D.T.M. v. Lanier Cansler

Filing 402840296

UNPUBLISHED PER CURIAM OPINION filed. Originating case number: 7:08-cv-00057-H. Copies to all parties and the district court/agency. [998357676] [09-1441]

D.T.M. v. Lanier Cansler

Doc. 402840296

Case: 09-1441

Document: 56

Date Filed: 06/11/2010

Page: 1

UNPUBLISHED UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT No. 09-1441 D.T.M., a minor child, by his mother Penny McCartney; E.C., a minor child, by his mother Selena McMillan; K.T., a minor child, by her father, Greg Tipton, individually and on behalf of all others similarly situated, Plaintiffs - Appellees, v. LANIER M. CANSLER, Secretary of North Carolina Department of Health and Human Services, in his official capacity, Defendant - Appellant.

Appeal from the United States District Court for the Eastern District of North Carolina, at Greenville. Malcolm J. Howard, Senior District Judge. (7:08-cv-00057-H) Argued: May 13, 2010 Decided: June 11, 2010

Before TRAXLER, Chief Judge, WILKINSON, Circuit Judge, and Samuel G. WILSON, United States District Judge for the Western District of Virginia, sitting by designation. Affirmed by unpublished per curiam opinion. ARGUED: Ronald Moore Marquette, NORTH CAROLINA DEPARTMENT OF JUSTICE, Raleigh, North Carolina, for Appellant. Douglas Stuart Sea, LEGAL SERVICES OF SOUTHERN PIEDMONT, INC., Charlotte, North Carolina, for Appellees. ON BRIEF: Roy Cooper, North Carolina Attorney General, Belinda A. Smith, Special Deputy Attorney General, Tracy J. Hayes, Assistant Attorney General, NORTH

Dockets.Justia.com

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CAROLINA DEPARTMENT OF JUSTICE, Raleigh, North Carolina, for Appellant. Jane Perkins, Sarah Jane Somers, NATIONAL HEALTH LAW PROGRAM, Chapel Hill, North Carolina, for Appellees. Unpublished opinions are not binding precedent in this circuit.

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PER CURIAM: Lanier Cansler, the Secretary of the North Carolina

Department of Health and Human Services ("HHS"), appeals the denial of his motion to dismiss this suit alleging that HHS has reduced or terminated Medicaid benefits received by plaintiffs and others in violation The of the Due Process Clause that and he the is

Medicaid

Act.

Secretary

primarily

argues

entitled to Eleventh Amendment immunity. affirm.

Finding no error, we

I. Medicaid assists states is in a cooperative federal-state services program to the that needy.

providing

medical

States need not participate in Medicaid, but once they choose to do so, they must implement plans for providing medical See 42

assistance that comply with detailed federal standards. U.S.C.A. § 1396a (West 2003 & Supp. 2009).

As is relevant here,

state plans are required to "provide for granting an opportunity for a fair hearing . . . to any individual whose claim for medical assistance . . . is denied or is not acted upon with reasonable promptness." plans also must contain 42 U.S.C.A. § 1396a(a)(3). reasonable standards for The state determining In

individuals' eligibility.

See 42 U.S.C.A. § 1396a(a)(17).

Medicaid parlance, "medical assistance" means payment of part or 3

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all

of

the

cost

of

care

and

services

or

provision

of

the

services themselves.

See 42 U.S.C. § 1396d(a), as amended by

the Patient Protection and Affordable Care Act, Pub. L. No. 111148, § 2304, 124 Stat. 119, 296 (Mar. 23, 2010). These services

generally include "health care, diagnostic services, treatment, and other measures . . . to correct or ameliorate defects and physical and mental illnesses" in children. 42 U.S.C.A. §

1396d(r)(5) (West Supp. 2009). HHS Medicaid is the state in agency North responsible for 42 administering U.S.C.A. §

programs In Inc.

Carolina. 2006, be and HHS's

See HHS

1396a(a)(5). ValueOptions, administer services

approximately ("VO"), to

contracted

with to

statewide

agent

behavioral North

health

developmental program.

disability The three

for

Carolina's

Medicaid

plaintiffs in this action are children who have been denied the level of medical assistance that they requested. requires preauthorization for medical assistance North Carolina of the type

Plaintiffs sought.

See 42 C.F.R. § 440.230(d) (2008) (providing

that states "may place appropriate limits on a service based on . . . utilization control procedures"). If a preauthorization

request is granted, Medicaid pays for the service for a certain length of time--90 days for Community Support Services and one year for the Community Alternatives Program for persons with mental retardation/developmental disabilities. 4 An applicant may

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appeal

an

adverse

decision

to

the

North

Carolina

Office

of

Administrative Hearings ("OAH"), with or without first appealing informally to the HHS hearing office. During the pendency of a

timely filed appeal, North Carolina authorizes the provision of services at the existing level of care. Plaintiffs brought this suit under 42 U.S.C.A. § 1983 (West 2003), Medicaid alleging Act and that the HHS Due violated Process their Clause rights of the under the

Fourteenth

Amendment by arbitrarily and capriciously denying their requests for services, terminating or reducing their benefits without

providing timely and adequate written notice and a fair hearing, and failing to ensure that their benefits continued while their appeals were pending. Plaintiffs' complaint requests

declaratory relief as well as an order enjoining the Secretary, his agents, successors, and employees to (a) continue to provide behavioral health and developmental disability services to all persons who have been receiving them, until Defendant corrects the practices and procedures alleged herein; (b) prospectively reinstate behavioral health and developmental disability services previously provided to the named Plaintiffs and members of the Plaintiff class that were improperly reduced or terminated under the illegal practices and procedures alleged herein; [and] (c) comply with the Due Process Clause of the U.S. Constitution and the Medicaid Act. J.A. 40. 5

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After

filing

suit,

Plaintiffs

filed

a

motion

in

the The

district court to certify this suit as a class action.

Secretary opposed class certification and moved to dismiss for lack of subject-matter jurisdiction and for failure to state a claim upon which relief can be granted. 12(b)(1), Secretary immunity, action had (6). argued that Regarding that he See Fed. R. Civ. P. jurisdiction, Eleventh and the

subject-matter entitled lacked also Harris, to

was

Amendment that the

the

Plaintiffs moot. He

standing, to U.S.

become under

sought 401

dismiss 37

because was

abstention

Younger v.

(1971),

appropriate.

The district court denied the motion to dismiss

and denied the class-certification motion without prejudice to Plaintiffs' right to refile the motion after further discovery.

II. On appeal, the Secretary argues that the district court erred in not dismissing the suit based on Eleventh Amendment immunity. * We disagree.

A district court order denying a motion to dismiss on the ground of Eleventh Amendment immunity is immediately appealable. The Secretary also maintains that the Plaintiffs lacked standing when they initiated this suit, and, alternatively, that the suit has become moot since it was filed. We decline to address those issues at this time. See Antrican v. Odom, 290 F.3d 178, 191 (4th Cir. 2002). 6
*

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See Antrican v. Odom, 290 F.3d 178, 184 (4th Cir. 2002). review such an order de novo.

We

See CSX Transp., Inc. v. Bd. of

Pub. Works, 138 F.3d 537, 541 (4th Cir. 1998). Although the Eleventh Amendment generally bars individual suits against non-consenting states and state officers, an

exception exists under the doctrine of Ex parte Young, 209 U.S. 123 (1908), for official capacity suits requesting prospective relief to achieve the officials' compliance with federal law. See Litman v. George Mason Univ., 186 F.3d 544, 549-50 (4th Cir. 1999). In such a case, a federal court may enjoin a state

officer from engaging in future conduct in violation of federal law. See Antrican, 290 F.3d at 184. In determining whether the

Ex parte Young exception applies, "a court need only conduct a `straightforward inquiry into whether the complaint alleges an ongoing violation of federal law and seeks relief properly

characterized as prospective.'"

Verizon Md. Inc. v. Pub. Serv.

Comm'n, 535 U.S. 635, 645 (2002) (alteration omitted). The Secretary asserts three arguments against application of Ex parte Young: that Plaintiffs seek a compensatory,

monetary remedy against the state rather than prospective relief against violation him; of that Plaintiffs law; and have that not the alleged Secretary an is ongoing not an

federal

appropriate party.

We will address these arguments seriatim.

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A. In arguing that Plaintiffs do not seek prospective relief, the Secretary focuses on one part of the relief requested in the amended complaint, that being Plaintiffs' request to enjoin him, his agents, successors, and employees to prospectively reinstate services to the named Plaintiffs. However, the request for

prospective reinstatement of benefits is precisely the type of relief that we recognized in Kimble v. Solomon, 599 F.2d 599, 605 (4th Cir. 1979), that plaintiffs may seek consistent with the Eleventh Amendment when they allege a state Medicaid The

agency's reduction of their benefits violated federal law.

Secretary argues that the facts alleged in the complaint do not legally entitle Plaintiffs to prospective reinstatement of

benefits since the benefits allegedly denied were for a discrete period in the past. However, even assuming arguendo that the

Secretary is correct on this point, the fact that Plaintiffs cannot prove entitlement to the prospective relief they seek does not mean that the relief they seek is not prospective. See

Verizon, 535 U.S. at 646 ("[T]he inquiry into whether suit lies under Ex parte Young does not include an analysis of the merits of the claim."). And, in any event, even if the prospective

reinstatement of benefits--the remedy on which the Secretary has focused--were not a prospective remedy, injunctive relief from

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the continuation of HHS's allegedly illegal practices would be, and the Ex parte Young exception would apply. B. The Secretary's second argument, that Plaintiffs have not alleged an ongoing violation of federal law, is also a meritsbased argument dressed in Eleventh Amendment clothing. The

Secretary argues that to determine whether Plaintiffs allege an ongoing violation for Ex parte Young purposes, "this Court must determine what pre-deprivation and post-deprivation process is provided and whether it is constitutionally adequate." Appellant, at 45. Brief of

However, to fall within the Ex parte Young

exception, it is sufficient for Plaintiffs' suit to allege an ongoing violation of federal law; actually proving such an

ongoing violation is unnecessary.

See Verizon, 535 U.S. at 646;

Burlington N. & Santa Fe Ry. Co. v. Vaughn, 509 F.3d 1085, 1092 (9th Cir. 2007); Deposit Ins. Agency v. Superintendent of Banks (In re Deposit Ins. Agency), 482 F.3d 612, 621 (2d Cir. 2007); McCarthy v. Hawkins, 381 F.3d 407, 415-17 (5th Cir. 2004). C. The Secretary finally maintains that his status as the

official responsible for administering North Carolina's Medicaid program is not a sufficient connection to the complained-of

actions to justify applying the Ex parte Young exception to him. We disagree. 9

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The

complaint

makes

clear

that

it

is

challenging

the

practices of the public agency.

The Secretary, as the person

responsible for assuring that the agency's decisions comply with federal law, was properly named as the defendant. See Ogden v.

United States, 758 F.2d 1168, 1177 (7th Cir. 1985) ("[W]here injunctive, as opposed to monetary relief is sought, no `direct and personal' involvement is required in order to hold highlevel officials responsible for the actions of subordinates and to subject them to the equitable jurisdiction of the court."). And, the Ex parte Young exception was therefore properly applied to him. Young See Antrican, 290 F.3d at 188-89 (holding Ex parte was properly applied to state officials

exception

overseeing the North Carolina Medicaid program in suit alleging wrongful denial of Medicaid services).

III. In sum, because we conclude that the district court

properly ruled that the Secretary was not entitled to Eleventh Amendment immunity, we affirm. AFFIRMED

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