M.A.C. v. BetitM.A.C. v. Betit
MEMORANDUM DECISION AND ORDER
This matter is before the court on Defendants’ Motion to Dismiss, Plaintiffs’ Motion for Class Certification, and Plaintiffs’ Cross Motion for Partial Summary Judgment. A hearing on these motions was held June 19, 2003. Defendants Rod Betit et al. (“Defendants”) were represented by Joel A. Ferre, and Plaintiffs M.A.C. et al. (“Plaintiffs” or “proposed plaintiff class”) were represented by Robert B. Denton. Before the hearing, the court considered carefully the memoranda and other materials submitted by the parties. Since taking the motions under advisement, the court has farther considered the law and facts relating to these motions. Now being fully advised, the court renders the following Memorandum Decision and Order.
I. BACKGROUND
Plaintiffs, a proposed class of people with disabilities, allege that Defendants have violated the Medicaid Act, the Americans with Disabilities Act (“ADA”), and section 504 of the Rehabilitation Act of 1973 (“ § 504” or “Rehabilitation Act”) by placing Plaintiffs on a waiting list for Medicaid Home and Community Based Services (“HCBS waiver”). Defendants are state agencies and individuals who administer the Medicaid program in Utah. The proposed plaintiff class is composed of all current and future Medicaid-eligible individuals residing in Utah who, because of
The Medicaid program, established by Title XIX of the Social Security Act,
In addition to the mandatory and optional services, a state may request approval from the Secretary for Health and Human Services (“Secretary”) to provide Medicaid services designed as an alternative to long term institutional care. The HCBS waiver program allows states to waive certain standard Medicaid mandates applicable to state plan services in developing a plan for noninstitutional alternative services.
While the Medicaid Act does not place a limit on the number of individuals to whom Utah can provide ICF/MR services, CMS may authorize an upper limit on the number of “unduplicated individuals” Utah may serve under an HCBS waiver program.
Plaintiffs allege that Utah has chosen to use the cap in the HCBS waiver to limit those who can receive services under the waiver. Plaintiffs further assert that Utah has never requested a modification of the cap in order to serve all individuals for whom HCBS waiver services are medically necessary. Those individuals above the cap who request HCBS waiver services are placed on a waiting list and categorized into two groups: those with an immediate need for HCBS waiver services and those with a future need for such services. Plaintiffs and the proposed plaintiff class will be or have been determined by Defendants to have an immediate need for HCBS waiver services. Plaintiffs allege that some individuals within the plaintiff
Pursuant to FecLR.Civ.P. 12(b)(1) and 12(b)(6), Defendants move this court to dismiss Plaintiffs’ complaint on the grounds that Plaintiffs lack standing to assert a claim under the Medicaid Act and Plaintiffs’ ADA and § 504 claims fail to state a claim for which relief may be granted. Defendants further move this court to dismiss Plaintiffs’ complaint because Plaintiffs’ claims are barred by the Eleventh Amendment. Plaintiffs filed a Motion for Class Certification under the
II. DISCUSSION
A. Plaintiffs’ Motion for Class Certification
For certification of a plaintiff class, the action must meet the four requirements of FRCP 23(a). Specifically, a plaintiff must demonstrate that “(1) the class is so numerous that joinder of all members is impracticable, (2) there are questions of law or fact common to the class, (3) the claims or defenses of the representative parties are typical of the claims or defenses of the class, and (4) the representative parties will fairly and adequately protect the interests of the class.”
First, joinder of every current and future individual on the HCBS waiver waiting fist is impracticable in that there are 1,316 people currently on the waiting list who are geographically dispersed throughout Utah. Because each of the proposed class members qualify for Medicaid-reimbursable institutional services, they by definition lack the financial resources on their own. Thus, the first requirement of impracticability is established.
Second, the material facts shared by each class member are nearly identical in that Plaintiffs allege that each proposed class member is being denied medically necessary waiver services sufficient in amount, duration, and scope, in violation of the Medicaid Act; each is being denied waiver services with reasonable promptness in violation of the Medicaid Act; each is being denied a meaningful choice between the receipt of HCBS waiver services and institutionalization in violation of the Medicaid Act; and each is threatened with unnecessary institutionalization in violation of the ADA and § 504. Thus, the second requirement of commonality is established.
Third, because the material factual circumstances and the legal claims and relief sought are identical as between the named plaintiffs and the class they seek to represent, the third requirement of typicality is met.
Fourth, Plaintiffs have met the requirement of adequacy. Plaintiffs seeking class certification must demonstrate that (a) counsel for named plaintiffs are competent to conduct the litigation as a class action, and (b) the interests of the party and the proposed class do not conflict.
See Smith v. Josten’s Am. Yearbook Co.,
B. Defendants’ Motion to Dismiss Plaintiffs’ Medicaid Act, ADA, and § 504 Claims
Defendants have moved to dismiss Plaintiffs’ Medicaid Act, ADA, and § 504 claims pursuant to FRCP 12(b)(1) and 12(b)(6). In ruling on a motion to dismiss under FRCP 12(b)(6), a court must determine whether the factual allegations in the complaint, if true, would entitle the plaintiff to a legal remedy.
See Conley v. Gibson,
1. Plaintiffs’ Medicaid Act Claims
Defendants assert that Plaintiffs lack standing because they have no protected right to HCBS waiver services and have failed to identify an underlying right to which they are entitled.
See Lewis v. Casey,
Plaintiffs’ complaint alleges five causes of action asserting violations of the Medicaid Act. Specifically, Plaintiffs assert that (1) Defendants’ denial of HCBS waiver services to Plaintiffs violates the Medicaid Act; (2) Defendants’ denial of HCBS waiver services to Plaintiffs is not reasonably related to the objectives of the Medicaid act and thus violates the Act; (3) Defendants’ denial of HCBS waiver services to Plaintiffs withholds services sufficient in amount, duration, and scope to reasonably achieve their purpose in violation of
Some courts have found a private right of action for the beneficiaries of at least some of the Medicaid provisions at issue in the instant case.
See, e.g., Chiles,
First, Congress must have intended that the provision in question benefit the plaintiff. Second, the plaintiff must demonstrate that the right assertedly protected by the statute is not so “vague and amorphous” that its enforcement would strain judicial competence. Third, the statute must unambiguously impose a binding obligation on the States. In other words, the provision giving rise to the asserted right must be couched in mandatory rather than prec-atory terms.
has led some courts to interpret Blessing as allowing plaintiffs to enforce a statute under § 1983 so long as the plaintiff falls within the general zone of interest that the statute intended to protect; something less than what is required for a statute to create rights enforceable directly from the statute itself under an implied right of action.
The
Gonzaga
Court stated that for a statute to confer a private right of action, the statutory language must be “ ‘phrased in terms of the persons benefited.’ ”
Id.
at 284,
The authorizing provision of the Medicaid Act does not contain rights-creating language unequivocally conferring an individual right to support a cause of action under § 1983. Specifically, the provision provides:
For the purpose of enabling each State, as far as practicable under the conditions of each State, to furnish (1) medical assistance on behalf of families with dependent children and of aged, blind or disabled individuals, whose income and resources are insufficient to meet the costs of necessary medical services, and (2) rehabilitation and other services to help such families and individuals attain or retain capability for independence or self-care, there is hereby authorized to be appropriated for each fiscal year a sum sufficient to carry out the purposes of this subchapter. The sums made available under this section shall be used for making payments to States which have submitted, and had approved by the Secretary, State plans for medical assistance.
Furthermore, the Medicaid Act specifically provides that if the Secretary finds that a state agency fails to “comply substantially” with the provisions in the Act in administering the state plan, the Secretary is to notify the state agency that it will no longer receive Medicaid funds until the Secretary is convinced that the state agency is complying with the provisions in the Act.
Additionally, none of the Medicaid Act provisions expressly cited in Plaintiffs’ complaint contains the rights-ereating language specified in
Gonzaga.
In particular, Plaintiffs allege that Defendants have violated
Plaintiffs further allege that Defendants have violated the reasonable promptness requirement of
Finally, Plaintiffs assert that Defendants have violated the freedom of choice provisions of
“A waiver shall not be granted under this subsection unless the State provides assurances satisfactory to the Secretary that ... such individuals who are determined to be likely to require the level of care provided in a hospital, nursing facility, or intermediate care facility for the mentally retarded are informed of the feasible alternatives, if available under the waiver, at the choice of such individuals, to the provision of inpatient hospital services, nursing facility services, or services in an intermediate care facility for the mentally retarded.”
While Plaintiffs cite numerous cases for the proposition that the various provisions of the Medicaid Act noted above confer a private right of action, each case cited by Plaintiffs is either a
pre-Gonzaga
case
(see Rodriguez v. City of New York,
The other
post-Gonzaga
case in which the court found a private right of action to enforce a Medicaid provision is
Rabin v. Wilson-Coker.
In that case, the United States District Court for the District of Connecticut noted that while
Gonzaga
requires that Congress’s intent to permit private enforcement of actions must be clear and unmistakable, it nonetheless held that a private right of action exists to enforce a Medicaid Act provision under the three-part
Blessing
test without addressing the specific language within the statute that unambiguously confers an enforceable right.
Rabin,
Therefore, because none of the Medicaid Act provisions at issue contain the unambiguous rights-creating language required by Gonzaga, this court finds that Plaintiffs do not have a private right of action to enforce the Medicaid Act. Thus, Counts I through V are dismissed.
2. Plaintiffs’ ADA and § 504 Claims
Title II of the ADA prohibits a public entity from discriminating against qualified individuals based on disability. Specifically, it provides that “no qualified individual with a disability shall, by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any such entity.”
Defendants assert that Plaintiffs’ ADA and § 504 claims alleging that Defendants have violated the integration mandates of both the ADA and § 504 fail as a matter of law in that Plaintiffs already live
Because there is no language in the integration mandates to suggest that a plaintiff must currently be institutionalized to bring a claim under the ADA or Rehabilitation Act, the court agrees with Plaintiffs.
See Fisher v. Oklahoma Health Care Auth.,
In
Fisher v. Oklahoma Health Care Authority,
the Tenth Circuit recently ruled that there is nothing in the plain language of the ADA’s integration mandate that limits protection to only those individuals currently institutionalized.
Plaintiffs’ complaint properly states a claim under the ADA and § 504 in that Plaintiffs have been or "will be determined by Defendants to have an immediate need for HCBS waiver services, and the placement of Plaintiffs on the HCBS waiver waiting fist threatens Plaintiffs with institutionalization because it forces Plaintiffs to choose between staying in the community without any services or entering an institution in order to receive services. Thus, Plaintiffs have properly stated a claim for violating the integration mandates of ADA and § 504.
C. Eleventh Amendment Immunity
Pursuant to
The Eleventh Amendment prohibits suits in federal court against a state brought by a state’s own citizens.
See Edelman v. Jordan,
1. Agency Defendants
In 1986, Congress amended the Rehabilitation Act to manifest its clear intent that the Act applies to states and state entities.
See
Because the Agency Defendants are arms of the state and Plaintiffs have not argued otherwise, the Agency Defendants cannot be sued under the ADA.
See Board of Trustees of the Univ. of Alabama v. Garrett,
2. Individual Defendants
The Tenth Circuit has held that in order to bring a cause of action against state officials under the
Ex Parte Young
doctrine, a plaintiff must demonstrate that “(1) the plaintiffs are suing state officials, rather than the state itself; (2) the plaintiffs have alleged a non-frivolous violation of federal law; (3) the plaintiffs seek pro
Because the court has granted Defendants’ Motion to Dismiss Plaintiffs’ Medicaid claims entirely, the issue of Eleventh Amendment immunity under
IV. CONCLUSION
For the reasons stated above, IT IS HEREBY ORDERED that Plaintiffs’ Motion for Class Certification [docket # 4] is GRANTED, Defendants’ Motion to Dismiss [docket # 10] is GRANTED in part and DENIED in part. Counts I through V are dismissed as to all Defendants and Count VI is dismissed as to the Agency Defendants. All other claims remain. Counts VI and VII remain. Plaintiffs’ Cross Motion for Partial Summary Judgment [docket # 14] is GRANTED in part and DENIED in part.
Notes
. The Agency Defendants are the Utah State Department of Health; the Utah Division of Health Care Financing, and the Utah Division of Services for People with Disabilities.
. The Individual Defendants are Rod L. Betit, Executive Director of the Utah State Department of Heath; Michael Deily, Director, Division of Health Care Financing, Utah State Department of Health; Fran Morse, Director, Division of Services for People with Disabilities, Utah State Department of Human Services.