United Cerebral Palsy of Georgia, Inc. v. Georgia Department of Behavioral Health and Developmental Disabilities
331 Ga. App. 616
Ga. Ct. App.2015Background
- United Cerebral Palsy of Georgia, several nonprofit providers, Medicaid recipients, and family representatives sued Georgia agencies administering Medicaid, alleging cuts to reimbursement rates and service limits under the NOW and COMP waivers.
- Plaintiffs claimed reductions were made without required public notice and without giving providers/recipients written notice of adverse agency actions, violating statutes, manuals, contract terms (statements of participation), and due process.
- The superior court dismissed the suit for failure to exhaust administrative remedies; plaintiffs appealed, arguing exhaustion was excused because they never received the required written notice of adverse actions.
- Medicaid statutes, agency regulations, and the Georgia Medicaid/COMP/NOW manuals set out providers’ and recipients’ rights to administrative hearings and specify written notice and deadlines for requesting review.
- The manuals and regulations contemplate mailed/written notice to providers and recipients; administrative review deadlines are triggered by the mailing or receipt of an adverse action notice.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether plaintiffs had to exhaust administrative remedies before suing | Exhaustion excused because agency never gave required written notice of adverse action | Plaintiffs had actual notice; agency not required to give formal written notice | Court held exhaustion was excused because agency failed to provide required written notice under statutes, regs, and manuals |
| Whether providers were entitled to written mailed notice before administrative-review deadline ran | Providers entitled to written mailed notice; deadline measured from mailing of notice | Agency contended actual notice sufficed; questioned need for formal mailed notice | Court held Medicaid manual and regs require mailing/written notice to trigger provider deadlines |
| Whether recipients were entitled to written notice of rights to appeal reductions in COMP/NOW services | NOW/COMP manuals expressly guarantee recipients written notice of appeal rights | Agency argued no formal notice required beyond actual knowledge | Court held manuals explicitly require written notice to recipients; absence of notice excuses exhaustion |
| Whether agency interpretations of its manuals are entitled to deference | N/A (plaintiffs rely on plain text of manuals) | Agency urged deference to its interpretation of manuals | Court declined to defer to agency interpretations of its own manuals and relied on plain terms requiring written notice |
Key Cases Cited
- Prado-Steiman v. Bush, 221 F.3d 1266 (11th Cir. 2000) (describing Medicaid as a federal-state cooperative program)
- Wilder v. Virginia Hosp. Assn., 496 U.S. 498 (1990) (states must have an approved Medicaid plan; waivers can exempt certain requirements)
- Pruitt Corp. v. Ga. Dept. of Community Health, 284 Ga. 158 (2008) (statement of participation can create contractual relationship incorporating agency manuals)
- Chatham County Bd. of Tax Assessors v. Emmoth, 278 Ga. 144 (2004) (agency cannot benefit from procedural irregularities it caused by failing to give requisite notice)
- Fulton-DeKalb Hosp. Auth. v. Metzger, 203 Ga. App. 595 (1992) (agency actions that prevent administrative review preclude agency from invoking failure-to-exhaust)