Sue DOE, Plaintiff-Appellant, v. Linda KIDD; Stan Butkus; Kathi Lacy; South Carolina Department of Disabilities and Special Needs; Robert Kerr; South Carolina Department of Health and Human Services, Defendants-Appellees, v. Sandra Ray, Guardian ad Litem Plaintiff.
No. 10-1191
United States Court of Appeals, Fourth Circuit
March 24, 2011
411
Argued: Dec. 8, 2010. Decided: March 24, 2011.
V.
We therefore affirm. We dispense with oral argument because the facts and legal contentions are adequately presented in the materials before the court and argument would not aid the decisional process.
AFFIRMED
ARGUED: Patricia L. Harrison, Columbia, South Carolina, for Appellant. Kenneth Paul Woodington, Davidson & Lindemann, PA, Columbia, South Carolina, for Appellees. ON BRIEF: William H. Davidson, II, Davidson & Lindemann, PA, Columbia, South Carolina, for Appellees.
Before MOTZ, KING, and GREGORY, Circuit Judges.
Reversed in part, affirmed in part, and remanded with instructions by unpublished opinion. Judge GREGORY wrote the opinion, in which Judge MOTZ and Judge KING joined.
Unpublished opinions are not binding precedent in this circuit.
Sue Doe, the plaintiff-appellant, is a young woman with developmental disabilities, including epilepsy, mild mental retardation, and cerebral palsy. She filed this
On remand, the district court again granted summary judgment in favor of Defendants. Doe subsequently filed this timely appeal challenging (1) the dismissal of her reasonable promptness claim; (2) the denial of her motion to amend the complaint; and (3) the denial of her request for attorney‘s fees.1 Because we find that Defendants have violated Doe‘s rights under the Medicaid Act as a matter of law, we reverse the district court and grant summary judgment in her favor. Accordingly, Doe may recover attorney‘s fees. However, the district court properly denied her motion to amend.
I.
We review a grant of summary judgment de novo, and present all facts and reasonable inferences in the light most favorable to the nonmoving party. Varghese v. Honeywell Int‘l, Inc., 424 F.3d 411, 416 (4th Cir.2005). The underlying material facts are not in dispute, and the extensive history of this case is laid out in further detail in our previous opinion. See generally Doe I, 501 F.3d at 351-53. DHHS is the South Carolina state agency responsible for administrating Medicaid programs. DDSN supervises the treatment and training of South Carolinians with mental retardation and related disabilities. Because South Carolina accepts Medicaid funding, these agencies are bound to comply with all related federal laws and regulations. Wilder v. Va. Hosp. Ass‘n, 496 U.S. 498, 502, 110 S.Ct. 2510, 110 L.Ed.2d 455 (1990).
In July 2002, after unsuccessfully applying twice in the past, Doe filed a third application for DDSN services under the Medicaid waiver program pursuant to
In December 2002, without having made a final decision as to Doe‘s eligibility for a waiver, DDSN placed Doe on the waiver
At a March 2003 hearing on the appeal, a DHHS hearing officer dismissed the matter. He found that, by moving Doe to the top of the critical waiting list and determining that she was eligible for services, DDSN had resolved all of Doe‘s claims in her favor. The hearing officer also found that DDSN had not provided Doe with services in a “reasonably prompt” period of time. However, because DDSN was then promising to provide Doe with services, the hearing officer found that he lacked the power to provide any other relief and the appeal was dismissed. Joint Appendix (“J.A.“) 887-89.
In April 2003, DDSN approved a “plan of care” that was developed for Doe pursuant to
In May 2003, in response to the declining mental health of Doe‘s mother, Doe asked to terminate the in-home services and, per the 2003 plan, receive “residential habilitation services” in either a CTH I or CTH II. J.A. 920, 923. In June 2003, after failing to receive any residential habilitation services, Doe initiated this action, wherein she accused Defendants of violating the Medicaid Act. She sought injunctive relief from DDSN, the payment of medical expenses, and attorney‘s fees.
In a letter dated June 26, 2003, DDSN authorized CTH I or SLP II services for Doe at a residential center (hereinafter the “authorization letter“). J.A. 942-44. According to the authorization letter, an assessment of Doe by DDSN revealed that her needs for “out-of-home placement/residential habilitation supervision, care and skills training” could be met at either of these two placements. J.A. 943. However, Doe rejected the DDSN chosen provider, the Babcock center, because she believed that the facility could not safely provide her with appropriate services. Through August 2003, Defendants and Doe discussed some alternative placements, including the possibility of upgrading the services at another CTH I setting or placement at a CTH II facility closer to her family. J.A. 1689. However, Defendants also maintained that a CTH I setting “represents the best long-term option” for Doe. Id. In an August 16, 2003 letter, DDSN gave Doe permission to reside in a CTH II facility, where she would receive “respite” or temporary services. J.A. 74. As of December 2010, Doe continues to reside in a CTH II facility.
In February 2005, DDSN reevaluated Doe‘s eligibility for Medicaid services. Based upon this reevaluation, DDSN now maintains that Doe is not mentally retarded and, therefore, is ineligible for the waiver program. J.A. 1208-09. According to Doe, the reevaluation was initiated in retaliation for her filing of this lawsuit. J.A. 105-06. She also believes it contradicts the Social Security Administration‘s prior determination that Doe is mentally retarded, and the similar longstanding diagnosis of Doe‘s physicians. J.A. 93-106. Doe administratively appealed this reevalua-
In February 2008, on remand, with only her reasonable promptness claim properly before the district court, Doe moved to amend her complaint. J.A. 77. The amended complaint would have added three causes of action based on the Supremacy Clause of the Constitution and the Due Process and Equal Protection Clauses of the Fourteenth Amendment. J.A. 106-15. These new causes of action would draw into the federal action Doe‘s state court challenges to Defendants’ reevaluation, as well as again dispute Defendants’ right to decide whether Doe is entitled to CTH I or CTH II services. The court denied her motion to amend.
On April 21, 2009, Defendants filed a motion for partial summary judgment on the issue of damages. The court granted that motion in a short text order on August 19, 2009.
On May 14, 2009, Plaintiffs also filed a motion for summary judgment, and, that same day, Defendants filed a second motion for summary judgment on all remaining issues in the case. Following opposition and reply briefs on these motions, the district court held a hearing on May 21, 2009.
On January 29, 2010, the district court dismissed Doe‘s reasonable promptness claim. J.A. 17-23. Specifically, the court held that Defendants are not obligated under the Medicaid Act to provide or pay for the specific residential habilitation services from the 2003 plan with reasonable promptness. J.A. 22-23 (citing Bruggeman ex rel. Bruggeman v. Blagojevich, 324 F.3d 906, 910 (7th Cir.2003)). The court dismissed her reasonable promptness claim because Defendants had promptly and continuously met their obligation to pay for some residential habilitation services. It held that, even though the services funded by Defendants were not the same ones called for in the 2003 plan and the authorization letter, the Medicaid Act did not actually require Defendants to provide any specific services, only to pay for some unspecified ones. J.A. 23. The court then added, speaking to the issues Doe attempted to raise related to her state administrative appeal, that her “challenge to DDSN‘s level of care and placement decisions must be made through the administrative procedures available to her in state court.”
II.
We disagree with the district court. Defendants’ failure to provide Doe with those residential habilitation services described in her 2003 plan in a reasonably prompt manner constituted a violation of the Medicaid Act. Thus, we grant summary judgment in favor of Doe and find that, as the prevailing party, she is entitled to attorney‘s fees. We affirm the denial of her motion to amend the pleadings.
A.
The sole issue to survive the prior appeal is whether the requisite medical services were provided to Doe in a reasonably timely manner. Doe I, 501 F.3d at 360. Thus, despite Doe‘s attempts to raise various issues related to the 2005 Medicaid eligibility determination, here, we must decide only that single, very narrow issue.
Under the Medicaid Act, “[a] State plan for medical assistance must—provide that all individuals wishing to make application for medical assistance under the plans shall have opportunity to do so, and such
It is undisputed that Doe applied for services in 2002, and qualified for CTH I residential habilitation services in June 2003. However, Defendants claim that she is not entitled to any relief because (1) they offered her a CTH I placement in June 2003, which she then turned down; and (2) because, Defendants have financed CTH II respite services since July 2003, they are not required to find a suitable CTH I residential habilitation placement for Doe. Alternatively, Defendants argue that, here, Doe has only appealed the district court‘s order on Defendants’ motion for summary judgment on the remaining issues, not its grant of partial summary judgment as to damages. Thus, they believe, even if we were to find in her favor, she cannot obtain any meaningful relief.
i.
Contrary to what the district court held and Defendants now argue, after Doe rejected the CTH I services offered in June 2003, Defendants were still obligated to present her with alternative CTH I services within a reasonably prompt period of time. Although this Court dismissed Doe‘s freedom of choice claim, finding that she had no right to choose between CTH I and CTH II services, we did note that Doe retains a “choice of providers, so long as the provider operates a CTH I facility, the kind of setting DDSN has determined would constitute the least restrictive environment for Doe.” Doe I, 501 F.3d at 360. In fact,
The district court, in granting summary judgment for Defendants relied upon the Seventh Circuit‘s definition of “medical assistance” in
Unlike the district court, we cannot see how our adoption of Bruggeman would change the outcome of this case. Even assuming we were to agree with the Seventh Circuit, Defendants obligations as to Doe, the 2003 plan, and the authorization letter would not change. As we outlined in Doe I, the Medicaid program requires Defendants to “select[] the appropriate setting for the provision of waiver services. Once a setting is selected, recipients have a choice of qualified providers among those who offer services in the setting DDSN has approved.” 501 F.3d at 359. Bruggeman itself also suggests that the distinction Defendants try to draw between duties to provide funding-for-care versus actual-direct-care is of no importance here, since the Medicaid regulations ensure the “prompt provision of funds to eligible individuals to enable them to obtain the covered medical services that they need . . . .” 324 F.3d at 910-11 (emphasis added). It therefore cannot suffice that Defendants have paid for another, albeit similar, type of residential habilitation service that Defendants themselves do not believe Doe needed or was even entitled to.
Here, per the 2003 plan and the authorization letter, DDSN found that Doe‘s placement at a CTH I facility would best meet her medical need for residential habilitation services in the least restrictive environment. See
The provision of different CTH II respite services by Defendants did not somehow relieve them of their legal responsibility to subsidize Doe‘s placement in a suitable CTH I setting, nor did it negate her freedom of choice among CTH I providers. Thus, the ongoing failure of Defendants to pay for the CTH I residential habilitation services is the same as a failure to provide any services.
ii.
Similarly, although the parties appear deeply concerned about the subtle difference between residential habilitation and respite services, we do not believe that parsing out these distinctions will alter the outcome of this case. We continue to believe that Doe I was correct in so far as it held that respite services and residential habilitation services are, to some extent, distinct:
Respite care, which Doe is currently receiving, “is furnished on a short-term basis due to the regular care giver‘s absence or need for relief.” Benjamin H. v. Ohl, No. 3:99-0338, 1999 WL 34783552, at *2 (S.D.W.Va. July 15, 1999). Residential habilitation, which Doe has requested, “helps recipients with the skills needed for daily living, such as eating and performing personal hygiene, household chores, and food preparation. It also focuses on the social and adaptive skills which enable an individual to avoid institutionalization.” Id. at *3.
Doe I, 501 F.3d at 354 n. 3. The 2003 plan only required DDSN to provide “residential habilitation services.” J.A. 625. State regulations define residential habilitation services as “the care, skills training and
Nevertheless, this debate is inconsequential because both parties concede the more important point: that the CTH II respite services currently being provided for Doe are not equivalent to the SLP II or CTH I residential habilitation services approved by the 2003 plan and the authorization letter. (Appellant‘s Br. at 34-35; Appellees’ Br. at 42-45.) Defendants were obligated under the Medicaid Act and its regulations to provide Doe with the needed services in the least restrictive environment. Doe I, 501 F.3d at 359. As conveyed in the authorization letter, after evaluating Doe and consulting with her representatives in the development of the 2003 plan, DDSN determined that Doe should receive residential habilitation services in either a SLP II or CTH I setting. Both parties concede that Doe has never actually received these services in the designated setting. (Appellant‘s Br. at 34-36; Appellees’ Br. at 43-45.) It is also undisputed that, after Doe rejected the Babcock center in 2003, Defendants have never offered Doe any other satisfactory CTH I placements. (Appellant‘s Reply Br. at 17; Appellees’ Br. at 45.) Instead, since 2003, Doe has only received “temporary” or respite services at a more restrictive CTH II facility. (Appellant‘s Br. at 34-35; Appellees’ Br. at 43-45.)
Notwithstanding Defendants’ arguments to the contrary or even Doe‘s own insistence that a CTH II setting may be more desirable, we reaffirm the holding of Doe I as to Defendants’ obligations and Doe‘s rights under the Medicaid Act: (1) Defendants were to make a determination as to the proper level of care, here, a CTH I setting; (2) Doe was then within her rights to refuse to accept the Babcock center, the first suggested CTH I facility; and (3) Defendants were then obligated to present her with “feasible alternatives” for the provision of residential habilitation services at a suitable care facility of her choice.
Indeed, Defendants admit that they abdicated their responsibility to furnish Doe with the necessary services in the least restrictive environment, i.e., a SLP II or CTH I setting, based upon the whims of Doe‘s representatives. (Appellee‘s Br. at 49-50.) However, as Defendants successfully argued in Doe I, it was ultimately Defendants’ responsibility to decide the appropriate setting for Doe and to execute the 2003 plan within that setting. 501 F.3d at 359. Neither of these matters fell upon Doe or her representatives to decide or implement. Thus, it is irrelevant that, after DDSN refused to upgrade services at the only CTH I placement proposed by it or to recommend another CTH I setting, Doe‘s representative sought a more restrictive CTH II level of care. The law places the burden on Defendants to work with Doe to find or establish an acceptable SLP II or CTH I setting, which, so far, they have utterly failed to do.
We therefore hold that, as a matter of law, Defendants have violated the Medicaid Act through their ongoing refusal to finance residential habilitation services at an acceptable CTH I placement of her choice.
iii.
Even with the abandonment of her damages claim on appeal, it is still within the
Since 2005, DDSN has declared Doe ineligible for Medicaid benefits, but continues to provide her with services pending her administrative appeal. Accordingly, Defendants assert that any equitable relief provided to Doe would be futile since she is no longer entitled to benefits, and that, even if her benefits were later reinstated, any judgment finding that her benefits had been provided with unreasonable delay would be meaningless. (Appellees’ Br. at 27-28.) However we note that, even now, Doe continues to receive services. And, if Doe were to ultimately win her state appeal, she would be entitled to future services.
We therefore find that it would be quite appropriate and within the equitable powers of the district court to order Defendants to finance a SLP II or CTH I placement of Doe‘s choice pending the resolution of the state appellate process. Alternatively, the district court may issue a declaratory judgment consistent with this opinion that may guide Defendants should Doe ever become eligible for Medicaid services again.4
iv.
Thus, having dispensed with all of Defendants’ arguments, we hold: (1) that Defendants never provided Doe with residential habilitation services in a SLP II or CTH I setting; (2) that the CTH II respite services that have been provided to Doe since July 2003 are not the equivalent of the SLP II or CTH I residential habilitation services to which she is entitled; and (3) that, given Defendants’ continuing violations of the timeliness provisions of the Medicaid Act and its regulations, they are ordered to provide Doe with services in a SLP II or CTH I facility of her choice (at least pending the outcome of her state appeal).
B.
“Ordinarily, we review an award of attorney‘s fees for abuse of discretion.” Smyth ex rel. Smyth v. Rivero, 282 F.3d 268, 274 (4th Cir.2002). However, a determination of whether Doe is the “prevailing party” for purposes of
Because we now reverse the district court, and direct it to grant summary judgment in her favor, there can be no question that Doe is the “prevailing party” for purposes of
Denial of leave to amend is subject to appellate review for abuse of discretion. US Airline Pilots Ass‘n v. Awappa, LLC, 615 F.3d 312, 320 (4th Cir.2010). We agree with the district court‘s decision to deny Doe‘s motion to amend the complaint.
Doe‘s proposed amended complaint would have added three causes of actions based upon the Due Process Clause, Equal Protection Clause, and Supremacy Clause. These ostensibly new causes of action sought to revive her earlier “freedom of choice” claim, i.e., that she should be allowed to choose between CTH I and CTH II services, and to collaterally attack the now pending state administrative proceedings as to her Medicaid eligibility.
Given our prior dismissal of her “freedom of choice” claim, we find that the first proposed due process claim, in so far as it alleges that state administrative hearings failed to consider certain medical evidence as to the suitability of a CTH I placement, would be futile. See GE Inv. Private Placement Partners II v. Parker, 247 F.3d 543, 548 (4th Cir.2001) (“Leave to amend may properly be denied where amendment would be futile.“). Moreover, this proposed amendment was brought before the court in 2008, long after the allegedly faulty hearing occurred in 2006. See Deasy v. Hill, 833 F.2d 38, 41 (4th Cir.1987) (“[A] motion to amend should be made as soon as the necessity for altering the pleading becomes apparent.“) (quoting 6 Wright & Miller, Federal Practice and Procedure § 1488 (1971)).
The district court also did not abuse its discretion when it rejected the amendments that would have added a second due process claim challenging the timeliness of the hearing officer‘s decision making process, and a third claim arising under the Equal Protection Clause and Supremacy Clause, wherein Doe alleged that Defendants and the state proceedings somehow misapplied federal law. “[L]ower federal courts possess no power whatever to sit in direct review of state court decisions.” Atlantic Coast Line R. Co. v. Engineers, 398 U.S. 281, 296, 90 S.Ct. 1739, 26 L.Ed.2d 234 (1970). This rule is particularly important where “the constitutional claims presented to a United States District Court are inextricably intertwined with the state court‘s denial in a judicial proceeding” of a plaintiff‘s request for relief. Dist. of Columbia Court of Appeals v. Feldman, 460 U.S. 462, 482 n. 16, 103 S.Ct. 1303, 75 L.Ed.2d 206 (1983); see also Johnson v. DeGrandy, 512 U.S. 997, 1005-06, 114 S.Ct. 2647, 129 L.Ed.2d 775 (1994) (noting that the Rooker-Feldman doctrine prevents an unsuccessful state court party “from seeking what in substance would be appellate review of the state judgment in a United States district court, based on the losing party‘s claim that the state judgment itself violates the loser‘s federal rights“).
In Feldman, the plaintiffs sought to challenge a D.C. Court of Appeals decision denying them permission to sit for the local bar exam. Id. at 468-469. The Supreme Court allowed the plaintiffs to proceed with a constitutional challenge to the local bar rules generally. Id. at 486-87. However, it held that the plaintiffs could not ask the district court to directly review the D.C. Court of Appeals’ judicially made determination that the plaintiffs were ineligible to sit for the bar exam. Id.
Doe was permitted under
For these reasons, we believe that the court did not abuse its discretion when it declined to allow Doe to amend her complaint.
III.
We reverse the district court‘s grant of summary judgment, and hold that Defendants violated Doe‘s rights under the Medicaid Act by failing to provide her with any of the residential habilitation services in a SLP II or CTH I setting, as authorized by DDSN and the 2003 plan, with reasonable promptness. Because Defendants have failed to demonstrate any disputed issue of material fact, we grant Doe‘s motion for summary judgment. We also find that Doe is entitled to attorney‘s fees. However, we affirm the district court‘s denial of Doe‘s motion to amend the complaint.
Thus, the order of the district court granting summary judgment for Defendants is reversed; Doe‘s motion for summary judgment is granted; the district court‘s denial of the motion to amend is affirmed; and we remand the case to the district court to devise appropriate remedial relief, and to determine reasonable attorney‘s fees pursuant to
REVERSED IN PART, AFFIRMED IN PART, AND REMANDED WITH INSTRUCTIONS