Flo. Dt. Ct. section 1983 decision

In a case regarding medical and dental services for children under Medicaid, the US District Court for the Southern District of Florida issued an order denying the bulk of the state’s motion to dismiss, ruling that numerous provisions of the Medicaid statute do confer enforceable rights. Florida Pediatric Society v. Levine, slip op., No. 05-2303 (Jan. 11, 2007).

In a case regarding medical and dental services for children under Medicaid, the US District Court for the Southern District of Florida issued an order denying the bulk of the state’s motion to dismiss, ruling that numerous provisions of the Medicaid statute do confer enforceable rights.  Florida Pediatric Society v. Levine, slip op., No. 05-2303 (Jan. 11, 2007). 

The court’s analysis begins by quoting the three-part test under Blessing v. Freestone, 520 U.S. 329, 341 (1997) for determining whether a federal statute creates an enforceable right.  The district court states that the “three-prong test established in Blessing [w]as refined by Gonzaga,” to require that statutory language impart an individual entitlement and have an unmistakable focus on the benefited class (quoting Gonzaga University v. Doe, 536 U.S. 273, 287 (2002)).

 

The court then analyzed the various provisions at issue in the case.  The court cited the pre-Gonzaga Eleventh Circuit decision in Doe v. Chiles, 136 F.3d 709, 719 (11th Cir. 1998), as having already decided the reasonable promptness provision of the Medicaid Act, 42 U.S.C. § 1396(a)(8), meets all three elements of the Blessing test.  The court stated: “Doe is binding, and I do not believe its holding has been called into doubt by Gonzaga.”  The court noted that Sabree v. Richman, 367 F.3d 180, 190-92 (3d Cir. 2004) had reached the same conclusion regarding the viability of Doe.

 

The court expressed agreement with six courts of appeals that 42 U.S.C. § 1396(a)(10) confers enforceable rights.  That provision requires that a State plan must provide for making medical assistance available.  The court noted that no circuit court had held that this provision is unenforceable.

 

The court bucked recent trends in holding that Medicaid’s equal access provision, 42 U.S.C. § 1396a(a)(30)(A), is enforceable.  The court quoted four cases from the First, Fifth and Eighth Circuits that have found it enforceable, of which three out of four were prior to Gonzaga (two of the four cases quoted were from the Eighth circuit).  The court expressed disagreement with the recent Ninth and Tenth Circuit cases that have held the equal access provision is unenforceable.  The court did not analyze the issue beyond indicating agreement or disagreement with court of appeals cases.

 

The court ruled against the plaintiffs on one count, holding that 42 U.S.C. § 1396u-2(b)(5) “does not establish a privately enforceable right under § 1983.”  This provision states that each “Medicaid managed care organization shall provide the State and the Secretary with adequate assurances…that the organization, with respect to a service area, has the capacity to serve the expected enrollment in such service area.”  The court held that the provision does not have the unmistakable focus on the benefited class required by Gonzaga.  Instead, the court held, the provision is aggregate and system-wide in nature.

 

Finally, the court ruled that 42 U.S.C. § 1396a(a)(43)(A), which requires the state to provide basic outreach and information about EPSDT to beneficiaries, is enforceable.  The court states that the Eleventh Circuit held that this provision is enforceable “in a pre-Gonzaga case,” 31 Foster Children v. Bush, 329 F.3d 1255 (11th Cir. 2003), cert. denied sub nom., 540 U.S. 984 (2003).  However, that case was in fact decided post-Gonzaga, and indeed it analyzes Gonzaga at great lengths.  Furthermore, 31 Foster Children did not address the enforceability of the Medicaid statute at all, because prior to the case reaching the court of appeals, the Medicaid claims had settled and been dismissed.  (While the Florida district court decision on appeal in 31 Foster Children did hold, prior to Gonzaga, that 42 U.S.C. § 1396a(a)(43)(A ) is enforceable (Bonnie L. ex rel. Hadsock v. Bush, 180 F.Supp.2d 1321 (S.D. Flo. 2001)), that issue was not reviewed by the Eleventh Circuit.)  The court correctly cites a number of district court cases that held that 42 U.S.C. § 1396a(a)(43)(A) is enforceable.  (While the decision cites the relevant district court decision in  Westside Mothers , the decision does not cite the Sixth Circuit decision in Westside Mothers that affirmed that 42 U.S.C. § 1396a(a)(43)(A) is enforceable, Westside Mothers v. Olszewski, 454 F.3d 532 (6th Cir. 2006).)  The court concluded that the EPSDT notice provision is intended to benefit the plaintiffs and that the right protected by the provision is neither vague nor amorphous.