nat i on. See, e. g. , 42 C
. F. R
. § 435. 832. Speci fi cal l y , W ong s ubm i t s that defe ndant s err ed as a mat t er of l aw w hen, i n cal cul at i ng hi s M edi cai d benef i t s , t heyt r eat ed
a s in c o m e th e m o n th lyS S D I b e n e f its th a t h e p lac e s in to a S p e c ial N e e d s T ru st. T o f a c ili tate
ourdi s cus s i on of thi s ar gum ent , w e fi r s t rev iew the s t atut oryand r egul at orypr ovi s i ons g o v e rn in g th e p o st-e lig ib ili ty tre a tm e n t o f in c o m e g e n e ra llya n d o f in c o m e p lac e d in tru sts
s p e c i f i c a l l y. 1
. P o s t - El i g i b i l i t yTr e a t me n to f I n s t i tu t i o n a l i z e d I n d i v i d u a l s ’ I n c o me U n d er the M ed icaid A ct, ind ividu als rece iving ca re in “ m ed ical i n sti tuti o n s” a re
e x p e c te d to c o n trib u te a sig n if ica n t p o rtio n o f

th e ir in c o m e to w a rd s th e c o st o f th e ir i n s t i tu t i o n a l c a r e . S e e 4 2 U
. S
. C
. § 1 3 9 6 a ( q ) ( 1 ) ( A )
. T o i m p l e m e n t t h i s r e q u i r e m e n t , HHS pr om ul gat ed 42 C
. F. R
. § 435. 832, w h ich g o verns pos t - el i gi bi l i t yt r eatm entof i ncome for i ndi vi dual s , l i ke W ong, w ho r ece i ve car e i n a nurs i ng hom e. Sect i on 435. 832 r equi r es t he agenc yt o m ake c er t ai n deduct i ons fr om t he i ndi vi dual ’ s i ncome and t hen t o appl yt he
r emai ni ng i ncome t o t he cos tof the i ndi vi dual ’ s i ns t i tut i onal car e. See 42 C
. F. R
. § 435. 832. 3 Sect i on 435. 832 has a s t at e ana l ogue atN
. Y
. C om p. C odes R
. & R egs . t i t . 18, § 360-In N e w Y o rk , th is p o st-e lig ib ili tyd e ter m in a tio n is p a rt o f a p ro c e ss c a lled “ c h ro n ic 4 c a r e b u d g e t i n g . ” S e e N. Y. Co mp . Co d e s R. & Re g s . t i t . 1 8 , § 3 6 0
- 4
. 9
. I n t h i s o p i n i o n , we w i l l us e t he fede r al r egul at or ynom encl atur e and r efe rt o the s econd de t erm i nat i on s i m pl yas a “ p o s t- e lig ib ility” d e te rm in a tio n o f b e n e f its
. 7 4
. 9 , w h ich re q u ir es th at, su b ject to certai n d ed u cti o n s, “a ll inco m e m u st b e a p p li ed tow ard t he cos tof [a n i ns t i tut i onal i zed i ndi vi dual ’ s ] car e i n t he fa cil it y . ” N ew Y or k r efe r s t o a 4 M edi cai d r eci pi ent ’ s m ont hl yi ncome m i nus t he appl i cabl e deduc t i ons as t he i ndividu al’s “netavai l abl e mont hl yi ncome” or “N A M I
. ” See N ew Y or k A s s ’ n of H om es & Ser vs . for the A g ing , Inc
. v . N o v ell o , 1 3 A
. D
. 3 d 9 5 8 , 9 5 8 , 7 8 6 N
. Y
. S
. 2 d 8 2 7 , 8 2 9 (3d D ep ’t2 0 0 4 ).

2
. P o st-E lig ib ili tyT re a tm e n t o f A ss e ts P lac e d in T ru sts T o r ece i ve feder al fundi ng, s t at es m us t al s o compl y w i t h 42 U
. S. C
. § 1396p( d) , t he
sec ti o n o f th e M ed icaid A ct th at sets fo rth rules co n ce rnin g tru sts crea ted w ith an ind ividu al’s
a ss e ts. S e e 4 2 U .S .C . § § 1 3 9 6 a (a )(1 8 ), 1 3 9 6 p (h )(1 ) (d e f in in g “ a ss e ts” to “ in c lu d e [ ] a ll in c o m e a n d re so u rc e s o f th e in d iv id u a l an d o f th e in d iv id u a l’s s p o u se ” ). In g e n e ra l, § 1 3 9 6 p (d )(3 ) re q u ire s a sta te, in th e c o u rse o f d e ter m in in g w h e th e r a n in d iv id u a l is e lig ib le for M edicai d, t o con si der a sset s p l aced i n a t rust by an i nd i vidual seeki ng M edicai d b enef i t s. See K ei t h v. R i zzut o, 212 F. 3d 1190, 1193 ( 10th C i r . 2000) ( “Sect i on 1396p( d) ( 3) does not
m e re ly‘a llo w ’ sta tes to c o u n t tru sts in d e ter m in in g M e d ica id e lig ib ili ty ; it re q u ire s th e m to do s o. ” ( emphasi s i n or i gi nal ) )
. W i t h r es pect t o r evoca bl e t rus t s , § 1396p( d) ( 3) pr ovi des t hat th e tru st c o r p u s “ sh a ll b e c o n sid e re d re so u rc e s a v a ilab le to th e in d iv id u a l” a n d “ p a ym e n ts fr om t he trus tt o orfort he benefi tof the i ndi vi dual s hal l be cons i der ed i ncome of t heA Speci al N eeds T rus ti s a “di s cr et i onaryt rus tes t abl i s hed fort he bene fi tof a pe r s on 5 w i t h s ever e and chr oni c or per s i s t ent di s abi l i t y and i s i nt ended t o pr ovi de forexpens es that as s i s t ance pr ogr ams s uch as M edi cai d do notcover . ” Sul l i van v. C ount y o f S u ff ol k, 174 F. 3d 282, 284 ( 2d C i r . 1999) ( i nt ernal quot at i on m arks om i t t ed)
. Par agr aph ( d) ( 4) ( A ) defi nes a Speci al N eeds T rus tas one cont ai ni ng t he ass et s of an i ndi vi dual under age 65 w ho i s di s abl ed ( as defi ned i n s ect i on 1382c( a) ( 3) of thi s t i t l e) and w hi ch i s es t abl i s hed fort he bene fi tof s uch i ndi vi dual by a par ent , gr andpar ent , l egal guar di an of t he i ndi vi dual , or a courti f the S t at e w i l l r ece i ve al l amount s r emai ni ng i n t he trus tupon t he death of s uch i ndi vi dual up t o an amount equal t o the t ot al m edi cal as s i s t ance p aid o n b eh alf o f th e ind ividu al un d er a S tat e p lan u n d er this su b ch ap ter. 8 i ndi vi dual
. ” 42 U
. S. C
. § 1396p( d) ( 3) ( A )
. W i t h r es pect t o i r r evoca bl e trus t s , the s t atut e s t at es t hatt he port i on of t he t rus t corpus or t he i ncome t her efr om “fr om w hi ch .
. . paym entt o t he i ndi vi dual coul d be made .
. . s hal l be consi der ed re s our ces avai l abl e t o the i ndi vi dual , ” and paym ent s m ade “ t o or for t he benef i t of t he i ndi vi dual ” fr om t he t rus t “s hal l be cons i der ed in c o m e o f

th e in d iv id u a l.” Id . § 1 3 9 6 p (d )( 3 )( B ). I n s ect i on 1396p( d) , how ever , C ongr es s pr ovi ded a l i m i t ed except i on t o t he gene r al rul e t hat a s tate m u st co nsi der trustasset s i n m aking M edicai d eli gibi l i t ydeterm i nati on s. S ect i on 13 96 p(d)( 1) i nst ruct s that the “rul es speci fi ed in paragraph (3) shal l app l yt o a trust
e s ta b lis h e d b y ” a n i n d iv id u a l s e e k in g M e d ic a id a s s is ta n c e , b u t “ s u b je c t to p a ra g ra p h (4 ).” Id . § 1 3 9 6 p (d )(1 ). P a ra g ra p h (4 ), in tu rn , in stru c ts th a t “ [ t]h is su b se c tio n sh a ll n o t ap p lyto anyof” the trus t s defi ned i n § 1396p( d) ( 4) ( A ) , ( B ) , and (C). I d. § 1396p( d) ( 4)
. T o r es ol ve t hi s appea l , w e foc us on t he for m of t rus tcr eat ed by§ 1396p( d) ( 4) ( A ) , know n as a Speci al N e e d s T ru st. 54 2 U
. S
. C
. § 1 3 9 6 p (d)(4 )(A ).

T he St at e M edi cai d M anual i s avai l abl e on the C M S w ebs it e. S M M , avai l abl e at 6 ht tp: //w w w . cms. hhs
. gov/( fol l ow “R egul at ion s & G ui dance ” hyper l i nk; t hen fol l ow “M anu al s” hyperl i nk un der the h eading “G uidance”; then foll ow “P ap e r-B a se d M anu al s” h yp e rlin k o n th e lef

t sid e o f th e p a g e ; th e n se lec t p u b lica tio n n u m b e r 4 5 , “T h e S tate M e d ica id M a n u a l.”). T h e S M M f o re w o rd e x p lain s th a t th e “ m a n u a l m a k e s a v a ilab le to a ll St at e M edi cai d agenc i es , i n a form s ui t abl e forr eadyr efe r ence , i nform at i onal and pr ocedur al m at er i al neede d by t he St at es t o admi ni s t er t he M edi cai d pr ogr am. . . . T he manual pr ovi des instruction s, reg u lat o ry cit ati o n s, an d inf o rm ati o n fo r i m p lem en ti n g p rov isi o n s o f T it le X IX of the Soci al Secur i t yA ct( t he A ct )
. I ns t ruct i ons ar e off i ci al i nt erpr et at i ons of the l aw and re g u la tio n s , a n d , a s s u c h , a re b in d in g o n M e d ic a id S ta te a g e n c ie s .” S M M F o re w o rd
. 9 T he Secr et aryhas i nt erpr et ed C ongr es s ’ s i ns t ruct i on thats ubs ect i on (d) “sh all not
a p p ly ” to th e tru sts listed in p a ra g ra p h (d )(4 ) a s a d e leg a tio n o f a u th o r it y to th e a g e n c yto d e ter m in e w h a t elig ib ili ty a n d p o st-e lig ib ili tyru les sh a ll ap p lyto th o se tru sts . S e e g e n e ra lly W i s cons i n D ep’ tof H eal t h & Fam i l y Ser vs . v. B l um er , 534 U
. S. at497 n. 13 ( “W e have l ong not ed C ongr es s ’ del egat i on of extr emel ybr oad r egul at oryauthor i t yt o t he S ec reta r yi n t he M edi cai d ar ea. ” (c i t i ng Schw ei ker v. G r ayPanther s , 453 U
. S. 34, 43 ( 1981) ) ; U ni t ed St at es
v . M e a d C o rp ., 5 3 3 U .S . 2 1 8 , 2 2 9 (2 0 0 1 ) (d isc u ss in g f o rm s o f c o n g re ss io n a l d e leg a tio n to agenc i es )
. A ccor di ngl y , i n N ovember 1994, t he S ecr et ary , t hr ough t he C M S, added s ect i on 32 59
. 7 to the S M M t o fil l t his percei ved st atutorygap . S M M 32 59
. 7 p rovi des as foll ow s: 6 W hen an exem pt t rust for a dis abled i nd i vidual [as defined in § 1 3 9 6 p ( d ) ( 4 ) ( A) ] i s e s t a b l i s h e d us i ng t h e i n d i v i d u a l ’ s i n c o me ( i
. e . , i n c o me cons i de r e d t o b e r e c e i ve d b ythe i nd i vi du a l un de rthe rul e s of the SSI p ro g ra m ), t h e p o lic ie s s e t f o rt h in s u b s e c tio n C f

o r t re a tm e n t o f

in c o m e . . . a p p l y.E xceptw her e not ed, t he fol l ow i ng di s cus s i on i s dr aw n fr om t he part i es ’ St at ement 7 o f S tip u la te d F a c ts , f

ile d w ith th e d is tr ic t c o u rt . 10 S M M 3 2 5 9 .7 (B )(1 ). S u b se c tio n C in stru c ts th a t: I ncome pl ace d i n a [Spec i al N eeds T rus t ] i s i ncome forSSI purpos es al t hough i ti s notcount ed as avai l abl e i n det erm i ni ng M edi cai d el i gi bi l i t y . T hus , s uch in c o m e is a lso su b

jec t to th e p o st-e lig ib ili ty ru les
. . . . [ A ]ll inc o m e p lac e d in a [Spec i al N eeds T rus t ] i s combi ned w i t h count abl e i ncome notpl ace d i n the t rustfor po st -el i gibi l i t ypu rposes. SM M 3259. 7( C ) ( 5) ( b) ( emphasi s added)
. T he ef fec tof SM M 3259. 7 i s t hat i ncome pl ace d in a S p e c ia l N e e d s T ru st is n o t co n sid e re d in m a k in g th e f irst d e ter m in a tio n o f

“ e lig ib ili ty for ” M ed icaid, buti s cons i der ed i n m aki ng the s econd de t erm i nat i on of the “e xt entof” b e n e f its to w h ich a n e lig ib le in d iv id u a l is e n tit led . R e ly in g o n S M M 3 2 5 9 .7 , d e f e n d a n ts countt he i ncome an i ns t i tut i onal i zed i ndi vidu al p l ace s i n a Speci al N eeds T rus tw hen det erm i ni ng how m uch of the i ndi vi dual ’ s i ncome he m us t contr i but e t o t he cos t of hi s car e. W ong chal l enges SM M 3259. 7 on t he gr ound thati t confl i ct s w i t h t he expr es s l anguage of 4 2 U .S. C
. § 1 39 6p (d)
. S ee 5 U
. S
. C
. § 7 06 (2) (C ) ( “T he revi ew i ng cou rtshal l
. . . h o ld unl aw ful and s etas i de age ncyact i on, fi ndi ngs , and concl us i ons found t o be .
. . i n exce s s of
s ta tu to ry ju ri s d ic tio n , a u th o ri ty, o r l im ita tio n s , o r s h o rt o f s ta tu to ry rig h t.” ). B
. Factual B ackgr ound 7 P lain tiff S a i K w a n W o n g is a d isa b led in d iv id u a l u n d e r th e a g e o f 6 5 w h o re sid e s in
a n u rsin g h o m e in N e w Y o rk C ity . O n D e c e m b e r 1 , 2 0 0 5 , W o n g b e g a n re c e iv in g m o n th ly M edi cai d contr i but i ons t ow ar ds t he cos tof hi s nur s i ng- hom e ca r e. B yw ayof exa m pl e, theIti s und i sputed t hat the trustest abli shed b yW on g q uali fi es as a Sp eci al N eeds T rust 8 u n d er § 1 3 9 6 (d)(4 )(A ). 11 p a r t i e s n o t e t h a ti n M a y2 0 0 7 , M e d i c a i d p a i d $ 8 , 0 9 5
. 8 9 o f W o n g ’ s mo n t h l yn u r s i n g h o me bi l l , whi c h e x c e e d s $ 9 , 0 0 0 p e r mon t h
. Se e W o n g v . Dai n e s , 5 8 2 F. Su p p . 2 d 4 75, 477 (S .D .N .Y . 2 0 0 8 ). D ur i ng t he r el evantt i m e per i od, W ong’ s s ol e s our ce of i ncome has been $1, 401. 00 i n m ont hl ySSD I benef

i t s . Pur s uantt o the s t atut oryand r egul at orys cheme s etfor t h above, N ew Y or k cal cul at ed t he r el evant deduct i ons fr om W ong’ s i ncome — deduct i ons t hatW ong does not chal l enge — and det erm i ned t hat W ong has a N A M I of $1, 024. 81. Pur s uantt o 42 C
. F. R
. § 435. 832 and N
. Y
. C om p. C o d es R
. & R eg s . t i t . 18, § 360- 4. 9, N ew Y or k has
r equi r ed W ong t o contr i but e thi s N A M I t o t h e m o n thlycos tof hi s nur s i ng- hom e ca r e, t her ebym aki ng up t he di ffe r ence betw een the t ot al m onthl ycos tof thatcar e and the port i on of i tpai d forbyM edi cai d. W ong m ade thi s m onthl ycontr i but i on unt i l N ovember2006. In N o v em b er 20 0 6 , W o n g ’s lega l g u ard ian crea ted a S p ec ial N ee d s T rust o n W o n g ’s b e h a lf , se e 4 2 U .S .C . § 1 3 9 6 p (d )(4 )(A ), an d b e g a n d e p o sitin g W o n g ’s $ 1 ,0 2 4 .8 1 N A M I in to t he trus t ea ch m o n th. W ong’ s guar di an not i fi ed N ew Y or k C i t y ’ s H um an R es our ces 8 Admi ni s t r a t i o n ( “ HRA” ) o f t h i s a c t i o n . I n a c c o r d a n c e wi t h S M M 3 2 5 9
. 7 , h o we v e r , HRA
c o n tin u e d to tre a t W o n g ’s N A M I as in c o m e a v a ilab le f o r c o n trib u tio n to w a rd s th e m o n th ly
c o s t o f W o n g ’s in s titu tio n a l c a re . O n February6, 2007, W ong, t hr ough hi s guar di an, fi l ed s ui ti n the Sout hern D i s tr i ctT h e d istri ct co u rtco n stru ed W o n g ’s co m p lai n t to raise c lai m s ag ains t th e S ec retary 9 of H H S pur s uantt o t he A dm i ni s t r at i ve Pr ocedur e A ct , 5 U
. S. C
. §§ 701- 706, and aga i ns tt he C om m i s s i oner s of the N ew Y or k St at e D epartm entof H ea l t h and N ew Y or k C i t yH um an R es our ces A dm i ni s t r at i on pur s uant t o 42 U
. S. C
. § 1983. See W ong v. D ai nes , 582 F. Supp. 2d at 476 & n . 1
. Th e d i s t r i c t c o u r t c o n c l u d e d t h a t § 1 3 9 6 p ( d ) ( 4 ) p r o v i d e s W o n g w i t h a f e d e ra l rig h t e n f

o rc e a b le th ro u g h 4 2 U .S .C
. § 1 9 8 3
. S e e id
. a t 4 7 9 ; ac c o rd L e w is v . R e n d e ll, 501 F. Supp. 2d 671, 687 ( E
. D
. Pa. 2007)
. W e as s um e, for purpos es of t hi s appea l onl y , t hat W ong has s uch a r i ght
. B eca us e w e re j ect W ong’ s cl ai m on t he m er i t s , how ever , w e nee d no tde c i de w he t he r § 139 6p ( d) ( 4) mee t s t he t e s t s e t fo r t h i n B l e s s i ng v. Fr e e s t on e , 52 0 U. S. 329, 340- 41 ( 1997) ( “Fi r s t , C on gr es s m us thave i nt ended thatt he pr ovi s i on i n ques t i on b e n e f it th e p lain tiff. S e c o n d , the p lain tiff m u st d e m o n stra te th a t th e rig h t as se rte d ly p ro tec ted b yth e sta tu te is n o t so ‘v a g u e a n d a m o rp h o u s’ th a t it s e n f o rc e m e n t w o u ld stra in j udi ci al compet ence . T hi r d, t he s t atut e m us t unambi guous l y i m pos e a bi ndi ng obl i gat i on on th e S tate s. In o th e r w o rd s, th e p ro v isio n g iv in g rise to th e a ss e rte d rig h t m u st b e c o u c h e d in m an d atory , rathe r th an p rec atory , term s. ” (c it ati o n s o m itted)). T he Secr et aryof H H S al s o m oved fordi s m i s s al on gr ounds that the co u r tl acke d 10 j ur i s di ct i on i n t he abs ence of a fi nal agenc yact i on, s ee 5 U
. S. C
. §§ 702, 704; thatpl ai nt i ff fai l ed t o exhaus thi s admi ni s t r at i ve r emedi es , s ee i d
. § 7 0 4 ; and thatpl ai nt i ff l acke d cons t i tut i onal s t andi ng beca us e he ha d fai l ed t o demonstrate inj ury - i n- fac tas r equi r ed by 12 o f N e w Y o rk o n b e h a lf

o f h im se lf a n d a c las s o f

sim ila rlysitu a ted M e d ica id -e lig ib le i ndi vi dual s w ho had depos i t ed thei rN A M I s i nt o Speci al N ee d s T rus t s , butw ho had
nevert hel es s been r equi r ed t o contr i but e thos e funds t o t he mont hl ycos tof thei ri ns t i tut i onal
car e pur s uantt o SM M 3259. 7. W ong ’s c o m pl ai ntas s ert s thatthe pl ai n l anguage of 9 § 1 39 6p (d) precl ud es d efen dan t s from con si deri ng i nco m e placed i n a S pecial N eeds T rust f o re i t h e rM e d i c a i d e l i g i b i l i t yo rp o s t - e l i g i b i l i t yp u rp o s e s a n d t h a tt h e S e c r e t a r yo f HHS t her efor e err ed i n i nt erpr et i ng t he s t atut e as cr eat i ng a gap r equi r i ng ag en cy inter vent i on. O n A ugus t31, 2007, al l t hr ee de fenda nt s m oved fo rs um m aryj udgm ent , and on S ep tem b er 2 9 , 2 0 0 8 , th e d istri ct co u rtg ran ted th e m o ti o n s. A lth o u g h the d istri ct co u rt 10A r t i cl e I I I of the C ons t i tut i on. T he di s t r i ct cour t r ej ect ed t he Secr et ary ’ s A r t i cl e I I I s t andi ng

arg u m en t b u t d ec li n ed to add ress his fina l- o rde r an d ex h au sti o n arg u m en ts be ca u se th e c o u rt w as r equi r ed, i n any event , t o r eac h t he mer i t s of pl ai nt i ff’ s cl ai m agai ns tthe C om m i s s i oner of the St at e D epart m entof H eal t h, and t hat cons i der at i on i ndi cat ed thats um m aryj udgm ent w as appr opr i at el ygr ant ed t o t he Secr et aryas w el l as the otherdefe ndant s . See W ong v. D ai nes , 582 F. Supp. 2d at 478. B eca us e t he Secr et ary does notr enew thes e ar gum ent s on appea l , w e nee d notaddr es s t hem exceptto n o te o u r agr eementw i t h t he di s t r i ctcour tt hat W on g ha s c on s t i tut i on a l s t a nd i ng t o br i ng t hi s c l a i m. H e ha s a l l e ge d tha t , a s a r e s ul tof SM M 3 2 5 9 .7 , h e h a s s u f

f e r e d a n in

ju ryth a t w o u ld b e re d re ss e d b ya d e c isio n o f th is c o u rt in h is f a v o r. S e e F rie n d s o f

th e E a r th v . L a id law , 5 2 8 U .S . 1 6 7 , 1 8 0 -8 1 (2 0 0 0 ) (n o tin g th a t “to sati sfyA rt icl e III ' s stan d ing req u ir em en ts, a p lai n ti ff m u st sho w (1) ith as su ff ere d an ‘i n

jury i n fac t ’ t hati s ( a) concr et e and par t i cul ar i zed and ( b) actual ori m m i nent , notconj ectur al or hypot het i cal ; ( 2) t he i nj ur yi s fai r l ytr ace abl e t o t he cha l l enged a ct i on of the def endant ; and 3 ) i t i s l i k e l y , a s o p p o s e d t o m e r e l y s p e c u l a t i v e , t h a tt h e i n j u r y w i l l b e r e d r e s s e d b y a fa v o rab le de cisi o n ” (c itti n g L u jan v
. D ef

en d ers o f W il d li fe , 5 0 4 U
. S
. 5 5 5 , 5 6 0 -61 (19 9 2 )); S e e Ju id ice v . V a il, 4 3 0 U .S . 3 2 7 , 3 3 1 (1 9 7 7 ) (a c k n o w led g in g p lain tiff s’ sta n d in g to su e sta te o f f ic ia ls f o r i n ju n c tiv e re lie f

). T he C om m i s s i onerof N ew Y or k C i t y ’ s H um an R es o u r c e s Admi n i s tr at i on al s o m oved t o di s m i s s t he compl ai ntpur s uant t o Fed. R
. C i v. P. 12( b) ( 6) on the gr ound thatthe C i t yhas no contr ol overt he ch all en ged pol i cyand ther efor e ca nnotbe s ubj ectt o l i abi l i t yunder42 U .S .C . § 1 9 8 3
. T h e d istric t co u rt d e c lin e d to a d d re ss th is a rg u m e n t, co n c lu d in g th a t it s res olut i on of the st at e’s m oti on for sum m ary j ud gm ent requi red t hat sum m ary j ud gm ent al so b e g r a n t e d i n f

a v o ro f t h e Ci t y . Al t h o u g h th e Ci t yh a s r e n e we d th i s a r g u me n to n a p p e a l , we n e e d n o t r e s o lv e it b e c a u s e w e a f f ir m th e d is tr ic t c o u rt ’s g ra n t o f s u m m a ry ju d g m e n t. 13 agr eed w i t h pl ai nt i ff that§ 1396p( d) ( 4) unambi guous l yexempt s Speci al N eeds T rus t s fr om bot h M edi cai d el igi bi l i t yand pos t - el i gi bi l i t ydet erm i nat i ons , i tnevert hel es s aw ar ded
su m m a ryju d g m e n t in f a v o r o f d e f e n d a n ts o n th e g ro u n d th a t th e e x e m p tio n p ro v id e d in (d )(4) app l i es on l y t o “[a] t rust con t ai ning the ass et s of an i nd i vidual , ” and t hat no th in g in (d) (4) preven t s the ag encyfrom t reat i ng W o n g ’s S S D I as avail able i nco m e bef ore tho se f u n d s a re p la c e d in tru s t. S e e W o n g v . D a in e s , 5 8 2 F . S u p p . 2 d a t 4 8 4
. W o n g tim e ly ap p e a le d th is d e c is io n .14

I I . D i s cus s i on In c h a llen g in g th e d istric t co u rt’s a w a rd o f s u m m a ryju d g m e n t, W o n g e ss e n tially
r el i es on t he l egal cl ai m s i n hi s compl ai nt , r ai s i ng a s ubs t ant i ve chal l enge t o the appl i cat i on of SM M 3259. 7 t o t he ca l cul at i on of hi s M edi cai d benef i t s and a pr ocedur al chal l enge t o 42 C
. F. R
. § 435. 832. W e r evi ew an aw ar d o f su m m ary jud g m entde novo. See Est at e of L ander s v. L eavi t t , 545 F. 3d 98, 105 ( 2d C i r . 2008)
. W e concl ude t hatW ong’ s s ubs t ant i ve
c h a lle n g e is w ith o u t m e ri t a n d h is p ro c e d u ra l c h a lle n g e is tim e -b a rr e d
. A
. W o n g ’s S u b s ta n tiv e C h a lle n g e to S M M 3 2 5 9 .7 W o n g a s s e r t s t h a tS M M 3 2 5 9
. 7 i s i n v a l i d b e c a u s e i tc o n f l i c t s wi t h 4 2 U. S
. C. § 1 3 9 6 p (d ). A c c o rd in g ly , h e su b m its th a t th e d istric t c o u rt e rre d in a llo w in g d e f e n d a n ts to
re lyo n th e ru le in tre a tin g a s in c o m e h is m o n th ly$ 1 ,0 2 4 .8 1 c o n trib u tio n o f S S D I b e n e f

its t o a Speci al N eeds T rus ti n det erm i ni ng the “ext ent of” M edi cai d benef i t s t o w hi ch he w as
e nt i t l e d. H e s ub mi t s tha tde fe nd a nt s s ho ul d, i n f a c t , ha ve be e n e nj oi ne d f r om ap pl y i ng SM M 3 2 5 9 .7 to th e c a lc u la tio n o f h is b e n e f

its . W e d is a g re e . I n r evi ew i ng W ong’ s chal l enge t o SM M 3259. 7, w e as k fi r s t“w hetherC ongr es s has di r ect l ys poken t o t he pr eci s e ques t i on at i s s ue, ” U ni t ed St at es v. C onnol l y , 552 F. 3d 86, 89 (2 d C ir. 2 0 0 8 ) (in ter n a l q u o tatio n m a rks om i tt ed), nam el y , w hat el ig ib ili tya n d p o st-e lig ib ili ty rul es applyt o incom e placed bya M edicai d-el i gibl e i nd i vidual i nto a Sp eci al N eeds T rust
c re a ted p u rsu a n t to § 1 3 9 6 p (d )(4 )(A ). B e c a u se w e c o n c lu d e th a t C o n g re ss d id n o t d ire c tly15

sp ea k to this i ssu e, w e p roc ee d to a s ec o n d in q u ir y , ask ing w h ethe r th e a g en cy ’s i nt erpr et at i on of § 1396p( d) i s of the type el i gi bl e fordefe r ence underC hevr on, U
. S. A
. , I nc.
v. N atur al R es our ces D efe ns e C ounci l , I nc. , 467 U
. S. 837 ( 1984)
. See E s t at e of Lander s v. L e a v i t t , 5 4 5 F
. 3 d a t1 0 4
- 0 5
. Re s o l v i n g t h a tCh e v r o n d e f e r e n c e i s n o td u e i n t h i s c a s e , “ we
cons t rue the s t atut e i n t he fi r s t i ns t ance , gi vi ng eff ectt o C M S’ s nonl egi s l at i ve i nt erpr et at i on t o t he ext entw e fi nd i t per s uas i ve i n acc or dance w i t h Ski dm or e v. Sw i ft& C o. , 323 U
. S. 134 ( 1 9 4 4 )
. ” E s t a t e o f

L a n d e r s v . L e a v i t t , 5 4 5 F
. 3 d a t1 0 5
. App l y i n g t h e s e p r i n c i p l e s , we
con cl ud e t hat j ud gm ent w as properl yenter ed in favo r of defen dan t s.

1. C ongr es s H as N otD i r ect l ySpoken t o t he Pr eci s e Q ues t i on atI s s ue A t th e f irst step o f a n a ly sis , w e c o n sid e r W o n g ’s a rg u m e n t th a t S M M 3 2 5 9 .7 c o n f licts
w ith the c lear inten t of

C o n g ress ex p resse d in the p lai n lang u ag e o f § 1 3 9 6 p (d)(1 ) an d (4). T o re itera te th a t lan g u a g e , su b p a ra g ra p h (d )(1 ) sta tes : Forpurpos es of det erm i ni ng an i ndi vi dual ’ s eli gi bi l i t yfor , oramount of, benef i t s under a St at e pl an under t hi s s ubchapt er , s ubj ectt o par agr aph ( 4) , the rul es s pec ifi ed i n par agr aph ( 3) s hal l appl yt o a trus tes t abl i s hed bys uch in d iv id u a l. 42 U
. S. C
. § 1396p( d) ( 1) ( emphasi s added)
. Subpar agr aph ( d) (4), in t urn, i ns t ruct s t hat “[t ] hi s s ubs ect i on s hal l notappl y ” t o the trus t s d ef ined i n ( d) ( 4) ( A ) , ( B ) , and ( C )
. I d. § 1 3 9 6 p (d ) ( 4 ). W o n g in terp re ts s u b p a ra g ra p h (d )(4 )’s in stru c tio n th a t th e ru les in “ th is
su b se c tio n sh a ll n o t a p p ly ” a s a c lea r sta tem e n t o f C o n g re ss ’s in ten t th a t “in c o m e p lac e d in
a [ S p e c ial N e e d s T ru st] m a yn o t b e c o u n ted ” f o r e ith e r e lig ib ili tyo r p o st-e lig ib ili tyT he di s t r i ctcour tconcl uded t hat “[d] efe ndant s ’ ar gum ent i gnor es t he si m pl es tand 11 cl ear es texpl anat i on: t hatC ongr es s exce pt ed [Speci al N eeds T rus t s ] fr om al l el i gi bi l i tyand benef i t s cal cul at i ons . N o gap exi s t s . . . . Subse ct i on ( d) i s t her efor e notambi guous . ” W ong v . D a in e s, 5 8 2 F . S u p p . 2 d a t 4 8 4 (e m p h a sis a d d e d ). W e d o n o t in terp re t th e sta tu te to m ani fes t cl ear congr es s i onal i nt ent t hat ( d) ( 4) t rus t s s houl d not be cons i der ed atal l i n m aki ng eli g ibil ityo r p o st- eli g ibil ity d eterm ination s. B ec au se w e ide n ti fyam b igu ityas to C o n g ress’s i nt enton t hi s i s s ue, w hi ch w e r es ol ve byacc or di ng Ski dm or e def er ence t o t he enfor ci ng a g e n c y ’s r u le , se e in f

ra a t [ 23- 30] , w e a ff

irm the c h all en g ed su m m aryjud g m en t aw ard w ith o u t re a c h in g th e q u e stio n a d d re ss e d b yth e d istric t co u rt, i .e., w h e th e r S o c ial S e c u rity benef i t s ar e pr oper l yt r eat ed as avai l abl e i ncome be for e bei ng pl ace d i n t rus t . See B ruh v. B es s emerV entur e Par t ner s I I I L
. P. , 464 F. 3d 202, 205 ( 2d C i r . 2006) ( “[W ] e mayaff i r m [a gr antof s um m ary j udgm ent ] on any bas i s for w hi ch t her e i s s uffi ci ents uppor ti n t he r ecor d, inclu d ing g rou n d s n o t r eli ed o n b ythe d istri ct co u rt . ”). A l t hough ( d) ( 4) i ns t ruct s t hatt he “s ubs ect i on s hal l not appl y ” t o the trus t s defi ned 12 i n ( d) ( 4) ( A )
- ( C ) , 42 U
. S. C
. § 1396p( d) ( 4) ( emphasi s added) , w e cons t rue thatcomm and as excl udi ng t he t rus t s s et for t h i n ( d) ( 4) fr om the rul es s etfor t h i n s ubpar agr aph ( d) ( 3)
. O ur cons t ruct i on i s compel l ed byt he t extof ( d) ( 1) and bythe rul e thatw e mustnotcons true a s t atut e i n a w ayt hatl eads t o abs ur d r es ul t s . See N i xon v. M o. M un. L eague , 541 U
. S. 125, 1 3 8 (2 0 0 4 ). It w o u ld in d e e d b e a b su rd to a ss u m e th a t C o n g re ss sp e c if ica llyd e f

in e d c e rta in qual i fy i ng t rus t s i n ( d) ( 4) ( A )
- ( C ) , onl yt o di s car d t hos e def i ni t i ons byi ns t ru cti n g that t he en ti retyo f su b sec ti o n (d) — incl u d ing tho se d ef init ion s — “sh all n o t app ly ” to th o se v ery t rus t s . M or eover , t he pl ai n l anguage of s ubpar agr aph ( d) ( 1) expl i ci t l yi dent i fi es t he comm and i n ( d) ( 4) as an exc ept i on t o the ru les setfor t h i n s ubpar agr aph ( d) ( 3) , nott o t he e n tir e ty o f

s u b s e c tio n (d ). 16 d eterm ination s. A p p ell an t’ s B r. at 3 1 (em p h asis ad d ed ). A lth o u g h the d istri ct co u rtap p ea rs t o have agr eed w i t h t hi s cons t ruct i on, w e concl ude t hat t he pl ai n l anguage of the s t atut e does not , i n fac t , compel t hi s concl us i on. 11 Sub p ara g rap h s (d)(1 ) an d (d)(4 ) t o g ethe r estab li sh tw o g rou p s o f trusts: thos e t o w hi ch ( d) ( 3) appl i es and thos e t o w hi ch i tdoes n o tappl y . C ongr es s ’ s negat i ve comm and that 12 ( d) ( 3) “s hal l notappl y ” t o t he trus t s r efe r ence d i n ( d) ( 4) d o es n o t, how ever , pr ovi de any17

gui dance as t o w hat rul es s hal l appl y t o ( d) ( 4) t rus t s . C f. C hevr on, U
. S. A
. , I nc. v. N atur al R es. D ef. C ou ncil , Inc. , 46 7 U
. S
. at84 7-48 ( no t i ng st atutory “gap ” creat ed w hen C on gress f a iled to re a c h c o n se n su s o n iss u e ). A c c o rd in g ly , w e h o ld th a t C o n g re ss h a s n o t “d ire c tly
s poken t o t he pr eci s e ques t i on ati s s ue. ” U ni t ed St at es v. C onnol l y , 552 F. 3d at89. Sul l i van v . C o u n ty o f Suffol k, 174 F. 3d 282 ( 2d C i r . 1999) , r el i ed on byW ong,
w a rra n ts n o d if

f e re n t co n c lu sio n . In S u lli v a n , this c o u rt h e ld th a t th e p lain tiff M e d ica id
r eci pi entw as r equi r ed t o s at i s fy a M edi cai d l i en, s ee 42 U
. S. C
. § 1396k( a) ( 1) ( A ) ; N
. Y
. Soc. Ser v. L a w § 1 0 4
- b , f

r o m th e p r o c e e d s o f h i s t o r t s e t t l e me n t a g a i n s t a t h i r d p a r t y b e f o r e he
co u ld d ep o sittho se f

u n d s into a S p ec ial N ee d s T rust cre ated p u rsua n t t o § 1 3 9 6 p (d)(4 )(A ),
s ee Sul l i van v. C ount y of Suffol k, 174 F. 3d at286. I n t he cour s e of ourdi s cus s i on, w e s t at ed th a t, “[ a ]c c o rd in g to [ § 1 3 9 6 p (d )(1 ), (4 )], tru st a ss e ts d o n o t a f f e c t th e b e n e f

icia ry ’s m e d ica id el i gi bi l i t yas l ong t he trus tcont ai ns a ‘ payback’ pr ovi s i on al l o w i ng t rus tas s et s r emai ni ng upon t he r eci pi ent ’ s death t o be us ed t o r ei m bur s e t he st at e forthe t ot al m edi cal as s i s t ance i tpr ovi ded t o t he t rus t benef i ci ary . ” I d. at285. W ong as s ert s thati n t hi s s ent ence w e “he l d” t hatt he pl ai n l anguage of the st atut e re qui r es t hat as s et s pl ace d i n a qual i fy i ng Speci al N eeds T ru st b e e x e m p ted f

ro m M e d ica id e lig ib ili tyo r b e n e f its d e ter m in a tio n s. H e is in c o rre c t. Fi r s t , t he cont extof the quot ed s t at ement fr om Sul l i van i ndi cat es t hat t he cour tw as
s i m pl ys t at i ng t he pl ai nt i ff’ s pos i t i on, notrul i ng as t o t he pr oper i nt erpr et at i on of t he s t atut e. T he par agr ap h c o n s i s t s o f f o u rs e n t e n c e s , t h e o t h e rt h r e e o f whi c h b e g i n wi t h “ Su l l i v an cl ai m s ” or“Sul l i van ar gues . ” I d. M or eover , t he fol l ow i ng par agr aph begi ns bys t at i ng, “W e18

re jec t ap p e llan t’s a rg u m e n ts . . . .” Id . at 2 8 6
. T o th e e x ten t th e q u o ted se n ten c e th u s m e re ly st at ed S ull i van ’s po si t i on , i tprovides no sup po rtfor W on g’s ar gu m ent that i tcon st i tutes a h o ld in g b yth is c o u rt . Fur t her , the q uot ed s ent ence w as notes s ent i al t o t he court ’ s hol di ng, w hi ch w as p rem ised o n a d eterm ination that the s tat e’s M ed icaid li en “a tt ac h ed d ir ec tl yto the tort
se ttl e m e n t p roceeds, ” such thatt he p l ai nti ff “h ad n o ri gh tt o the [fun ds] and co uld not use [them] t o es t abl i s h a t rus t . ” I d. B eca us e t he pl ai nt i ff had no r i ght t o t he funds ati s s ue under 4 2 U .S .C . § 1 3 9 6 k (a )(1 )(A ) a n d N .Y . S o c . S e rv . L a w § 1 0 4 -b , o u r c o u rt h a d n o re a so n to d e ter m in e th e e f

f e c t th o se f

u n d s w o u ld h a v e h a d o n h is M e d ica id e lig ib ili tya n d p o ste lig ib ili tyb e n e f

its d e ter m in a tio n s h a d th e M e d ica id lien n o t atta c h e d a n d h a d h e b e e n a b le to pl ace tho se fun ds i n a S pecial N eeds Trust
. T herefore, even t o the ext ent t he sin g le sent ence in S ull i van m i gh t be read t o supp ort W on g’s const ruct i on of § 13 96 p(d), i ti s atbest di ctum t hatdoes not bi nd us her e. See C entr al V a. C m t y . C ol l
. v. K at z, 546 U
. S. 356, 363 ( “[W ] e ar e notbound t o fol l ow ourdi ct a i n a pr i orcas e i n w hi ch the poi ntnow ati s s ue w as
n o t fu ll yd eb ated
. ”); M arti n ez v . M u k ase y , 5 5 1 F
. 3 d 1 1 3 , 1 2 1 n . 1 0 (2d C ir
. 2 0 0 8 ). W e a re a lso u n p e rsu a d e d b yW o n g ’s a rg u m e n t th a t u se o f th e ter m “ a ss e t” in § 1 3 9 6 p (d )(4 )(A ) c o m p e ls th e c o n c lu sio n th a t C o n g re ss in ten d e d to a llo w in d iv id u a ls to
s hel t erfr om M edi cai d pos t - el i gi bi l i t y cons i der at i on SSD I i ncome pl ace d i n Speci al N eeds T rust s . W ong not es t hata Speci al N eeds T rus ti s a trus tt hatcont ai ns an i ndi vi dual ’s

“ a ss e ts,” 4 2 U .S .C . § 1 3 9 6 p (d )(4 )(A ); th a t “a ss e ts” a re sta tu to rily d e f in e d to in c lu d e “ a llC ont r aryt o W ong’ s as s er t i on, t he appl i cat i on of S M M 3259. 7 does not l ead t o t he 13
“ a b su r d re su lt” th a t an in d iv id u a l m a yn e v e r p lac e h is in c o m e in a S p e c ial N e e d s T ru st. 19 in c o m e a n d re so u rc e s,” id . § 1 3 9 6 p (h )(1 ); a n d th a t th e sta tu to ryd e f in iti o n o f “ in c o m e ,” in tur n, i ncl udes SSD I benef i t s , s ee i d. § 1396p( h) ( 2) ( i ncorpor at i ng defi ni t i on of i ncome fr om § 1392a)
. W ong ar gues t hat , beca us e S SD I benef i t s ar e “as s et s , ” and as s et s m aybe pl ace d i n a S p e c i a l Ne e d s T ru s t , Co n g r e s s mu s t h a v e i n t e n d e d t o p e rmi ti n d i v i d u a l s t o s h e l t e rS S DI ben efi t s i n S pecial N eeds T rust s fr om po st -el i gibi l i t ydeterm i nati on s. W h ile W o n g ’s d e sc rip tio n o f th e se sta tu to ryd e f in iti o n s is c o rre c t as f

a r a s it g o e s, it cannotgo s o faras t o s uppor thi s concl ud ing ar gum ent . W e mayas s um e thatt he ci t ed
s t atut or ypr ovi s i ons perm i tt he cr eat i on of a Spec i al N eeds T rus t w i t h SSD I i ncome. I ndeed, defe ndant s do notdi s put e thatW ong cr eat ed a b o n a fid e S peci al N eeds T rus tunder § 1 3 9 6 p ( d ) ( 4 ) ( A)
. Th e i s s u e p r e s e n t e d o n t h i s a p p e a l , h o we v e r , i s n o twh e t h e rS S DI i n c o me
m ayb e u sed to cre ate a S p ec ial N ee d s T rust, b u t w h at M ed icaid p o st- eli g ibil ityrules g o v ern t h e i n c o me o n c e i ti s p l a c e d i n s u c h a t ru s t . Wo n g ’ s a r g u me n two u l d h a v e f o r c e o n l yi f

we
a g re e d w ith h is a ss e rtio n th a t C o n g re ss e x p re ss lye x c lu d e d (d )(4 ) tru sts f ro m p o st-e lig ib ili ty det erm i nat i ons . W e do not . M or eover , w e di s cern no i ncons i s t encyi n a s t atut e thatpr ovi des t hat an i ndi vi dual m ay cr eat e a Speci al N eeds T rus tw i t h SSD I i ncome, butl eave s i tt o t he
a g e n c yt o d e t e r mi n e h o w t o t r e a tt h e i n c o me c o n t a i n e d i n s u c h a t ru s t

— wh e t h e r f r o m S S DI
o r a n yo th e r so u rc e — f o r p u rp o se s o f

M e d ica id e li g ib ili tya n d p o st-e lig ib ili ty determ i nati on s. 13A ppel l ant ’ s B r . at22. T he SM M rul es pr ovi de thatan i ndi vi dual ’ s i ncome str eam m aybe

pl ace d i n a Speci al N eeds T ru st a n d s hel t er ed fr om pos t - el i gi bi l i t ycons i der at i on i f the i ncom e is irr evoca bl yas s i gned t o t he trus t . See SM M 3259. 7( B ) ( 1) N ot e. W ong has not i nvoked thi s rul e, s ee A ppel l ant ’ s B r . at34, and w e ther efor e nee d notdet erm i ne w hethert he S o c ial S e c u rityA c t’s a n ti-alie n a tio n p ro v isio n w o u ld p re v e n t W o n g f ro m irre v o c a b ly as s i gni ng hi s SSD I i ncome t o a Speci al N eeds T rus ti n thi s w ay . See 42 U
. S
. C
. § 407( a) ( “T h e ri ghtof anyper s on t o anyfutur e paym entunderthi s s ubchapt ers hal l notbe t r ans fer abl e oras s i gnabl e, atlaw o ri n equi t y . ”) ; s ee a l s o R eames v. O kl ahoma, 411 F. 3d 1164, 1172- 73 ( 10t h C i r . 2005) ( hol di ng that§ 407( a) pr event s SSD I r eci pi entfr om as s i gni ng benef

i t s t o Speci al N eeds T rus t )
. W e nee d onl ynot e that , r egar dl es s of w hether th is o p tio n is a v a ila b le to W o n g ’s “ n a rr o w s u b c la s s o f S p e c ia l N e e d s [ T ]r u s t b e n e f ic ia ry,” i tappea r s t o be ava i l abl e “t o t hos e i ndi vi dual s w ho pr ot ect as s et s t hey had pr i ort o s ett i ng up t he trus t , i nher i t ed ass et s , oras s et s fr om s et t l ement s compensa t i ng them for thei rdi s abl i ng in ju rie s,” R e a m e s v . O k lah o m a , 4 1 1 F .3 d a t 1 1 7 3 , as w e ll as to th o se w ith in d isp u tab ly a s s ig n a b le in c o m e s tr e a m s . 20

2. S M M 32 59
. 7 M eri t s Skidm ore R atherthan C hevr on D efe r ence B eca us e w e conc l ude that , i n cr eat i ng t he ( d) ( 4) exce pt i on, C ongr es s di d nots peak d ire c tlyto th e iss u e W o n g ra ise s o n th is a p p e a l, w e p ro c e e d to c o n sid e r w h a t d e f e re n c e is properl yaccorded S M M 32 59
. 7 to fi l l the st atutorygap l eftbyC on gress . W e c o n clud e tha t SM M 3 2 5 9
. 7 m erit s S k idm o re rathe r th an C h ev ron d ef ere n ce . In
re a c h in g th is co n c lu sio n , w e a re m in d f u l th a t “n o n leg isla tiv e ru les ,” lik e th o se c o n tain e d in th e S M M , “a re n o t p e r se in e lig ib le f o r C h e v ro n d e f

e re n c e .” E sta te o f

L a n d e rs v . L e a v itt , 5 4 5 F .3 d a t 1 0 6 . N e v e rth e les s, a s w e re c e n tlyo b se rv e d , the re a re “ f e w , if a n y , ins tan c e s in
w hich an agenc y m anu al , i n part i cular , has been accorded C hev ron deference. ” Id. ; see al so Ra b i n v . W i l s o n - Co k e r , 3 6 2 F
. 3 d a t 19 8 ( a c c o r d i n g S k i d mo r e d e f e r e n c e t o CM S i nt erpr et at i on) ; acc or d D i cks on v. H ood, 391 F. 3d 581, 590 & n. 6 ( 5th C i r . 2004) ( “A l t hough21

n o t en tit led to C h e v ro n d e f e re n c e , rela tiv e lyin f

o rm a l C M S in terp re tatio n s o f th e M e d ica id A ct , s uch as t he St at e M edi cai d M anual , ar e ent i t l ed t o r es pect ful cons i der at i on in l i ghtof t he agenc y ’ s s i gni fi cant expert i s e, t he t echni cal compl exi t yof the M edi cai d pr ogr am, and the
e x c e p tio n a llyb ro a d a u th o rityc o n f e rre d u p o n th e S e c re tar yu n d e r th e A c t.”); In d ian a F a m ily & S oc. S ervs. A dm i n. v. T ho m pson , 28 6 F. 3d 47 6, 48 0 ( 7th C i r. 20 02 ) (not i ng t hat “[l ]es s form al agenc yi nt erpr et at i ons , i ncl udi ng t hos e i n agenc ym anual s , ” s houl d be ac cor ded S k id m o re d e f

e re n c e ). To b e s u r e , i n 4 2 U. S. C. § 1 3 9 6 a ( a ) ( 1 7 ) , Con g r e s s h a s e x p r e s s l y d e l e g a t e d t o t he S e c r e t a r y o f HHS t h e a u t h o r i t y “ t o p r e s c r i b e s t a n d a r d s g o v e r n i n g th e a l l o c a t i o n o f i n c o me and r es our ces for M edi cai d [el i gi bi l i t yand pos t - el i gi bi l i t y ] purpos es . ” W i s cons i n D ep’ tof H eal t h & Fam i l ySer vs . v. B l um er , 534 U
. S. at 497. I n r el evantpar t , the s t atut e pr ovi des as f o llo w s: A s ta te p la n f

o r m e d ic a l a s s is ta n c e m u s t . . . in c lu d e re a s o n a b le s ta n d a rd s . . . fordet erm i ni ng el i gi bi l i t yforand the ext entof m edi cal as s i s t ance u n d erthe pl an w hi ch .
. . pr ovi de fort aki ng i nt o acc ount onl y s uch i ncome and r es our ces a s a r e , a s d e t e r m i n e d i n a c c o r d a n c e w i th s t a n d a r d s p r e s c r i b e d b y t h e S e c r e t a r y, avai l abl e t o t he appl i cantorr eci pi entand .
. . as w oul d notbe di s r egar ded ( or s etas i de for futur e needs ) i n det erm i ni ng hi s el i gi bi l i t yfors uch ai d, as s i s t ance , or bene fi t s. 4 2 U .S .C . § 1 3 9 6 a (a )( 1 7 )( B ) ( e m p h a s is a d d e d ). In U ni t e d St a t e s v. M e a d Corp. , the Sup r e me Cour tob s e r ve d tha ts uc h a n “express
con gress i on al authori zat i on [] t o en gag e i n the process of ru lem a k in g or adj ud i cat i on ” i s a “very good i ndi cat or ” t hatC hevr on defe r ence t o an age ncyi nt erpr et at i on i s w arr ant ed. 53322

U
. S. at229. T he C our tt emper ed thi s i nstru ct i on, how ever , bynot i ng t hata congr es s i onal del egat i on w arr ant s C hevr on defe r ence w hen the del egat i on “pr oduces r egul at i ons orrul i ngs forw hi ch def

er ence i s cl ai m ed. ” I d. A l t hough C ongr es s has cl ear l ypl ace d i n the hands of t he Secr et aryof H H S t he author i t yt o cr eat e s t andar ds r el evantto W o ng’ s cl ai m , t he Secr et aryh as n ei t her“pr oduced r egul at i ons ” pur s uantt o § 1396a( a) ( 17) , s ee Est at e of L ander s v. L eavi t t , 545 F. 3d at 106 ( not i ng t hat SM M notpr om ul gat ed “thr ough not i ce a nd
comm entoradj udi cat i on, ori n anotherform atauthor i zed by C o n g ress forus e i n i s s ui ng ‘l eg isl ati v e’ ru les”), no r “ claim ed ” C h ev ron d ef ere n ce fo r S M M 3 2 5 9
. 7 , see A p p ell ee ’s B r. at 3 9 -40 (s ug gest i ng t hat SM M 32 59
. 7 w arr ants on l yS kidm ore deference). N evertheles s, t he C our t al s o obs erved i n M ead t hat , “as s i gni fi cantas not i ce- and- comm enti s i n poi nt i ng t o C hevr on author i t y , t he w antof thatpr ocedur e her e does not deci de the ca s e, forw e have
so m e tim e s f

o u n d re a so n s f

o r C h e v ro n d e f

e re n c e e v e n w h e n n o su c h a d m in istra tiv e f o rm a lity
w as r equi r ed and none w as aff or ded. ” 533 U
. S. at230- 31. A l t hough U ni t ed St at es v. M ead Corp. thus r ai s es an i nt er es t i ng ques t i on aboutt he p o ss ib ili tyo f a c c o rd in g C h e v ro n d e f e re n c e in th is c a se , in th e e n d w e a re c o n ten t sim p lyto
r el y on t he agency ’ s conce s s i on t hatSki dm or e pr oper l ygui des ouras s es s m entas aff i r m ance
w ou l d b e w arr anted un der ei t her st and ard. S ee gen eral l y D oe v. L eavitt , 55 2 F
. 3d 75 , 80 (1st C ir. 2 0 0 9 ) (d e e m in g it u n n e c e ss a ryto d e c id e w h e th e r in f o rm a l ad ju d ica ti o n p u r su a n t to expr es s congr es s i onal del egat i on w arr ant s C hevr on or Ski dm or e defe r ence beca us e age ncy i nt erpr et at i on “w i t hs t ands s crut i ny ” underei t h er s t andar d)
. I ti s enough t o s aythat , i n t he23

cont exto f

th i s c a s e i n v o l v i ng t he M edi cai d A ct , C ongr es s ’ s expr es s del egat i on of rul emaki ng
au tho ri tyto H H S in § 1 3 9 6 a(a )(17 ) i n fo rm s, as itm u st, o u r a n a lysis o f th e a g en cy ’s in te rp re ta tio n .

3
. S M M 3 2 5 9
. 7 is Pe rsua sive U n d er Skidm ore U n d e r S k id m o re v . S w if t & C o ., w e g iv e th e a g e n c y ’s in te rp re ta tio n in S M M 3 2 5 9 .7

“‘ r es pect acc or di ng t o i t s per s uas i venes s , ’ as evi dence d by‘ t he thor oughnes s evi denti n t he agenc y ’ s cons i der at i on, t he val i di t yof i ts rea soni ng, i t s cons i s t encyw i t h ear l i erand l at er p ron o u n ce m en ts, an d all tho se f ac tors w h ich g ive it p o w er to p ersu ad e.’” E stat e o f L an d ers
v. L eavi t t , 545 F. 3d at 107 ( ci t at i ons and al t er at i on om i t t ed) ( quot i ng U ni t ed St at es v. M ead C o rp ., 5 3 3 U .S . a t 2 2 8 ; S k id m o re v . S w if t & C o ., 3 2 3 U .S . a t 1 4 0 ). W hi l e the appl i cat i on of S ki dm or e defer ence can t hus pr oduce “ a s pectrum of j udi ci al
r es pons es , fr om gr eatr es pectatone end t o near i ndi ffe r ence at t he other , ” U ni t ed St at es v. M e a d Co rp . , 5 3 3 U. S
. a t 2 2 8 ( c i t a t i o n s o mi t t e d ) , t h e S u p r e me Co u r t h a s s i g n a l e d t h a tHHS i nt erpr et at i ons s houl d r ece i ve more r es pectthan the mi ne- run of age ncyi nt erpr et at i ons , s ee E s t at e of Lander s v. L eavi t t , 545 F. 3d at107 ( ci t i ng T hom as J eff er s on U ni v. v. Shal al a, 512 U
. S
. 5 0 4 , 5 1 2 ( 1 9 9 4 ) ; S c h w e i k e rv . G r a y P a n t h e r s , 4 5 3 U
. S
. a t4 3 & n . 1 4 )
. A c c o r d i n g l y, “[w ] e have hel d t hateven r el at i v el yi nform al C M S i nt erpr et at i ons w arr antr es pect ful
con si derat i on du e t o t he co m plexi t yof the M edicai d st atute and t he co nsi derabl e exp ert i se of t he adm i n i s t e r i n g a g e n c y . ” M o r e n z v . W i l s o n - Cok e r , 4 1 5 F. 3 d a t2 3 5 ( a l t e r a t i o n , a nd i nt ernal quot at i on m arks om i t t ed)
. I ndeed, w e have char act er i zed the SM M “as pr eci s el yt he24

ki nd of i nform al i nt erpr et at i on t hatw arran ts so m e si gni fi cantm eas ur e of de fer ence . ” I d. ( al t er at i on and i nt ernal quot at i on m arks om i t t ed)
. C ons i s t entw it h thes e vi ew s , w e have
o b serv ed that “ in ca ses s u ch as th o se in v o lving M ed icare o r M ed icaid, i n w h ich C M S , ‘a h ig h lye x p e rt a g e n c y , ad m in iste rs a lar g e c o m p lex re g u lato rysc h e m e in c o o p e r a tio n w ith
m a n y o t h e ri n s t i tu t i o n a l a c t o r s , t h e v a r i o u s p o s s i b l e s t a n d a r d s f o rd e f e r e n c e ’ — n a m e l y, C hevr on and Ski dm or e — ‘ begi n t o conver ge. ’ ” Est at e of Lander s v . L eavi t t , 545 F. 3d at 107 ( al t er at i on om i t t ed) ( quot i ng C om m uni t yH ea l th Ctr . v . W i l s o n - Cok er , 311 F. 3d 132, 138 (2d C ir
. 2 0 0 2 )). W ith th is in m in d , w e b e g in o u r a n a ly sis o f th e a g e n c y ’s in terp re tatio n b ya g a in
cons i der i ng t he t extand s t ructur e of § 1396p( d ). S ee Jo hn H ancoc k M ut . L i fe I ns . C o. v. H arr i s T rus t& Sav. B ank, 510 U
. S. 86, 109 ( 1993) ( quot i ng Publ i c Em pl oy ees R et . Sy s . of O h io v . B e tts, 4 9 2 U .S . 1 5 8 , 1 7 1 (1 9 8 9 ), f o r th e p ro p o sitio n th a t “n o d e f e re n c e is d u e to agenc yi nt erpr et at i ons atodds w i t h the pl ai n l anguage of the s t atut e i t s el f”)
. A s di s cussed
m o re f u llysu p ra a t [ 15- 17] , su b p a ra g ra p h (d )(4 ) e x e m p ts q u a lify in g tru sts f ro m th e ru les in (d )(3 ) b u t is s ilen t ab o u t th e n a tu re o r sc o p e o f th e ru les th e a g e n c ysh o u ld a p p lyin th e ir
s t ead. Si gni fi cant l y , s ubpar agr aph ( d) ( 4) cont ai ns no t extual l i m i ton t he s cope of t he agenc y ’ s author i t yt o fi l l t he gap l eftbyC ongr es s . A s al r eadynot ed, i n t he M edi cai d s t atut e, C o n g ress sp ec ifi ca ll yco n fe rred b roa d g ener al rulem ak ing au tho ri tyo n the a g en cy . S ee su p ra
a t [ 21- 22]
. I n t hat cont ext , w e ar e not i ncl i ned t o i nfer fr om s t atut ory s i l ence a congr es s i onal in te n t to h a v e n o ru le s w h a ts o e v e r a p p ly to in c o m e p la c e d in q u a lif y in g (d )( 4 ) t ru s ts .25

Second, w e not e thatSM M 3259. 7 i s ful l ycons i s t entw i t h C o n g ress ’ s gener al in stru c tio n th a t in d iv id u a ls m u st c o n trib u te th e ir a v a ilab le in c o m e to th e c o st o f th e ir i ns t i tut i onal car e. See gene r al l yU ni t ed St at es v. M ead C o rp., 5 33 U
. S. at235 ( quot i ng M etr opoli ta n St evedor e C o. v. R ambo, 521 U
. S. 121, 136 ( 1997) , forpr opos i t i on t hat “re aso n ab le ag en cyinterpre tat ion s ca rry ‘a t le ast so m e a d d ed p ersu asiv e f o rce ’ w h ere C hevr on i s i nappl i cabl e”)
. Forexampl e, under42 U
. S. C
. § 1396a( q) ( 1) ( A ) , “the St at e pl an
m us tpr ovi de t h at, in the cas e of a n i ns t i tut i onal i zed i ndi vi dual
. . . , i n det erm i ni ng t he
am o u n t of

the in d ividu al’s .
. . inco m e to b e ap p li ed m o n thly to p ay m en t f o r th e c o st of

ca re i n an i nsti tuti o n , t her e s hal l be deduc t ed fr om t he mont hl yi ncome ( i n addi t i on t o ot her
a llo w a n c e s o th e rw is e p ro v id e d u n d e r th e S ta te p la n ) a m o n th ly p e rs o n a l n e e d s a llo w a n c e .” 4 2 U .S .C . § 1 3 9 6 a (q )(1 )(A ) (e m p h a sis a d d e d ). S e c tio n 1 3 9 6 r-5 (d )(1 ) a p p lies a sim ilar r u le to a n in d iv id u a l’ s s p o u s e ’s in c o m e . S e e id . § 1 3 9 6 r- 5 (d )( 1 ). C ongr es s h as cr eat ed s t atut oryexempt i ons t o t hi s gener al rul e. Forexampl e, i ndi vi dual s i n i ns t i tut i onal car e ar e ent i t l ed t o an i ncome exempt i on for a modest“per s onal
n e e d s a llo w a n c e .” S e e id . § 1 3 9 6 a (q )(1 )(A ). T h e d e d u c tio n is sm a ll, h o w e v e r, b e c a u se , in C ongr es s ’ s j udgm ent , “mosts ubs i s t ence nee d s are m etbythe i ns t i tut i on. ” H
. R
. R ep. N o. 92
- 2 3 1 ( 1 9 7 1 ) , a s r e p r i n t e d i n 1 9 7 2 U. S
. C. C. A. N. 4 9 8 9 , 5 1 3 6
. S i mi l a r l y , 4 2 U. S
. C. § 1396a( r ) ( 1) ( A ) i ns t ruct s t hat“r eparati on paym ent s m ade byt he Feder al R epubl i c of G erm any ” “shal l be d i sr egarded ” i n the “po st -el i gibi l i t y t reatm ent of incom e of indivi du al s”
r e c e i v i n g i n s t i tu t i o n a l c a r e . F i n a l l y , i n 4 2 U. S
. C. § 1 3 9 6 a ( o ) Co n g r e s s i n s t ru c t e d th a tS S DIO n t hi s appea l , W ong does not cl ai m t hat he fai l ed t o r ece i ve anyof the exe m pt i ons 14 to w h ic h h e w a s e n title d
. 26 benef i t s pai d i n acc or dance w i t h § 1382( e) ( 1) ( E ) and (G ) “w i l l be di s r egar ded forpurpos es of d et erm i ning t he am ou nt of anypo st -el i gibi l i t y con t ri bu t i on bythe indi vidual t o the cost
o f th e c are an d serv ices pro v ided b ythe h o sp it al, sk il led n u rsi n g fa cil ity , o r i n term ed iat e c are fa cil ity . ” T h ese ex p ress e x em p ti o n s reinf o rce o u r co n clus ion that C o n g res s ’s st atuto ry
s i l ence i n § 1396p( d) ( 4) about w hat rul es appl y t o pos t - el i gi bi l i t ydet erm i nat i ons for( d) ( 4) t rusts i s pr oper l yunder s t ood as a congr es s i onal del egat i on of the i s s ue t o t he enf or ci ng
a g e n c y. 14 T hi r d, as w e expl ai ned i n E s t at e of Lander s v. L eavi t t , a rul e i s s ued i n a C M S pol i cy
m a n u a l w a rra n ts d e f

e re n c e a s “ th e p ro d u c t o f a n in terp re tatio n th a t is re lativ e lyf o rm a l w ith in the u n iverse of

i nform al i nt erpr et at i ons . ” 545 F. 3d at110. “‘ T he def er ence due’ t o an agenc yi nt erpr et at i on ‘ i s att he hi gh end of the s pectrum of def er ence ’ w hen ‘ the i nt erpr et at i on i n ques t i on i s notm er el yad hoc but i s appl i cabl e t o al l cas es . ’ ” I d. ( quot i ng C hauff eur ’ s T r ai ni ng Sch. , I nc. v. Spel l i ngs , 478 F. 3d 117, 129 ( 2d C i r . 2007) )
. W ong does notdi s put e thatSM M 3259. 7 i s uni ver s al l y appl i cabl e and, i ndeed, t he S M M For ew or d not es t hat t he i nst ruct i on s con t ai ned t herei n “ar e off i ci al i nterpret at i on s of t he law and regul at i on s,
an d , as su ch , are b ind ing o n M ed icaid S tat e ag en cies.” S M M F o rew o rd (e m p h asis ad d ed ). I n Ra b i n v . W i l s o n - Co k e r , we c o n s i d e r e d SM M 33 08
. 1 , s e e 3 6 2 F
. 3 d a t1 9 8 , a CM S i nt erpr et at i on t hatt he SM M i dent i fi ed as m er el y“t ent at i ve” a nd “advi s ory o n ly u nt i l s uch27

t i m e as r egul at i ons ar e publ i s hed, ” SM M 3308. 1, and w e ac cor ded thatC M S i nt erpr et at i on an “i nt erm edi at e l evel ” of de fer ence , 362 F. 3d at198. A s a fi nal and l ong- s t andi ng in terp re tatio n o n a m a tter e x p re ss lyd e l egated to th e a g e n c y , S M M 3 2 5 9 .7 is d u e su b sta n tially
m o re d e f e re n c e th a n th e S M M p ro v is io n a t is s u e in R a b in v . W ils o n -C o k e r. Four t h, SM M 3259. 7 w as i s s ued i n N ovember 1 9 9 4 , the y earaft er§ 1396p( d) w as
enac t ed on A ugus t10, 1993, as par tof the O m ni bus B udgetR econc i l i at i on A ctof 1993, Pub. L
. N o. 103- 66, § 13611( b) , 107 St at . 312, 625 , and i thas r em aine d u n changed s i nce that t i m e. W e gi ve “s ubs t ant i al w ei ght ” t o an age ncy ’ s cons t ruct i on of a st atut e thati ti s char ged
w i t h enfor ci ng, “part i cul ar l y w hen t he cons t ruct i on i s cont empora neous w i t h t he ena ctm ent
o f th e s ta tu te ,” L o w e v . S .E .C ., 4 7 2 U .S . 1 8 1 , 2 1 6 (1 9 8 5 ) ( c itin g S k id m o re v . S w if t & C o ., 32 3 U
. S
. at14 0), and “l on gst and i ng , ” E st at e of L and ers v. L eavitt , 54 5 F
. 3d at 10 7. S ee al so N or t h H aven Bd. of Educ. v. B el l , 456 U
. S. 512, 522 n. 12 ( 1982) ( “I n cons t rui ng a s t atut e, th is C o u rt n o rm a llya c c o rd s g re a t d e f e re n c e to th e in terp r e tatio n , p a rticu lar lyw h e n it i s l ongs t andi ng, of the age ncychar ged w i t h t he s t atut e’ s admi ni s t r at i on. ”) ; B arnettv. W ei nber ger , 818 F. 2d 953, 960- 61 ( D
. C
. C i r . 1987) ( “I ti s w el l es t abl i s hed thatt he pr es t i ge of a s t atut or ycons t ruct i on by an agency depends cruci al l yupon w hetheri tw as pr om ul gat ed cont empora neous l y w i t h enac t m ent of t he s t atut e and ha s been a dher ed t o cons i s t ent l yover t i m e. ” (f oot not es om i t t ed) ) ; A t chi s on, T opeka & Sant a Fe R y . C o. v. Pena, 44 F. 3d 437, 445 ( 7t h C i r . 1994) ( not i ng t hatunder S k idm o re, c our t s m us t“payat t ent i on” t o w hether ch all en g ed interpre tat ion is co n tem p o ran eo u s w ith p assa g e o f law an d co n sist en t ov er ti m e).28

Fi nal l y , w e not e thatSM M 3259. 7 has never fac ed a s er i ous chal l enge i n ei t herfede r al
o r s ta te c o u rt . W e a re a w a re o f o n ly o n e c a s e in w h ic h t h e a r g u m e n t th a t S M M 3 2 5 9 .7 confl i ct s w i t h § 1396p( d) has been a ddr es s ed. See R eames v. O k laho m a, 411 F. 3d 1164 ( 10t h C ir
. 2 0 0 5 ). I n r ej ect i ng t he ar gum ent , R eames hel d t hatSM M 3259. 7 “does not
c o n f lict w ith th e p u rp o se s o f f e d e ra l law ” in so f

a r as th e ru le “ p ro v id e s fo r f u ll § [1396p] ( d) ( 4) ( A ) pr ot ect i on t o al l t hos e w ho w oul d us e i tt o pr ot ecti ncome r ece i ved fr om
s our ces ot her than S o cial Secur i t y , and att empt s t o eff ectuat e both fede r al l aw and fe der al
r egul at i on even f

ort hat narr ow cl as s of di s abl ed i ndi vi dual
. ” I d. at1171 ( quot at i on m arks
om i t t ed)
. T h att hi s as pectof SM M 3259. 7 has been c hal l enged s o i nfr equent l yi s fur ther
e v id e n c e th a t th e ru le is w e ll- s e ttle d
. In lig h t o f

o u r a lre a d yh e ig h ten e d d e f e re n c e to H H S in terp re tatio n s o f th e M e d ica id A ct , C ongr es s ’ s expr es s del egat i on of author i t yt o the agenc y , and ourcons i der at i on of the S k id m o re f

a c to rs, w e h a v e n o d if

f ic u lt y c o n c lu d in g th a t S M M 3 2 5 9 .7 is p e rsu a siv e in its po st -el i gibi l i t yt reatm ent of S S D I i nco m e placed i n § 13 96 p(d)( 4)( A ) Special N eeds T rust s. B
. W ong’ s Pr ocedur al C hal l enge t o 42 C
. F. R
. § 435. 832 I n addi t i on t o hi s s ubs t ant i ve cha l l enge to S M M 3259. 7, W ong r ai s es a pr ocedur al chall eng e t o 4 2 C
. F
. R
. § 4 35
. 83 2, t he 1 98 0 regulat i on requi ri ng t hat “[t ]he agen cym ust
r educe i t s paym entt o an i ns t i tut i on . . . byt h e am o u n t thatr emai ns aft erdeduct i ng t he amount s s peci fi ed in p aragr aphs ( c) and ( d) of thi s s ect i on, fr om t he i ndi vi dual ’ s t ot al i ncome. ” Sect i on 435. 832 i s m at er i al l yt he s ame as N ew Y o rk’s reg ul at i on, N
. Y
. C om p.29

C odes R
. & R egs . t i t . 18, § 360- 4. 9, w hi ch r equi r es t hat “[f ] or a per s on i n perm anentabs ence
s t atus i n a medi cal fac i l i t y. . . al l i ncome m us tbe appl i ed t ow ar d t he cos tof c are i n the fac i l i t y ” s ubj ectt o deduct i ons t hatt r ac k thos e i n t he fe der al r egul at i on. W ong ar gues t hat t he feder al r egul at i on i s i nval i d beca us e i t w as notpr om ul gat ed i n acc or dance w i t h the not i ce and comm entr equ ir em ent s of the A dm i ni s t r at i ve Pr ocedur e A ct( A PA ) , 5 U
. S. C
. § 553. T h is a rg u m e n t n e e d n o t d e ta in u s . W ong’ s pr ocedur al chal l enge t o t he val i di t y of § 435. 832 i s governed by“the s i x- y ear ‘c a tch -a ll statu te o f lim itatio n s f o r f e d e ra l c laim s’ th a t w e h a v e p re v io u slyf o u n d a p p lica b le t o pr ocedur al chal l enges t o agenc yact i on br oughtundert he A PA ” i n cas es w her e no d iffe ren t sta tu te o f

lim ita tio n s is p re s c ri b e d b ys ta tu te . S c h ille r v . T o w e r S e m ic o n d u c to r L td ., 449 F. 3d 286, 293 n. 7 ( 2d C i r . 2006) ( quot i ng Pol anco v. U
. S. D rug E nfor cement A d m in., 1 5 8 F
. 3 d 6 4 7 , 6 5 2 (2d C ir
. 1 9 9 8 )); H arris v . F A A , 3 5 3 F
. 3 d 1 0 0 6 , 1 0 0 9 (D
. C
. C ir
. 2004) ; s ee a l s o 28 U
. S. C
. § 2 4 0 1 (a) ( “[E] veryci vi l act i on comm ence d agai ns tt he U ni t ed St at es s hal l be barr ed unl es s t he compl ai nti s fi l ed w i t hi n s i x y ear s aft er t he ri ght of ac t i on fi r s tacc rues . ”)
. U nder t he A PA , the s t atut e of l i m i t at i ons begi ns t o run att he t i m e the chal l enged a gen cy act i on becomes fi nal
. See 5 U
. S. C
. § 704; H arr i s v. FA A , 353 F. 3d at 1010. I n t he ca s e of c l ai m ed pr ocedur al err ori n the pr om u lgati on of a r egul at i on, fi nal agency act i on occur s upon i s s uance of the r egul at i on. See, e. g. , Pr emi ngerv. Sec’ yof V et er ans A ffa i r s , 517 F. 3d 1299, 1307- 08 ( Fed. C i r . 2008) ( hol di ng t hat § 2401( a) s t atut e of l i m i t at i ons on pr ocedur al chal l enge be gan t o run “atthe l at es t ” on the d at e the cha l l engedSubst ant i ve cha l l enges under t he A PA ar e al s o governed by t he s i x- y ears t atut e of 15 lim ita tio n s in § 2 4 0 1 (a ), u n le s s a d if f e re n t lim ita tio n s p e ri o d is s p e c if ie d b ys ta tu te . S e e , e .g ., N agahi v. I N S, 219 F. 3d 1166 , 1 1 7 1 (10th C i r . 2000) ; s ee a l s o Pr emi ngerv. Sec’ yof V eteran s A ffa i r s , 517 F. 3d at 1307 ( col l ect i ng cas es )
. T he s t atut e of l i m i t at i ons for a s ubs t ant i ve cha l l enge, how ever , begi ns t o run at t he t i m e of t he adve r s e age ncyact i on on t he p arti cu lar clai m . S ee W ind R iver M ining C o rp. v. U n it ed S tat es, 94 6 F
. 2 d 7 1 0 , 7 1 6 (9th C ir
. 1 9 9 1 ) (“ [ A ] su b sta n tiv e c h a llen g e to a n a g e n c yd e c is io n a lleg in g lac k o f a g e n c ya u th o rity m a yb e b ro u g h t w ith in six y e a rs o f th e a g e n c y ’s a p p lica tio n o f th a t d e c isio n to th e sp e c if ic c h a l l e n g e r . ” )
. I ti s u n d i s p u t e d t h a t W o n g ’ s s u b s t a n t i v e c h a l l e n g e t o S M M 3 2 5 9
. 7 i s t i m e l y. 30 reg u lat ion w as am en d ed ); C ed ars-S inai M ed
. C tr . v . S h alala, 1 7 7 F
. 3 d 1 1 2 6 , 1 1 2 9 (9th C ir
. 1999) ( “[A ] caus e of a ct i on chal l engi ng pr ocedur al err or s i n t he pr om ul gat i on of r egul at i ons
ac cru es o n the issu an ce o f th e rule. ”); JE M B roa d
. C o . v . F C C , 2 2 F
. 3 d 3 2 0 , 3 2 5 (D
. C
. C ir
. 1 9 9 4 ) (con cl ud i ng t hat expi rat i on of st atute of l i m i t at i on s barr ed p rocedu ral chall eng e to ag en cyen fo rce m en t acti o n ). 15 T he s t atute o f li m i t at i ons on W ong’ s pr ocedur al chal l enge t o § 435. 832 thus began to ru n in 1 9 8 0 a n d e x p ire d six y e a rs la ter , reg a r d le s s o f th e f a c t th a t W o n g n o w c laim s to
r ai s e th e i s s u e a s a d e f

e n s e t o d e f

e n d a n t s ’ e n f

o r c e me n t o f t h e r e g u l a t i o n . Se e Sc h i l l e r v. T ow er Semi conduct orL t d. , 449 F. 3d at293 ( “‘ [C ] hal l enges t o t he pr ocedur al l i neage of agenc y r egul at i ons , w hether r ai s ed bydi r ectappea l , bypet i t i on foramendm entorr es ci s s i on of the r egul at i on oras a def ens e t o an age ncyenfor cementpr ocee di ng, w i l l notbe ent ert ai ned out s i de the t i m e per i od p rovi ded bys t atut e. ’ ” ( emphasi s and al t er at i on om i t t ed and other
em p h asis ad d ed ) (qu o ti n g JE M B roa d
. C o . v . F C C , 2 2 F
. 3 d at 32 5 )). C o n seq u en tl y , W o n g ’s
c la im o f p ro c e d u ra l e rr o r i n th e p ro m u lg a tio n o f § 4 3 5 .8 3 2 is tim e -b a rr e d
.31

I I I . C oncl usi on T o su m m a riz e , w e c o n c lu d e th a t: ( 1) t he t extof 42 U
. S. C
. § 1396p( d) does not s peak t o t he pr eci s e i s s ue r ai s ed by W o n g ’s c laim , i.e., w h e th e r in c o m e p lac e d in a S p e c ial N e e d s T ru st c re a ted p u rsu a n t to § 1 3 9 6 p (d )(4 )(A ) is e x e m p t f ro m M e d ica id p o st-e lig ib ili tyd e ter m in a tio n s; (2) S M M 32 59
. 7, w hich w as i ssued by t he agen cy t o fi l l t he gap l eft byC on gress is p e rsu a siv e in lig h t o f (a ) o u r h e ig h ten e d d e f e re n c e to H H S in terp re tatio n s o f th e M e d ica id A ct , ( b) C ongr ess’s e x p r es s del egat i on of author i t yt o the age ncyt o pr es cr i be s t andar ds governi n g t he pos t - el i gi bi l i t yt r eatm entof i ncome, and ( c) ouranal y s i s of the r el evant S kidm ore fact ors; ( 3 ) W o n g ’ s a l t e r n a t i v e c l a i m o f p r o c e d u r a l e r r o ri n t h e p r o mu l g a t i o n o f 4 2 C. F
. R. § 4 3 5 .8 3 2 is tim e -b a rr e d
. T h e d is tr ic t co u rt ’s g ra n t o f s u m m a ry ju d g m e n t is h e r e b y A FF I R MED a s to a ll d e f e n d a n ts .