Salazar v. District of Columbia
236 F. Supp. 3d 411
| D.D.C. | 2017Background
- This long‑running Medicaid suit began in 1993; after trial the court found D.C. violated the Medicaid Act and the parties entered a 1999 Settlement Order that required EPSDT dental services beyond federal minima.
- In 2004 the Court entered a Dental Order setting detailed obligations (periodicity schedule, annual Corrective Action Plans (CAPs), provider outreach, reporting) and six specific utilization targets (oral assessments for infants/toddlers, school-entry screenings, sealant rates, and overall/ preventive dental service rates).
- Plaintiffs moved in 2016–2017 to enforce the 2004 Dental Order, seeking a five‑year CAP and a September 30, 2020 deadline to meet the six numerical performance goals.
- D.C. conceded the 2004 numerical targets have proved unattainable nationally, but argued it exceeds federal requirements, ranks above national averages on several metrics, and has implemented a State Oral Health Action Plan (SOHAP), school programs, and other improvement measures.
- The Court reviewed recent utilization data, D.C.’s programmatic efforts (including CMS‑approved fluoride varnish reimbursement and school‑based services), and the parties’ multi‑year mediation, and denied plaintiffs’ Motion to Enforce.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether plaintiffs violated Paragraph 80 (10‑day notice + good‑faith negotiation) before filing the enforcement motion | Plaintiffs complied with notice but defendants contended plaintiffs failed to negotiate in good faith | D.C. argued plaintiffs didn’t negotiate in good faith before filing | Court: Plaintiffs did not violate Paragraph 80 given two years of prior good‑faith mediation |
| Whether D.C. is violating the 2004 Dental Order’s requirements overall | Plaintiffs argued D.C. still fails to meet the Dental Order goals and needs a detailed 5‑year CAP with interim deadlines to achieve compliance by 2020 | D.C. argued it has made genuine, reasonable improvements, exceeds federal requirements, and pursues a functioning SOHAP and annual CAPs | Court: D.C. is making credible, reasonable progress; full compliance by 2020 is not achievable; enforcement relief denied |
| Whether the 2004 numerical utilization targets are feasible and enforceable as absolute deadlines | Plaintiffs sought firm numerical deadlines and a five‑year plan to reach them | D.C. noted the targets have been unattainable nationally, but D.C. outperforms national averages and has targeted improvement plans | Court: Targets are unrealistic as strict deadlines; D.C.’s programmatic steps justify denying plaintiffs’ requested relief |
| Whether plaintiffs have received the relief the prior judgment required (i.e., whether enforcement is necessary) | Plaintiffs said additional enforcement and a five‑year CAP are necessary to secure the Dental Order’s protections | D.C. said annual CAPs, SOHAP, and demonstrated improvements satisfy the Dental Order’s aims | Court: Plaintiffs have not established that the District failed to provide the required relief; motion denied |
Key Cases Cited
- Salazar v. District of Columbia, 954 F. Supp. 278 (D.D.C. 1996) (original bench‑trial decision finding Medicaid violations and informing later settlement)
- The Fund for Animals v. Norton, 390 F. Supp. 2d 12 (D.D.C. 2005) (district court authority to enforce its mandates)
- Heartland Hosp. v. Thompson, 328 F. Supp. 2d 8 (D.D.C. 2004) (motion to enforce standard: relief granted when defendant has not complied with judgment)
- Watkins v. Washington, 511 F.2d 404 (D.C. Cir. 1975) (denial of enforcement appropriate when plaintiff already received required relief)