Shakhnes Ex Rel. Shakhnes v. Berlin
689 F.3d 244
2d Cir.2012Background
- Plaintiffs are New York City Medicaid home health enrollees/applicants who requested fair hearings challenging denials/reductions of services.
- The District Court granted declaratory and injunctive relief requiring a 90-day window for “Final Administrative Action,” including implementation of relief from hearing decisions.
- 42 C.F.R. § 431.244(f)(1)(ii) defines final administrative action as ordinarily within 90 days, but does not define or require implementation of relief.
- The District Court held the Medicaid fair hearing right, as defined by the regulation, enforceable under 42 U.S.C. § 1983.
- The District Court’s Order defined Final Administrative Action to include implementing relief, and thus was entered as an overbroad injunction.
- Appellants appeal the district court’s legal construction and the breadth of the injunction.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Does regulation 431.244(f) create an enforceable federal right under §1983? | Regulation fleshes out the statutory right. | Regulation cannot independently create a federal right enforceable under §1983. | Yes; regulation defines the scope of the statutory right and is enforceable. |
| Is the district court’s injunction overbroad by requiring implementation of relief within 90 days? | Right includes fair hearing and decision timely; relief can be implemented promptly. | Final action includes implementation of relief within 90 days. | Overbroad; final administrative action does not include implementation of relief. |
| Does the 90-day regulatory requirement apply to all Medicaid enrollees, not just MCO enrollees? | Regulation applies to all enrollees. | Regulation limited to MCO-related hearings. | Regulation applies to all Medicaid enrollees; injunctive scope not overbroad. |
Key Cases Cited
- Wright v. City of Roanoke Redevelopment and Housing Authority, 479 U.S. 418 (U.S. Supreme Court 1987) (regulation may define the content of a statutory right enforceable under §1983)
- D.D. v. N.Y.C. Bd. of Educ., 465 F.3d 503 (2d Cir. 2006) (regulation defines scope of right under IDEA; timing is defined, not immediate implementation)
- Harris v. James, 127 F.3d 993 (11th Cir. 1997) (regulation alone cannot create a federal right; must define content of an underlying statutory right)
- Suter v. Artist M., 503 U.S. 347 (U.S. Supreme Court 1992) (regulations fleshing out rights under statutory provisions; regulation must define content)