Melissa Wilson v. Darin Gordon
822 F.3d 934
| 6th Cir. | 2016Background
- Plaintiffs are eleven Tennessee residents whose Medicaid (TennCare) applications remained undecided longer than federal time limits (45 days for non‑disability; 90 days for disability) and who were denied fair hearings on those delayed applications.
- Plaintiffs filed a class action seeking declaratory and injunctive relief under 42 U.S.C. § 1396a(a)(3) and (a)(8) and the Due Process Clause; the district court certified a class and issued a preliminary injunction ordering the State to provide fair hearings on delayed adjudications within 45/90 days after a member requests one.
- Tennessee had been redirecting MAGI‑based applications to the federal Exchange because its state IT system (TEDS) was not ready after ACA implementation; the State argued delays were caused by CMS/Exchange processes.
- Before the district court ruled on certification, the State agreed (by joint motion) to specially process the named plaintiffs’ and up to 100 other identified applications; the named plaintiffs received determinations and benefits before certification.
- The State appealed only the preliminary injunction (not the class certification). The Sixth Circuit affirmed the preliminary injunction, holding the case was not moot under the "inherently transitory" and "picking off" exceptions and that the State retains ultimate responsibility for administering Medicaid despite the ACA.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Mootness after named plaintiffs obtain relief pre‑certification | Case is not moot because class certification relates back; exceptions apply (inherently transitory; picking‑off) | Case is moot because the named plaintiffs obtained the relief they sought before certification | Not moot: "inherently transitory" and "picking off" exceptions apply; "capable of repetition yet evading review" does not apply |
| State responsibility for delayed MAGI‑based applications post‑ACA | State remains ultimately responsible to provide fair hearings and ensure compliance with Medicaid law; cannot delegate away core duties | ACA/Exchange operation shifts responsibility to CMS for Exchange‑processed MAGI cases | State retains ultimate responsibility; preliminary injunction narrowly requires State to provide fair hearings on delays |
| Necessity of joining CMS as indispensable party under Rule 19 | CMS bears responsibility for Exchange delays; therefore CMS must be joined | Court can accord complete relief without joining CMS because State can obtain needed information and is not a joint tortfeasor requiring joinder | CMS is not a required party; State can obtain relevant information and provide hearings without joining CMS |
| Compliance with hearing‑file rules and Exchange confidentiality | Regulations require state provide case file materials for hearings; State can produce what it possesses or obtain needed data from CMS | Providing full case files or soliciting applicant data may conflict with Exchange rules and data limitations | Court interprets regulation to require disclosure of the evidence the State possesses; applicants may voluntarily supply additional info at hearings; injunction is permissible |
Key Cases Cited
- Gerstein v. Pugh, 420 U.S. 103 (1975) (applies inherently transitory exception where individual claims may terminate before certification due to the nature of the underlying situation)
- Sosna v. Iowa, 419 U.S. 393 (1975) (discusses relation‑back of class certification and transitory claim concerns)
- Deposit Guaranty Nat'l Bank v. Roper, 445 U.S. 326 (1980) (criticizes defendants’ efforts to "pick off" named plaintiffs to avoid class litigation)
- Campbell‑Ewald Co. v. Gomez, 136 S. Ct. 663 (2016) (addresses effect of offers to satisfy individual claims on mootness and class action concerns)
- County of Riverside v. McLaughlin, 500 U.S. 44 (1991) (applies inherently transitory doctrine to prompt probable‑cause determinations)
- Brunet v. City of Columbus, 1 F.3d 390 (6th Cir. 1993) (class survives mooting of named plaintiffs post‑certification; discusses relation‑back principles)
- Blankenship v. Secretary of HEW, 587 F.2d 329 (6th Cir. 1978) (applies exception where defendants expedited relief for named plaintiffs while systemic delays continued)
- Carroll v. United Compucred Collections, Inc., 399 F.3d 620 (6th Cir. 2005) (Rule 68 offers do not necessarily moot class actions when certification is pending)
- Genesis Healthcare Corp. v. Symczyk, 133 S. Ct. 1523 (2013) (limits some transitory‑claim arguments in FLSA collective action context; distinguishes Rule 23 class actions)