309 F. Supp. 3d 250
M.D. Penn.2018Background
- Plaintiffs (a certified class of Pennsylvania youth under 21 adjudicated dependent with diagnosed mental-health disabilities) allege DHS and its Acting Secretary failed to provide appropriate mental-health services and placements, leaving youth in RTFs, psychiatric hospitals, juvenile detention, or awaiting out-of-state placements.
- Named plaintiffs include minors and young adults who experienced prolonged stays in inappropriate institutional settings or long waits for community-based placements and services despite eligibility for Medical Assistance (Medicaid).
- Plaintiffs assert three claims: (1) §1983 claim alleging violations of Title XIX (Medicaid) — §§1396a(a)(10)(A) and 1396a(a)(43)(C) (EPSDT); (2) §1983 claim alleging violation of §1396a(a)(8) (reasonable promptness); and (3) discrimination claims under Title II of the ADA and Section 504 of the Rehabilitation Act relying on integration and reasonable-modifications regulations.
- Defendants moved to dismiss all counts, arguing the cited statutory and regulatory provisions do not create privately enforceable rights under §1983 or otherwise.
- The court evaluated the pleadings under Rule 12(b)(6), applied Blessing/Gonzaga (and Third Circuit precedent), and denied the motion to dismiss in full.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether §§1396a(a)(10)(A) (entitlement) and 1396a(a)(8) (reasonable promptness) create privately enforceable rights under §1983 | These provisions unambiguously confer individual entitlements enforceable under §1983 | Armstrong and statutory structure foreclose private enforcement; administrative remedy is exclusive | Denied dismissal: Third Circuit precedent (Sabree) binds court; these provisions create privately enforceable rights |
| Whether §1396a(a)(43)(C) (EPSDT — arranging services for under-21 Medicaid eligibles) creates a private right | EPSDT contains mandatory, individual‑focused, rights‑creating language and detailed duties (via §1396d(r)) | Section lacks unambiguous individual-right language and resembles §30(a) in Armstrong; administrative remedies suffice | Denied dismissal: court finds EPSDT meets Blessing/Gonzaga and confers a private right |
| Whether ADA/RA implementing regulations (integration and reasonable‑modifications) are enforceable | Regulations implement statutory prohibitions on segregation and failure to accommodate; Olmstead integrates these duties into Title II and RA, so private suits are proper | Regulations exceed statutory text or lack private‑enforcement basis under Sandoval | Denied dismissal: statutes (ADA/RA) plainly support the regulatory duties; regulations interpret enforceable statutory rights |
| Overall sufficiency of complaint to state plausible claims | Complaint alleges concrete examples of prolonged inappropriate institutionalization and denial/delay of services tied to DHS policies | Defendants argue legal basis is unavailable even if facts true | Denied dismissal: pleadings adequate; statutory/regulatory bases are enforceable, so claims survive 12(b)(6) |
Key Cases Cited
- Blessing v. Freestone, 520 U.S. 329 (recognizing factors for when federal statutory provisions create §1983 rights)
- Gonzaga Univ. v. Doe, 536 U.S. 273 (statutory language must unambiguously confer individual rights for §1983 enforcement)
- Sabree v. Richman, 367 F.3d 180 (3d Cir.) (Medicaid §§1396a(a)(10) and 1396a(a)(8) create private rights enforceable under §1983)
- Armstrong v. Exceptional Child Ctr., Inc., 135 S. Ct. 1378 (2015) (Supreme Court rejected private enforcement of §1396a(a)(30)(A); distinguishes provider‑focused provisions)
- Alexander v. Sandoval, 532 U.S. 275 (regulations cannot create private rights beyond what statute unambiguously provides)
- Olmstead v. L.C. ex rel. Zimring, 527 U.S. 581 (Title II of ADA can require community placement and recognizes unjustified isolation as discrimination)
- Barnes v. Gorman, 536 U.S. 181 (statutory remedies under ADA and RA are privately enforceable)