35 F. Supp. 3d 1101
N.D. Cal.2014Background
- Brazil, a FEHBA enrollee, had residential treatment denied under the Plan; the Plan excludes residential treatment centers from mental health benefits.
- She sought damages, declaratory relief, and fees, aggregating claims under FEHBA, California parity law, and MHPAEA.
- OPM asserted sovereign immunity and FEHBA preemption to block merits-based relief.
- The court treated Brazil’s action as challenging a federal agency and addressed jurisdiction and preemption issues.
- OPM moved for summary judgment; Brazil cross-moved seeking broader relief, then sought limited relief directing payment of benefits.
- The court ultimately granted OPM summary judgment on all claims due to sovereign immunity and preemption conclusions.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the court has jurisdiction over FEHBA claims. | Brazil asserts federal-question jurisdiction under FEHBA. | OPM argues lack of FEHBA-based waiver and insufficient pleading. | Subject matter jurisdiction found; claims not frivolous. |
| Whether FEHBA permits monetary damages or only directs payment of benefits. | Brazil seeks monetary damages; requests to force payment. | FEHBA waivers do not permit monetary judgments. | Sovereign immunity bars monetary damages; limited waiver allows only directing carrier to pay. |
| Whether California Mental Health Parity Act is preempted by FEHBA. | Parity act not preempted; applicable state law should govern. | FEHBA preempts state parity law regarding FEHBA plans. | California parity act preempted by FEHBA. |
| Whether MHPAEA claims are cognizable against OPM or FEHBA plan. | MHPAEA requires parity; OPM voluntarily enforces parity for FEHBA plans. | MHPAEA not applicable to FEHBA plans; no waiver of sovereign immunity. | Sovereign immunity bars MHPAEA claims; not otherwise cognizable. |
| Whether declaratory relief is barred by sovereign immunity. | Seeks declaratory relief under 28 U.S.C. § 2201. | Declaratory relief does not waive sovereign immunity; no explicit waiver. | Declaratory relief barred by sovereign immunity. |
Key Cases Cited
- Empire HealthChoice Assur., Inc. v. McVeigh, 547 U.S. 677 (U.S. 2006) (FEHBA preemption and contract-terms approach analyzed by Supreme Court)
- Botsford v. Blue Cross & Blue Shield of Mont., Inc., 314 F.3d 390 (9th Cir. 2002) (FEHBA preemption and denial-of-benefits principles in Ninth Circuit)
- Roach v. Mail Handlers Benefit Plan, 298 F.3d 847 (9th Cir. 2002) (FEHBA preemption and benefits disputes)
- Harlick v. Blue Shield of California, 686 F.3d 699 (9th Cir. 2012) (Parity claims under California Mental Health Parity Act; ERISA/FEHBA context)
- United States v. Mitchell, 463 U.S. 206 (U.S. 1983) (sovereign immunity general principles; consent required for suits)