Kathryn A. PRICE, et al., Plaintiffs-Appellees, v. MEDICAID DIRECTOR, OFFICE of Medical Assistance, et al., Defendants-Appellants.
No. 15-4066
United States Court of Appeals, Sixth Circuit.
Argued: April 28, 2016. Decided and Filed: September 30, 2016
838 F.3d 739
KETHLEDGE, Circuit Judge.
Even if we were to hold that the pre-amendment version of
A document filed pro se is “to be liberally construed.” Erickson v. Pardus, 551 U.S. 89, 94, 127 S.Ct. 2197, 167 L.Ed.2d 1081 (2007) (citing Estelle v. Gamble, 429 U.S. 97, 106, 97 S.Ct. 285, 50 L.Ed.2d 251 (1976)). The record shows that Smotherman complied with
Smotherman‘s declaration under penalty of perjury was word-for-word identical to the requirements of
Thus, Smotherman‘s pro se motion and accompanying declaration on November 25 was “deposited in the institution‘s internal mail system on or before the last day for filing,” and his declaration complied with one of the enumerated methods provided for proving timeliness under
Before: BOGGS and KETHLEDGE, Circuit Judges; STAFFORD, District Judge.*
KETHLEDGE, Circuit Judge.
OPINION
Ohio offers assisted-living coverage to its Medicaid beneficiaries on a prospective basis. The plaintiffs here, a class of Ohio Medicaid beneficiaries, sued Ohio‘s Medicaid administrators on the claim that federal law requires Ohio to cover certain assisted-living services retrospectively. The district court granted summary judgment to the plaintiffs. We reverse.
I.
A.
In 1965, Congress used its Spending Clause power to establish Medicaid. See
Per Congress‘s conditions, all State Medicaid plans must apply uniformly statewide, provide medical assistance equally “in amount, duration, [and] scope” among Medicaid beneficiaries, and establish a “single standard to be employed in determining” eligibility for medical assistance among different classes of beneficiaries. See
Since 1981, therefore, Congress has allowed the Secretary of Health and Human Services to waive the uniformity and equal-provision conditions for States that pay the cost of “home or community-based services (other than room and board).”
In 2006, the State of Ohio applied for and received a Medicaid waiver to provide assisted-living services to low-income seniors. Ohio Ctrs. for Assisted Living Br. at ii. Under Ohio‘s Medicaid regulations, a senior wishing to benefit from the waiver program must satisfy several criteria, including a determination by a county-level “passport” agency that the senior‘s “health related needs ... can be safely met” in a state-approved assisted-living facility (as opposed, for example, to a nursing home). Ohio Admin. Code 5160-33-03(B)(3). Per Congress‘s conditions on Medicaid funding through the assisted-living waiver, Ohio‘s county-level passport agencies will enroll a senior into the waiver program only after the senior meets several eligibility requirements, including approval of the senior‘s “service plan” by the county passport agency. Ohio Admin. Code 173-38-03(C)(1)(b); see also Ohio Admin. Code 173-38-01(B). Ohio does not permit the disbursement of any Medicaid funding for waiver-program services rendered before the passport agency approves the service plan. See Ohio Admin. Code 173-38-03(C)(1)(c).
B.
1.
In 2008, Betty Hilleger—then suffering from dementia, heart problems, and arthritis—moved into The Lodge Care Center, an assisted-living facility in Cincinnati. During her first four years at The Lodge, Hilleger paid the center‘s $4,300 monthly fee out of her own pocket. Then she ran out of money, and her daughters began paying the center‘s fee. In October 2012, Hilleger applied for Medicaid assistance through Ohio‘s assisted-living waiver program. Soon thereafter, her local passport agency approved a service plan for her. Later, in January 2013, the agency determined that Hilleger was financially eligible for the waiver program. Medicaid then began paying for the costs of Hilleger‘s care at The Lodge.
In April 2012, Geraldine Saunders checked into a hospital and then a rehabilitation facility after suffering a fall. Her stress fractures and worsening dementia prevented her from returning home. In June 2012, she moved into the Close to Home assisted-living center in Ironton, Ohio. The same day, she applied for Medicaid assistance through Ohio‘s assisted-living waiver program. Eighteen days la
2.
In February 2013, Hilleger and Saunders—acting through their daughters, Marilyn Wenman and Kathryn Price, respectively—sued the director of Ohio‘s Medicaid program and the director of the Ohio Department of Aging in a putative class action in federal district court. The plaintiffs alleged that Ohio‘s omissions of Medicaid coverage for the first 18 days of Saunders‘s assisted-living costs, and for the first three months of Hilleger‘s assisted-living costs, were in violation of federal law. The plaintiffs sought declaratory and injunctive relief under
for care and services included under the [Medicaid] plan and furnished in or after the third month before the month in which [the beneficiary] made application ... for such assistance if such [beneficiary] was (or upon application would have been) eligible for such assistance at the time such care and services were furnished.
The plaintiffs asserted that they were eligible for Medicaid assistance under Ohio‘s waiver program from the moment each of them took up residence at their assisted-living centers, and that they were therefore entitled to retroactive benefits (i.e., payments for services provided before a passport agency‘s approval of their service plans) under
In November 2014, the plaintiffs amended their complaint and added two more claims under
In September 2015, the district court certified the plaintiffs’ proposed class of Medicaid beneficiaries and granted summary judgment to the plaintiffs. The court held that federal law required Ohio to “assess whether, at any time up to three months prior to [an] application for assisted living waiver benefits, the [applicant] met the financial eligibility benefits; whether the [applicant] had a need for intermediate or skilled level of care; and whether the [applicant] received supportive services consistent with the plan of care. If so, the State must grant retroactive assisted living waiver benefits in accordance with
This appeal followed.
II.
A.
The defendants argue that the plaintiffs lack standing to sue and that the district court thus should have dismissed their complaint. We review de novo whether the plaintiffs have standing. See Stalley v. Methodist Healthcare, 517 F.3d 911, 916 (6th Cir. 2008).
Standing has three elements. First, the plaintiff must show that she has suffered an “injury in fact“: that is, some invasion of her legal interests that is both “concrete and particularized” and “actual or imminent, not conjectural or hypothetical.” Lujan v. Defs. of Wildlife, 504 U.S. 555, 560, 112 S.Ct. 2130, 119 L.Ed.2d 351 (1992). Second, she must show that there is a “causal connection” between her injury and the defendant‘s actions. Id. Third, “it must be likely, as opposed to merely speculative, that the injury will be redressed by a favorable decision.” Id. at 561.
The defendants focus on the third element here, arguing that the plaintiffs lack standing because the relief awarded by the district court cannot redress the named plaintiffs’ injuries. As to the claim asserted in the plaintiffs’ original complaint, that relief took two forms: first, a declaration that the plaintiffs were entitled to an award of assisted-living benefits for up to three months of assisted-living services provided before the date of their application for benefits, even though a passport agency had not approved their service plans before that date; and second, as ancillary relief, notice to class members of their right to an administrative hearing under state law (a hearing that might in turn lead to an award of retroactive benefits for a beneficiary). The defendants argue that neither form of relief can do the named plaintiffs any good, because (under the Eleventh Amendment, as discussed below) the plaintiffs cannot use the declaration to obtain an award of damages in federal court; instead, they can use it only to obtain an award of benefits in a state administrative hearing as to whether they were entitled to more benefits than they in fact received. And under state law that hearing is available for only a limited time: Ohio gives Medicaid beneficiaries 90 days to request a state administrative hearing to challenge or adjust a Medicaid benefits determination. See Ohio Admin. Code 5101:6-3-02(B)(2). Once that window closes, therefore, even a declaratory judgment that Hilleger and Saunders were entitled to additional benefits is useless to them as a practical matter, because they have no forum in which to wield it. And for both Hilleger and Saunders, as of this writing, that 90-day window (which began on the dates the State notified them of their award of benefits) passed long ago. Moreover, neither named plaintiff is likely to seek assisted-living benefits in the future: Hilleger passed away in September 2013 after the initiation of this lawsuit, and Saunders currently lives in a nursing home, with no sign that she will ever return to an assisted-living facility. Thus, the relief awarded by the district court—the declaration of entitlement to additional benefits, and notice of a state hearing in which the plaintiffs could seek an award of
The problem with that argument is that Hilleger‘s 90-day window to seek a hearing was still open when the plaintiffs filed their complaint in this case. (Saunders‘s 90-day window was closed by then.) And the fact that Hilleger‘s window remained open, in turn, implicates a rule unique to class actions: in cases where the claims asserted on behalf of the class are “so inherently transitory” that the named plaintiff‘s claims will “expire” before the district court can even rule on a motion for class certification, the plaintiff is deemed to have standing to sue—notwithstanding that her claim has “expired,” i.e., that the relief available for the claim can no longer do her any good—so long as she had standing to sue “at the time the ... complaint was filed[.]” Cty. of Riverside v. McLaughlin, 500 U.S. 44, 51-52, 111 S.Ct. 1661, 114 L.Ed.2d 49 (1991). (The idea behind the rule is that, if the district court had granted a motion for class certification before the plaintiff‘s claim expired, the unexpired claims of other class members would then carry the torch for standing purposes; and it is hardly the plaintiff‘s fault that the district court could not rule upon that motion before her “inherently transitory” claims expired. See Genesis Healthcare Corp. v. Symczyk, 569 U.S. 66, —, 133 S.Ct. 1523, 1531, 185 L.Ed.2d 636 (2013).) Hilleger meets that test here—at the time she filed her complaint, 80 days of her 90-day period to seek a hearing still remained—and thus she does have standing to assert the claim set forth in her original complaint.
But the same is not true of the claims asserted in the amended complaint. We determine standing for each plaintiff on a claim-by-claim basis; “standing is not dispensed in gross.” Fednav, Ltd. v. Chester, 547 F.3d 607, 614 (6th Cir. 2008). The plaintiffs have standing to assert only the claims they had standing to assert when the claims themselves were first pled. Lynch v. Leis, 382 F.3d 642, 647 (6th Cir. 2004). And by November 2014—when the plaintiffs first pled, in their amended complaint, that the defendants breached their duties under
In sum, the plaintiffs have standing to pursue only their February 2013 claim that the defendants failed to comply with federal law by refusing to award retroactive assisted-living benefits under
B.
The defendants argue that the Eleventh Amendment bars the plaintiffs’ remaining claim for relief. We review de novo the defendants’ entitlement to sovereign immunity under the Eleventh Amendment. Babcock v. Michigan, 812 F.3d 531, 533 (6th Cir. 2016). Under that Amendment, the plaintiffs may not sue a state in federal court for “retroactive monetary relief.” Pennhurst State Sch. & Hosp. v. Halderman, 465 U.S. 89, 103, 104 S.Ct. 900, 79 L.Ed.2d 67 (1984).
Yet the federal courts must also ensure that state officers meet their obligations under federal law. Thus, a federal court may, without violating the Eleventh Amendment, issue a prospective injunction
Here, the plaintiffs sought (and the district court ordered) prospective relief in the form of an injunction directing the defendants, Ohio‘s Medicaid administrators, to cease their practice of providing waiver-program benefits only for the period following an eligibility determination, in purported violation of
The defendants argue that the district court‘s order violates the Eleventh Amendment because the order might be construed as commanding the defendants to “redo past eligibility determinations” or to make hearings available to class-members who have no right to a hearing under state law. Defs.’ Br. at 19-25. But we do not read the order that way. The court ordered the defendants to “advise[] [the plaintiffs] of the state administrative procedure, compliant with due process requirements, available if [the plaintiffs] desire to have defendants determine whether or not they may be eligible for additional days of Medicaid assisted living waiver coverage.” In our view that order does not require anything other than notice of currently available state procedures. That notice might result in new eligibility determinations for class members who are still entitled to a hearing under state law, and thus might ultimately lead to payment of benefits that are past due. But that result is consistent with Quern. The Eleventh Amendment therefore does not bar the plaintiffs’ claim for injunctive relief.
C.
Finally, the defendants argue that the district court misconstrued
We review de novo the district court‘s interpretation of
for care and services included under the [Medicaid] plan and furnished in or after the third month before the month in which [the beneficiary] made application ... for such assistance if such [beneficiary] was (or upon application would have been) eligible for such assistance at the time such care and services were furnished.
(emphasis added). Thus, under
Meanwhile, under
Yet the plaintiffs argue (and the district court held) that the phrase “pursuant to,” as used in
Justice Jackson likewise used “pursuant to” in precisely this sense, when he wrote that the President‘s “authority is at its maximum” when he “acts pursuant to an express or implied authorization of Congress.” Youngstown Sheet & Tube Co. v. Sawyer, 343 U.S. 579, 635, 72 S.Ct. 863, 96 L.Ed. 1153 (1952) (Jackson, J., concurring). And for purposes of Justice Jackson‘s rule, and otherwise, the President cannot act “pursuant to” a statute that Congress has not yet passed. Nor can a police officer search a home “pursuant to” a warrant she obtains after the search; the Fourth Amendment‘s warrant requirement would be meaningless if an officer could search first, then obtain a warrant, and then claim she acted “pursuant to” it simply because the search was consistent with the warrant‘s terms.
“Pursuant to” is a narrower term than “consistent with.” A decision of the Supreme Court, for example, might be consistent with a decision of our court; but none of the Supreme Court‘s decisions are made “pursuant to” ours. “Pursuant to” means more than mere consistency; it means, in addition, that an action is directed or permitted by the authority by which the action is taken. And in no case is the Supreme Court acting at our direction or authority.
That assisted-living services are “consistent with” a service plan, therefore, does not mean that the services were provided “pursuant to” the plan. To be provided “pursuant to” a plan, the services must be authorized by the plan. And just as a warrant cannot authorize a search before the warrant is issued, neither can a plan authorize the provision of assisted-living benefits before the plan is approved. Under Ohio‘s waiver program and the relevant provisions of the Medicaid Act, therefore, assisted-living benefits can be provided “pursuant to a written plan of care[,]”
The plaintiffs’ remaining argument is that the defendants’ policy renders the retroactivity requirement of
The Ohio Centers for Assisted Living, appearing as amicus curiae in support of the plaintiffs, dispute this point. They contend that submission of an application to the Ohio Department of Job and Fami
The district court erred when it held that
The district court‘s judgment is reversed, and the case remanded with instructions to enter judgment in favor of the defendants.