Tiffany Romano v. Bruce Greenstein
721 F.3d 373
5th Cir.2013Background
- Romano, a Louisiana Medicaid recipient, had her benefits terminated by the Louisiana Department of Health and Hospitals (DHH); an ALJ initially reversed termination, then later affirmed termination on a second appeal.
- Romano sued DHH in federal court under 42 U.S.C. § 1983, alleging violation of the Medicaid Act and the Constitution; the district court granted Romano summary judgment and denied DHH’s motion to dismiss.
- DHH appealed only the denial of its motion to dismiss, arguing lack of subject-matter jurisdiction (exhaustion), no private right enforceable under § 1983, and that the district court should have abstained under Burford.
- The Fifth Circuit limited its review to (1) whether Romano had to exhaust Louisiana’s state judicial review before suing in federal court, (2) whether 42 U.S.C. § 1396a(a)(8) creates a § 1983–enforceable right, and (3) whether Burford abstention was required.
- The court held: no state judicial-exhaustion requirement barred federal suit; § 1396a(a)(8)’s “reasonable promptness” mandate creates an individual right enforceable under § 1983; and Burford abstention was unwarranted.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether federal court lacked subject-matter jurisdiction because Romano failed to exhaust state judicial review | Romano contends exhaustion of state court review was not required because she had pursued ALJ review and § 1983 claims need not exhaust state remedies | DHH says Louisiana’s availability of judicial review (state district court) divests the federal court of jurisdiction and Romano had an adequate state remedy | Held: No exhaustion requirement; availability of state judicial review does not preclude federal § 1983 suit; federal court has jurisdiction |
| Whether § 1396a(a)(8) creates a private right enforceable under § 1983 | Romano argues § 1396a(a)(8) (assistance furnished with “reasonable promptness”) confers an individual right to timely Medicaid benefits | DHH argues there is no § 1983 cause of action (did not argue Congress foreclosed § 1983) | Held: § 1396a(a)(8) meets Blessing/Gonzaga tests and creates a private right enforceable under § 1983 |
| Whether the district court should have abstained under Burford | Romano argues federal adjudication is proper because the claim arises under federal Medicaid law and no special state forum compels abstention | DHH urges abstention to defer to state processes and expertise | Held: Burford abstention inappropriate—factors weigh against abstention (federal law claim, no unsettled state law, paramount federal interest) |
| Whether Congress or law foreclosed § 1983 enforcement of the Medicaid Act | Romano: Congress did not clearly foreclose § 1983; enforcement appropriate | DHH: (did not show Congress foreclosed § 1983) | Held: No showing of congressional foreclosure; § 1396a(a)(8) enforceable under § 1983 |
Key Cases Cited
- Blessing v. Freestone, 520 U.S. 329 (1997) (three‑part test for when a statute creates a right enforceable under § 1983)
- Gonzaga Univ. v. Doe, 536 U.S. 273 (2002) (requirement of unambiguous, rights‑creating statutory terms for § 1983 relief)
- Wilder v. Va. Hosp. Ass’n, 496 U.S. 498 (1990) (Medicaid statute interpretation holding certain Medicaid provisions enforceable under § 1983)
- Equal Access for El Paso, Inc. v. Hawkins, 509 F.3d 697 (5th Cir. 2007) (discussion of federal‑state cooperative nature of Medicaid and review standards)
- Dickson v. Hood, 391 F.3d 581 (5th Cir. 2004) (holding similar Medicaid statutory language created enforceable individual rights under § 1983)
- Sabree v. Richman, 367 F.3d 180 (3d Cir. 2004) (concluding Medicaid provision enforceable under § 1983)