The Second Circuit Court of Appeals ruled that qualifying Medicaid recipients have a constitutionally protected property interest in receiving 24-hour personal care services, but that New York’s existing appeals procedure adequately protects that interest. Bellin v. McDonald, No. 24-341 (2nd Cir. May 21, 2026). 
Rosalind Bellin, an 80-year-old woman who suffered from several serious illnesses, filed a suit in federal district court against the Commissioner of the New York Department of Health (Commissioner), challenging the appeals procedures available to Medicaid recipients who seek 24-hour in-home personal care services. Rosalind sought 24-hour care, but was initially offered 8 hours of daily care. Under New York’s appeal procedures, Medicaid recipients cannot immediately appeal the level of personal care services they are offered. They must first enroll in the offered plan and then request a change in the level of services. If their request is denied, they may then appeal. Rosalind asserted that New York’s procedures violated the due process clause. The district court granted summary judgment in favor of the Commissioner, finding that Rosalind did not have a cognizable property interest in 24-hour personal care services and thus was not entitled to procedural due process protections. Rosalind appealed.
The Second Circuit Court of Appeals, in considering whether New York’s procedures violated the due process clause, first evaluated whether Rosalind had a property interest in 24-hour personal care services. The court noted that in Goldberg v. Kelly, 397 U.S. 254 (1970), the US Supreme Court had established that public assistance benefits may qualify for due process protections as a type of property interest. To establish that a benefits program provides a protected property right, the recipient must show a legitimate claim of entitlement to the benefits rather than merely an abstract need or expectation. In determining whether there is a legitimate claim of entitlement, a court must evaluate whether the state statute or regulation meaningfully channels official discretion by mandating a defined administrative outcome—or if it affords the decisionmaker unguided discretion. If a state official is authorized to take an action but is not bound by standards in making a decision, a beneficiary is not entitled to the benefits and does not have a property interest in them. However, if regulations impose standards that meaningfully channel official discretion in decision-making by prescribing determinate and well-defined criteria that mandate a defined administrative outcome, a recipient may have a cognizable property interest in the benefits.
In the present case, the court found that New York did not have unguided discretion in authorizing 24-hour personal care services. Rather, under New York’s policies, once the prerequisites for personal care services are met, authorizations for Medicaid recipients are mandatory. The court further found that years of fair hearing decisions issued in personal care services appeals showed meaningful channeling in determining whether Medicaid recipients’ requests for increases to 24-hour care should be authorized: The decisions have consistently been framed in objective terms, i.e., whether a managed long-term care plan’s determination that an increase to 24-hour care was not medically necessary was either correct or incorrect. Therefore, the court determined that Rosalind had a cognizable property interest in 24-hour personal care services.
The court found that New York’s procedures were constitutionally adequate to protect the interests of qualifying Medicaid recipients in 24-hour care. In considering the adequacy of New York’s procedures, the court balanced three considerations: (1) the importance of the private interest at stake; (2) the risk of erroneous deprivation of the private interest under the procedures and the value of other procedural safeguards; and (3) the burden on the government if other procedures were imposed.
In the present case, the court found that the private interests at stake—a Medicaid recipient’s interest in promptly receiving 24-hour care when needed—were meaningful to the recipient affected. However, New York’s current procedures mitigate erroneous deprivation by allowing an immediate appeal of outright denials of personal care services and providing expedited methods for Medicaid recipients who have an urgent need for personal care services. In addition, the delay resulting from the absence of an immediate right to appeal was minor. Further, the court found that when Medicaid recipients like Rosalind pay out-of-pocket for additional services during the pendency of their appeal, they may be entitled to reimbursement for at least part of their costs; as a result, the impact on the recipients’ financial interests was limited.
The court also concluded that the right to an immediate appeal was unlikely to produce more than a modest decrease in the duration of an erroneous deprivation or significantly reduce the risk of erroneous deprivations.
In evaluating the burden on the government of a right to an immediate appeal, the court determined that little weight should be afforded to the government's interests; requiring New York to permit Medicaid recipients to use existing procedural mechanisms to appeal an initial offer would create only a modest additional burden.
After balancing the foregoing interests, the court found that New York’s appeals procedures adequately protected Rosalind’s property interest in receiving 24-hour personal care services and thus did not violate the due process clause.
The court affirmed the district court’s judgment in favor of the Commissioner.
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