Gary Dube & a. v. New Hampshire Department of Health and Human Services & a.
166 N.H. 358
N.H.2014Background
- Harbor Homes, a New Hampshire nonprofit, provided Medicaid-funded rehabilitative mental-health services to ~160 clients, including four individual plaintiffs.
- New Hampshire rule He-M 426.04(a)(2) required community mental health providers to maintain an interagency agreement (IAA) with a regional community mental health program (CMHP) to qualify for Medicaid reimbursement.
- Harbor Homes had an IAA with Greater Nashua Mental Health Center (GNMHC) effective 7/1/2008–6/30/2011; GNMHC declined to renew the IAA in 2011, jeopardizing Harbor Homes’ Medicaid provider status and services for many clients.
- Plaintiffs sought declaratory and injunctive relief to prevent DHHS from disqualifying Harbor Homes and to preserve beneficiaries’ ability to obtain services from their chosen provider.
- The superior court granted DHHS summary judgment, ruling the IAA requirement was a permissible qualification under the Medicaid Act; the Supreme Court of New Hampshire reversed on appeal.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether He-M 426.04(a)(2)’s IAA requirement violates the Medicaid free-choice-of-provider provision | The IAA requirement does not relate to a provider’s ability to perform required medical services and therefore unlawfully limits beneficiaries’ choice | States may set reasonable provider-qualification standards; the IAA ensures continuity, collaboration, and quality, so it is a reasonable qualification | Rule invalid as applied: the IAA requirement conditions Medicaid qualification on a factor unrelated to a provider’s fitness to perform required services and thus violates 42 U.S.C. § 1396a(a)(23)(A); reversed and remanded |
Key Cases Cited
- Planned Parenthood v. Com’r of Dept. of Health, 699 F.3d 962 (7th Cir. 2012) (interprets "qualified" in free-choice provision as fitness to perform needed medical services)
- Planned Parenthood Arizona Inc. v. Betlach, 727 F.3d 960 (9th Cir. 2013) (agrees that "qualified to perform the service" denotes general competency to carry out the service)
- O’Bannon v. Town Court Nursing Center, 447 U.S. 773 (1980) (free-choice-of-provider protects beneficiary choice among qualified providers)
- Meyers by Walden v. Reagan, 776 F.2d 241 (8th Cir. 1985) (state must comply with federal Medicaid requirements once it elects to offer optional services)
- Eder v. Beal, 609 F.2d 695 (3d Cir. 1979) (state must comply with Medicaid Act where it elects to provide optional services)