The court specifically considered New York’s system for determining whether Medicaid beneficiaries would be entitled to receive extended home health care, as opposed to getting their care in an institutional setting.

  Under state regulations, a certified home health agency is required to make a determination whether the cost of extended (more than sixty days) of home health services would exceed ninety percent of the cost of providing the same care services in an institutional setting.

  If the cost of home health care will exceed ninety percent of the cost of institutional care, and no specific exception is found to apply, home health care benefits are to be denied to the Medicaid beneficiary, in favor of institutional care.

  The feature of this plan which the U.S. Circuit Court of Appeals found objectionable, and which the court threw out, was the absence of any provision for the Medicaid beneficiary to demand and get a fair hearing under Federal law to challenge the home health agency’s determination.