Doctors Nursing and Rehabilitation Center, LLC et al v. Norwood
Filing
50
MEMORANDUM Opinion and Order: For the reasons set forth in the accompanying Memorandum Opinion and Order, Defendant's Motion to Dismiss 36 is denied. See Order for further details. Signed by the Honorable Elaine E. Bucklo on 6/7/2017. Mailed notice(ep, )
IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ILLINOIS
EASTERN DIVISION
Doctors Nursing and
Rehabilitation Center, LLC, et
al.,
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)
)
)
)
)
)
)
)
)
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)
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)
)
)
Plaintiffs,
v.
Felicia F. Norwood, in her
official capacity as the
Director of the Illinois
Department of Healthcare and
Family Services,
Defendant,
and related cases.
No.
No.
No.
No.
No.
No.
No.
1:16-cv-9837
1:16-cv-9842
1:16-cv-9922
1:16-cv-10255
1:16-cv-10614
1:17-cv-0104
1:17-cv-0640
Memorandum Opinion and Order
In these related cases, several healthcare providers and
their patients in the State of Illinois seek declaratory and
injunctive
relief
against
the
Director
of
the
Illinois
Department of Healthcare and Family Services (“HFS”), Felicia
Norwood, in her official capacity. Plaintiffs allege that the
defendant
provide
has
failed
Medicaid
to
process
benefits
with
Medicaid
reasonable
applications
and
promptness
to
residents of long-term care facilities in violation of Title XIX
of
the
Social
Security
Act
(the
“Medicaid
Act”)
and
its
implementing regulations, the Americans with Disabilities Act
1
(“ADA”), the Rehabilitation Act, and the Fourteenth Amendment.
Before me is defendant’s motion to dismiss for lack of subject
matter jurisdiction and for failure to state a claim upon which
relief can be granted [Case. No. 1:16-cv-9837, ECF No. 36]. For
the reasons set forth below, I deny defendant’s motion.
I.
Plaintiffs
in
these
seven
related
cases
are
Illinois
healthcare providers and certain elderly and disabled patients
they
serve.
healthcare
The
healthcare
companies
provider
owning
and/or
plaintiffs
are
Illinois
operating
nursing
home
facilities throughout the state of Illinois. These facilities
provide
twenty-four
patients
and
hour,
patients
long-term
with
nursing
disabilities,
care
some
to
of
elderly
whom
are
Medicaid applicants or beneficiaries.
The
patient
provider
patient
plaintiffs
plaintiffs’
plaintiffs
are
long-term
fall
into
residents
nursing
two
at
care
groups:
(1)
the
healthcare
facilities.
those
who
The
are
awaiting Medicaid eligibility determinations and (2) those who,
despite
receiving
approval,
are
still
awaiting
Medicaid
benefits.
The healthcare provider plaintiffs purport to serve as the
patient
plaintiffs’
“authorized
representatives”
for
the
purposes of pursuing Medicaid benefits pursuant to 42 C.F.R. §
2
435.923. The patient plaintiffs also bring suit on their own
behalves.
Defendant is Felicia Norwood, the Director of the Illinois
Department of Healthcare and Family Services, who is sued in her
official capacity. HFS is a state agency charged with operating
Illinois’s
Medicaid
program.
Two
of
the
complaints
also
separately list HFS as a defendant.1
Plaintiffs
allege
that
defendant
Norwood
has
failed
to
provide medical care services to eligible Illinois residents as
required by the Medicaid Act. Specifically, plaintiffs charge
that
defendant
applications,
has
render
failed
to
eligibility
process
plaintiffs’
determinations,
and
Medicaid
provide
benefits with reasonable promptness. They allege that HFS has
exceeded the forty-five days or ninety days that the Medicaid
regulations
permit
to
determine
applicant
eligibility.
Plaintiffs further allege that defendant has failed to provide
benefits to the patient plaintiffs who have had their Medicaid
applications
plaintiffs
approved.
allege,
HFS’s
violates
inaction
42
U.S.C.
on
these
matters,
§§
1396a(a)(10)(A),
1396d(a)(4)(A), and 1396a(a)(8). Additionally, plaintiffs assert
that these inactions constitute violations of the ADA, Section
504 of the Rehabilitation Act, and the Equal Protection Clause
1
See Case No. 1:16-cv-9842 [ECF No. 12]; Case No. 1:16-cv-10255
[ECF No. 3].
3
of
the
Fourteenth
Amendment.
Plaintiffs
seek
injunctive
and
declaratory relief to ensure the defendant’s future compliance
with the Medicaid statute.
II.
Defendant moves to dismiss the seven complaints against her
because,
she
argues,
this
court
lacks
subject
matter
jurisdiction to hear the cases and plaintiffs fail to state
claims
upon
which
relief
may
be
granted.
When
considering
motions to dismiss for failure to state a claim or lack of
subject matter jurisdiction, I “take as true all well-pleaded
factual
allegations
inferences
from
Disability
Rights
in
those
the
complaint
allegations
Wisconsin,
and
the
in
Inc.
make
plaintiffs'
v.
Walworth
all
plausible
Cty.
favor.”
Bd.
of
Supervisors, 522 F.3d 796, 799 (7th Cir. 2008); see Scanlan v.
Eisenberg, 669 F.3d 838, 841 (7th Cir. 2012) (applying the same
standard
to
Rule
12(b)(1)
motions).
To
survive
a
motion
to
dismiss under Rule 12(b)(6), a complaint must provide factual
allegations that, if taken as true, “state a claim to relief
that is plausible on its face.” Bell Atl. Corp. v. Twombly, 550
U.S. 544, 570 (2007). Similarly, a complaint will survive a
facial challenge to jurisdiction brought under a Rule 12(b)(1)
motion to dismiss if it “has sufficiently alleged a basis of
subject
matter
jurisdiction.”
Apex
Digital,
Roebuck & Co., 572 F.3d 440, 443 (7th Cir. 2009).
4
Inc.
v.
Sears,
A. Lack of Subject Matter Jurisdiction
Defendant
contends
that
all
seven
complaints
should
be
dismissed for lack of subject matter jurisdiction. In her motion
to
dismiss,
defendant
initially
challenged
this
court’s
jurisdiction to hear these cases on Article III standing and
Eleventh Amendment grounds. Defendant subsequently dropped her
Article III challenge in her reply brief, and I will therefore
not
address
defendant
it
here.
does
plaintiffs'
Def.’s
continue
authority
Reply
to
sue
3
[ECF
challenge
to
at
the
on
behalf
No.
45].
The
institutional
of
the
patient
plaintiffs, but, because the patients themselves are plaintiffs
asserting a cognizable injury, this issue does not implicate my
subject
matter
jurisdiction
and
is
better
understood
as
a
challenge arising under Rule 12(b)(6), as discussed below. See
Whelan v. Abell, 953 F.2d 663, 672 (D.C. Cir. 1992).
Defendant’s remaining jurisdictional argument concerns the
Eleventh Amendment. Defendant contends that plaintiffs’ claims—
with the exception of those brought under the Rehabilitation
Act—are barred by the Eleventh Amendment and the doctrine of
state
sovereign
immunity
because
plaintiffs
seek
an
order
compelling payments for services already rendered. Plaintiffs
counter
that
they
seek
only
prospective
injunctive
and
declaratory relief to ensure defendant’s future compliance with
federal law.
5
The
shall
not
Eleventh
extend
Amendment
to
suits
states
that
against
a
federal
state
by
jurisdiction
a
citizen
of
another state or foreign country. U.S. Const. amend. XI. In
addition
to
what
it
explicitly
guarantees,
the
Eleventh
Amendment also incorporates the doctrine of sovereign immunity.
See
Hans
v.
Louisiana,
134
U.S.
1,
13-14
(1890).
Thus,
the
Amendment “guarantees that ‘an unconsenting State is immune from
suits brought in federal courts by her own citizens as well as
by citizens of another State.’” Bd. of Regents v. Phoenix Int'l
Software,
Inc.,
653
F.3d
448,
457
(7th
Cir.
2011)
(quoting
Edelman v. Jordan, 415 U.S. 651, 662–63 (1974)).
The Eleventh Amendment’s bar on citizens suing their state,
however, is not complete. There are several common exceptions
that allow plaintiffs to pursue claims against a state or its
agents. One such exception was first articulated in Ex Parte
Young, 209 U.S. 123 (1908). There, the Supreme Court held that
the Eleventh Amendment does not preclude claims against state
officials
for
prospective,
injunctive
relief
to
stop
ongoing
violations of federal law. Ex Parte Young, 209 U.S. at 159-60.
While a federal court cannot order a state to pay retrospective
damages, it can require a state officer to prospectively comply
with federal law, even when that compliance might require the
state to expend funds. See Milliken v. Bradley, 433 U.S. 267,
289-90 (1977).
6
This is what plaintiffs seek here. Plaintiffs sue Director
Norwood in her official capacity as defendant.2 In these cases,
plaintiffs
seek
declaratory
and
injunctive
relief
requiring
defendant Norwood to process applications and provide benefits
in
accordance
with
the
Medicaid
Act
and
its
implementing
regulations. Importantly, plaintiffs are not requesting money
damages for past violations, nor are they attempting to bring
state claims against a state actor in federal court. Rather,
plaintiffs seek to stop defendant’s ongoing conduct—or, in this
case, inaction—that they allege violates federal law. They ask
me
to
declare
injunction
defendant’s
“requiring
conduct
[defendant]
unlawful
to
and
arrange
for
issue
an
medical
assistance and nursing facility services” for plaintiffs. Pls.’
2d Am. Compl. at 16 [Case No. 1:16-cv-9837; ECF No. 21]. The
Eleventh Amendment permits such relief.
In sum, the prospective equitable relief that plaintiffs
seek
against
Director
Norwood
in
2
her
official
capacity
is
In Case No. 1:16-cv-9837, Case No. 1:16-cv-10614, Case No.
1:16-cv-9922, Case No. 1:17-cv-0104, and Case No. 1:17-cv-0640,
plaintiffs sue only Director Norwood. In the other two, Case No.
1:16-cv-9842 and Case No. 1:16-cv-10255, plaintiffs also name
the Illinois Department of Healthcare and Family Services as a
defendant. As defendant notes, HFS, as a state agency, is an arm
of the state of Illinois, and therefore may not be sued by its
citizens in federal court. See Edelman, 415 U.S. at 663; Burrus
v. State Lottery Comm'n of Ind., 546 F.3d 417, 420 (7th Cir.
2008).
7
permitted
under
Ex
Parte
Young.
This
court
therefore
has
jurisdiction to hear these matters.
B. Failure to State a Claim
In
her
complaints
motion
fail
to
to
dismiss,
state
claims
defendant
for
asserts
several
that
reasons.
the
First,
defendant challenges the healthcare providers’ authority to file
suit, arguing that they are not the real parties in interest and
do
not
have
statutory
authority
to
sue
on
the
patient
plaintiffs’ behalves. Second, defendant argues that plaintiffs
fail
to
sufficiently
concerning
the
plead
provision
Count
of
II
required
in
each
medical
complaint,
assistance.
Finally, defendant contends that Count III in each complaint,
concerning the prompt delivery of Medicaid benefits, fails to
state a claim because the applicable provision of the Medicaid
statue does not create enforceable rights and, even if it did,
plaintiffs do not provide sufficient allegations.
1. Real Party in Interest/Authority to Bring Suit
Defendant
healthcare
interest
Reply
provider
and
at
argues
cannot
3-5.
This
that
dismissal
plaintiffs
sue
on
are
their
argument
is
not
required
the
patients’
fails
because
because
real
parties
behalves.
it
the
in
Def.’s
ignores
the
patients’ participation in these suits. Defendant focuses on the
status of the institutional plaintiffs, but she notably does not
contend
that
the
real
parties
8
in
interest—the
nursing
home
patients—are absent from this litigation. On the contrary, the
patients
are
plaintiffs
in
these
lawsuits.
Because
the
real
parties in interest are prosecuting their own claims, no counts
require dismissal. See Fed. R. Civ. P. 17(a).
In any event, I also find that the patient plaintiffs may
authorize their representatives to pursue litigation to secure
Medicaid benefits. I reach this conclusion by looking to the
Medicaid statute and regulations. See In re Davis, 194 F.3d 570,
578 (5th Cir. 1999) (“[A]n entity is the real party in interest
when it is statutorily authorized to bring suit to enforce a
claim. . . . The statutory right to sue must stem from the
substantive law controlling the action and may be granted by
either state or federal law”); New York v. Cedar Park Concrete
Corp., 665 F. Supp. 238, 241 (S.D.N.Y. 1987) (citing 3A J. Moore
& J. Lucas, Moore's Federal Practice, ¶ 17.14 (2d ed. 1986))
(“Under
Rule
17(a),
a
party
may
sue
on
behalf
of
one
it
represents as long as the relevant underlying federal and state
statutes authorize such a suit.”). The Social Security Act, of
which Medicaid is a part, directs the Secretary of Health and
Human
Services
“necessary
to
(“HHS”)
the
to
efficient
publish
rules
administration”
and
of
regulations
the
federal
programs that HHS is charged with overseeing. 42 U.S.C. § 1302.
Pursuant to this authority, HHS published 42 C.F.R. § 435.923,
which permits a Medicaid applicant or beneficiary to authorize a
9
representative to act on his or her behalf “in applying for and
maintaining coverage.” 78 Fed. Reg. 42174 (July 15, 2013). This
representative
C.F.R.
§
can
be
an
435.923(b).3
representatives
to
individual
The
perform
or
regulations
the
following
an
organization.
permit
tasks
42
authorized
for
Medicaid
applicants and beneficiaries:
(1) Sign an application on the applicant's behalf;
(2) Complete and submit a renewal form;
(3) Receive copies of the applicant or beneficiary's
notices and other communications from the agency;
(4) Act on behalf of the applicant or beneficiary in
all other matters with the agency.
42 C.F.R. § 435.923(b). The Federal Register entries regarding
this
provision
state
that
the
applicant
or
beneficiary
ultimately defines the scope of any representation within the
limits of the regulation.4 78 Fed. Reg. 42175 (July 15, 2013).
The regulatory text does not explicitly address whether a
patient
can
authorize
a
Medicaid
3
representative
to
file
a
See also 78 Fed. Reg. 42174 (July 15, 2013) (“We believe that
there are situations in which an individual may need an
organization to serve as his or her authorized representative
and it is appropriate for an organization to serve in this
capacity, such as for individuals residing in a nursing home who
do not have family available to assist them.”).
4
The regulatory history also clarifies that states are not
permitted
to
impose
additional
requirements
on
this
representative relationship. 78 Fed. Reg. 42174 (“[S]tates may
not limit authorized representatives to individuals identified
in such a legal document or granted authorization under
operation of state law or otherwise impose requirements other
than those listed in § 435.923 on other individuals whom an
applicant or beneficiary wishes to have serve as his or her
authorized representative.”).
10
lawsuit on his or her behalf. Defendant argues that the phrase
“matters with the agency” in 42 C.F.R. § 435.923(b)(4) should be
construed
to
exclude
bringing
a
suit
against
the
agency.
Plaintiffs counter that permitting authorized representatives to
bring claims against the agency is necessary to ensure that
beneficiaries can secure the Medicaid benefits to which they are
entitled.
lawsuits,
The
regulations
plaintiffs
beneficiary’s
argue,
power
to
might
but
not
they
assign
explicitly
also
sanction
do
to
authority
not
limit
his
or
a
her
representative.
Defendant’s
restrictive
interpretation
of
the
authorized
representative relationship does not comport with the language
and purpose of the regulation. 42 C.F.R. § 435.923(b) provides
three
specific
representative
examples
may
perform
of
in
duties
the
that
course
of
an
authorized
representation,
followed by one catch-all provision. The catch-all clause is
written in broad terms. It states that a beneficiary can choose
to authorize her representative to handle “all other matters
with
the
agency.”
42
C.F.R.
§
435.923(b)(4).
It
is
the
beneficiary who sets the limits of representation, see 78 Fed.
Reg.
42175,
and
the
expansive
language
of
this
provision
apparently permits beneficiaries to set these parameters quite
broadly.
11
There is no indication that the words “with the agency”
were
included
activities
in
to
the
those
regulatory
internal
text
to
the
to
limit
authorized
applicable
agency.
Litigation arguably involves “matters with the agency” as well.
A beneficiary’s legal claim that an agency has deprived her of
Medicaid benefits, for instance, is a matter in dispute with
that agency. While the first three tasks listed in 42 C.F.R. §
435.923(b)
are
likely
more
common
activities
performed
by
authorized representatives, there is room in the regulation’s
text for the representative relationship, in unusual cases such
as
these,
to
require
additional
steps,
like
litigation,
to
secure a beneficiary’s rights. So long as the beneficiary gives
express authorization to his or her representative, as required
by 42 C.F.R. § 435.923(a), the Medicaid regulations allow the
authorized representative to initiate suit on the beneficiary’s
behalf. The healthcare provider plaintiffs may therefore remain
in these suits.
2. Failure to provide medical assistance
In Count II of their complaints, plaintiffs allege that
defendant, in her official capacity as the Director of HFS, has
failed to comply with the Medicaid Act’s requirement under 42
U.S.C.
§
including
1396a(a)(10)(A)
nursing
Medicaid-eligible
facility
that
certain
services,
individuals.
be
Defendant
12
medical
made
assistance,
available
acknowledges
that
to
a
private
right
of
action
exists
to
enforce
section
1396a(a)(10)(A). Def.’s Memo at 9 [Case No. 1:16-cv-9837; ECF
No. 37]; Def.’s Reply at 8 n.3 [Case No. 1:16-cv-9837; ECF No.
45].5 However, she contends that plaintiffs have not sufficiently
pled violations of this section and, consequently, have failed
to state claims upon which relief can be granted. Def.’s Reply
at 8. Specifically, defendant argues that the complaints contain
no allegations that Director Norwood has failed to authorize
necessary nursing facility services, nor any allegations that
the
patient
plaintiffs
have
been
denied
these
services.
Id.
Defendant misstates plaintiffs’ allegations. The complaints
do, in fact, contain allegations concerning defendant’s failure
to provide nursing facility services to the patient plaintiffs.
For example, in the lead complaint, plaintiffs identify Clint
Daugherty as a patient who has not received necessary medical
assistance from HFS. Plaintiff Daugherty “suffers from chronic
and severe medical conditions” and requires “twenty-four hour
skilled nursing care” for which he is unable to pay. Pls.’ 2d
5
The Seventh Circuit has, indeed, held that the provision
plaintiffs cite—42 U.S.C. § 1396a(a)(10)(A)—creates enforceable
individual rights by requiring state Medicaid plans to “provide
. . . for making medical assistance available . . . to all
[eligible] individuals.” Bontrager v. Indiana Family & Soc.
Servs. Admin., 697 F.3d 604, 606-07 (7th Cir. 2012); Miller v.
Whitburn, 10 F.3d 1315, 1319-20 (7th Cir. 1993); see also
Planned Parenthood of Ind., Inc. v. Comm'r of Ind. State Dep't
Health, 699 F.3d 962, 975-76 (holding that 42 U.S.C. §
1396a(a)(23) also creates an enforceable right).
13
Am. Compl. ¶¶ 5, 23 [Case No. 1:16-cv-9837; ECF No. 21]. Despite
submitting
a
Medicaid
application
on
June
28,
2016,
Mr.
Daugherty had not received public assistance by the time the
second amended complaint was filed on January 11, 2017. Id. ¶¶
5,
26.
As
a
outstanding
result,
balance
plaintiffs
of
state
$31,003.68
that
for
Daugherty
the
an
care
nursing
had
he
received at Doctors Nursing and Rehabilitation Center, LLC. Id.
¶
5.
Defendant
Norwood’s
failure
to
timely
process
Medicaid
applications like plaintiff Daugherty’s, plaintiffs allege, has
resulted
in
Medicaid
eligible
individuals
not
receiving
necessary medical assistance from the state of Illinois plan, as
required by 42 U.S.C. §§ 1396a(a)(10)(A), 1396d(a)(4). Id. ¶¶
23-34, 51-53. Plaintiffs therefore claim that defendant Norwood
has deprived the patient plaintiffs of their right to nursing
facility
care
under
the
color
of
state
law.
These
factual
allegations are sufficient to survive a motion to dismiss.
3. Failure to timely provide medical services
In Count III of each complaint, plaintiffs bring a section
1983 claim alleging that defendant has violated their rights
under 42 U.S.C. § 1396a(a)(8) by failing to issue eligibility
determinations and provide medical assistance with reasonable
promptness.
Defendant
argues
that
plaintiffs
have
no
private
right of action under section 1983 to enforce these timeliness
provisions. Defendant further asserts that, even if a private
14
right of action were available, plaintiffs have not sufficiently
alleged violations of the timeliness provisions.
The
Medicaid
Act
requires
that
benefits
be
provided
promptly. States that participate in Medicaid must “provide that
all
individuals
wishing
to
make
application
for
medical
assistance under the plan shall have opportunity to do so, and
that
such
assistance
promptness
to
all
shall
be
eligible
1396a(a)(8).
The
Medicaid
“reasonable
promptness”
furnished
individuals.”
regulations
by
with
42
clarify
providing
time
reasonable
U.S.C.
§
the
meaning
of
limitations
for
certain agency actions. For instance, state Medicaid agencies
have ninety days to determine the eligibility of applicants who
apply for Medicaid on the basis of disability and forty-five
days to determine the eligibility of all other applicants. 42
C.F.R. § 435.912(c)(2). They must “promptly and without undue
delay consistent with [these] timeliness standards . . . furnish
Medicaid
to
eligible
individuals”
who
apply.
42
C.F.R.
§
435.911(c)(1); see also 42 C.F.R. § 435.930. State agencies must
also pay all Medicaid claims within 12 months of the date of
receipt. 42 C.F.R. § 447.45(d). By requiring states to follow
these and other timeliness standards, HHS ensures that Medicaideligible
individuals
receive
promptness.
15
benefits
with
reasonable
For plaintiffs to be able to privately enforce Medicaid’s
reasonable promptness requirement, as they seek to do here, 42
U.S.C.
§
1396a(a)(8)
must
create
an
enforceable
right
appropriate for section 1983 prosecution. Section 1983 provides
a “federal remedy against anyone who, under the color of state
law, deprives ‘any citizen of the United States . . . of any
rights, privileges, or immunities secured by the Constitution
and laws.’” Planned Parenthood of Ind., Inc. v. Comm'r of Ind.
State Dep't Health, 699 F.3d 962, 972 (7th Cir. 2012) (quoting
42 U.S.C. § 1983). It thus creates a private right of action for
aggrieved
rights
persons
arising
to
under
enforce
federal
federally-protected
statutes
and
the
individual
Constitution.
Maine v. Thiboutot, 448 U.S. 1, 4-5 (1980); Wilder v. Va. Hosp.
Ass’n,
496
U.S.
498,
508
(1990).
“To
state
a
claim
under
[section] 1983, a plaintiff must allege the violation of a right
secured
by
[federal
law]
and
must
show
that
the
alleged
deprivation was committed by a person acting under color of
state law.” L.P. v. Marian Catholic High Sch., 852 F.3d 690, 696
(7th
Cir.
2017)
(quoting
West
v.
Atkins,
487
U.S.
42,
48
(1988)).
Section 1983 provides a means of enforcing federal rights,
not vague or diffuse interests. Gonzaga Univ. v. Doe, 536 U.S.
273, 283 (2002). To determine whether a federal statute creates
individual
rights
appropriate
for
16
section
1983
enforcement,
courts
assess
whether:
(1)
Congress
intended
the
statutory
provision to benefit the plaintiff; (2) the asserted right is
not “so vague and amorphous that its enforcement would strain
judicial competence”; and (3) the statutory provision employs
mandatory, not precatory, language. Planned Parenthood, 699 F.3d
at 972–73 (quoting Blessing v. Freestone, 520 U.S. 329, 340–41
(1997)). In short, the statute must contain unambiguous “rightscreating language.” Id. at 973.
Applying these factors to 42 U.S.C. § 1396a(a)(8), many
circuits have concluded that an enforceable right exists. See
Romano v. Greenstein, 721 F.3d 373, 379 (5th Cir. 2013); Doe v.
Kidd, 419 F. App’x 411, 416 (4th Cir. 2011), reaff’g 501 F.3d
348, 356-57 (4th Cir. 2007); Sabree ex rel. Sabree v. Richman,
367 F.3d 180, 183 (3d Cir. 2004); Bryson v. Shumway, 308 F.3d
79, 89 (1st Cir. 2002); Doe v. Chiles, 136 F.3d 709, 719 (11th
Cir. 1998). The Seventh Circuit has stated that it assumes that
42
U.S.C.
§
1396a(a)(8)
creates
an
enforceable
right.
See
Bertrand ex rel. Bertrand v. Maram, 495 F.3d 452, 457–58 (7th
Cir. 2007).
Following the well-reasoned decisions of the circuits that
have squarely decided this issue, I find that the reasonable
promptness
provision
language
for
Congress
used
section
in
42
contains
1983
the
necessary
enforcement.
U.S.C.
§
17
rights-creating
First,
1396a(a)(8)
is
the
language
unambiguously
intended to benefit specific individuals, namely all persons who
meet
the
Medicaid
eligibility
standards.
Here,
the
patient
plaintiffs allege that they meet the Medicaid Act’s eligibility
standards.
They
can
therefore
be
considered
the
intended
beneficiaries. Second, the reasonable promptness provision is
“not so ‘vague and amorphous’ that its enforcement would strain
judicial competence.” Blessing, 520 U.S. at 340–41. As the Fifth
Circuit
has
explained,
the
statute
and
the
accompanying
regulations “clarify the scope of the ‘reasonable promptness’
duty.” Romano, 721 F.3d at 379. Courts are therefore not left to
guess
what
42
U.S.C.
§
1396a(a)(8)
protects.
Finally,
the
mandatory language of the reasonable promptness provision—the
use of “shall” and “must”—indicates that Congress intended to
impose a “binding obligation on the States.” Id. Nothing in the
statutory
text
suggests
that
this
commitment
to
reasonable
promptness was just aspirational or conditional. An enforceable
right under section 1983 therefore exists.6
To the extent that defendant challenges the sufficiency of
plaintiffs’ allegations in Count III, these arguments fail for
the
same
Plaintiffs
reasons
have
they
properly
failed
alleged
6
with
respect
violations
to
of
42
Count
II.
U.S.C.
§
There is also no indication that Congress intended to foreclose
section 1983 enforcement of the Medicaid Act. See Wilder, 496
U.S. at 522-23; Planned Parenthood, 699 F.3d at 974-75; Doe v.
Kidd, 501 F.3d 348, 356 (4th Cir. 2007).
18
1396a(a)(8)
by
defendant
Norwood,
depriving
them
of
their
federally protected rights to reasonable promptness. Plaintiffs
have identified specific Medicaid-eligible patients who have not
received
timely
eligibility
determinations
or
timely
medical
assistance. See, e.g., Pls.’ 2d Am. Compl. ¶¶ 5-11 [Case No.
1:16-cv-9837,
ECF
No.
21].
They
have
identified
the
medical
services they require. Id. They have provided the application
dates for these individuals and have alleged that they have not
timely
received
the
public
assistance
to
which
they
are
entitled. Id. ¶¶ 5-11, 23-34, 54-58. Plaintiffs have provided
enough factual allegations to state their section 1983 claims.
III.
For the foregoing reasons, defendant’s motion to dismiss is
denied.
ENTER ORDER:
________________________
Elaine E. Bucklo
United States District Judge
Dated: June 7, 2017
19
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