Hillspring Health Care Center v. Director, Ohio Department of Job and Family Services, et al.
Filing
30
MEMORANDUM OPINION AND ORDER granting 10 Defendants' Motion to Dismiss Amended Complaint. This case is TERMINATED on the docket of this Court. Signed by Magistrate Judge Stephanie K. Bowman on 1/4/2018. (km)
UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF OHIO
WESTERN DIVISION
HILLSPRING HEALTH CARE
CENTER, LLC,
Civil Action No. 1:17-cv-35
Plaintiff,
Bowman, M.J
vs.
CYNTHIA C. DUNGEY, et al.,
Defendants.
MEMORANDUM OPINION AND ORDER
This civil matter is before the Court on the Motion to Dismiss of Defendants
Cynthia C. Dungey, Director of the Ohio Department of Job and Family Services
(“ODJFS”), and Barbara Sears, Director of the Ohio Department of Medicaid (“ODM”)
(collectively, “Defendants”).
(Doc. 10). Plaintiff Hillspring Health Care Center, LLC
(“Plaintiff” or “Hillspring”) has filed a response in opposition (Doc. 11), and Defendants
have filed a reply (Doc. 14). The parties also have submitted supplemental authority in
support of these briefings. (Docs. 17, 19, 21, 23, and 29). For the reasons that follow,
Defendant’s Motion to Dismiss is GRANTED.
I.
Background and Factual Allegations
This case centers on the denial of Medicaid benefits to Barbara Graham
(“Graham”), now deceased, based upon a finding that her life insurance policy was a
countable resource that placed her above the financial threshold for eligibility.
Graham was an elderly woman who suffered from numerous medical conditions
that required 24-hour care and assistance. (Doc. 3, PageId 23). She was admitted to
1
Hillspring, an Ohio skilled nursing facility, on October 5, 2013. (Id., PageId 22-23).
Upon her admission, Graham executed an Admission Agreement and Assignment with
Hillspring that is alleged to make Hillspring an intended third-party beneficiary of
Graham’s Medicaid benefits. (Id., PageId 23). On February 3, 2014, Graham submitted
an application for a Medicaid Nursing Home Vendor Payment. (Id.). Graham owned a
$10,000 life insurance policy that is central to the issues raised herein. (Id.). Graham
is alleged to have lacked the mental and physical capacity to act on her own behalf to
convert that life insurance policy to a cash value. (Id.).
At the time of Plaintiff’s Medicaid application, Ohio applicants with countable
resources in excess of $1,500 were ineligible for benefits for nursing home services.
Ohio Admin. Code § 5160:1-3-05(B)(11)(a), (C) (eff. 10-1-13). 1 “Resources” included,
inter alia, life insurance policies that “an individual . . . has an ownership interest in, has
the legal ability to access in order to convert to cash (if not already cash), and is not
legally prohibited from using for support and maintenance.”
Ohio Admin. Code §
5160:1-3-05(B)(8), (B)(10). Such policies could not be a resource, however, “if the
individual lack[ed] the legal ability to access funds for spending or to convert noncash
property into cash.”
Ohio Admin. Code § 5160:1-3-05(B)(10)(a). 2
“Countable
resources” meant those resources remaining after all exemptions were applied. Ohio
Admin. Code § 5160:1-3-05. A life insurance policy generally was not exempt if the
total cash surrender value for an individual exceeded $1,500. Ohio Admin. Code §
1
That provision has since been repealed and replaced by Ohio Admin. Code § 5160:1-3-05.1 (eff. 8-116).
2
Ohio Admin. Code § 5160:1-3-05(C)(7)(a) also provided: “If the applicant is unable to access or
liquidate property due to a legal impediment or due to conduct of another person, the administrative
agency must refer the individual to legal aid services or the prosecuting attorney’s office to determine if
they can assist in making the resource available.”
2
5160:1-3-30. 3
However, a life insurance policy could be excluded if the Medicaid
applicant or recipient would be unable to surrender the policy for cash value due to a
lack of required consent from another person or if another person would be entitled to
receive all of the proceeds of the policy. Ohio Admin. Code § 5160:1-3-05(E).
Graham passed away on February 14, 2014. (Doc. 3, PageId 23). Defendants
denied payment under Medicaid on April 22, 2014 upon a finding that Graham was
over-resources. (Id.).
After denial of Graham’s Medicaid application, Plaintiff requested a state hearing
by ODJFS to challenge the determination that Graham’s life insurance policy was a
countable resource.
(Doc. 10, PageId 97-102). 4
According to the state hearing
decision, Plaintiff’s position was “that the policy had been assigned to the funeral home
and was therefore an exempt resource.”
(Id., PageId 99).
The hearing officer
concluded that the evidence submitted did not demonstrate that the life insurance policy
was irrevocably assigned to the funeral home. (Id., PageId 99-100). The hearing officer
therefore deemed the life insurance policy a countable resource, and affirmed the denial
of Graham’s Medicaid application. (Id., PageId 100).
Plaintiff appealed the state hearing officer’s decision to the ODJFS’s
Administrative Appeal Section.
(Doc. 10, PageId 103-05).
In that appeal, Plaintiff
argued “that there was no evidence that [Graham’s] son was her power of attorney and
3
Effective October 2, 2014, this provision was repealed and replaced by Ohio Admin. Code § 5160:1-305.12. On August 1, 2016, these rules were rescinded and new rules were promulgated in Ohio Admin.
Code § 5160:1-3-05.12. Nonetheless, the rules continue to provide that a life insurance policy with a
cash surrender value in excess of $1,500 generally will be considered a countable resource.
4
The Court may take judicial notice of the decisions of administrative agencies. Int'l Broth. of Teamsters
v. Zantop Air Transp. Corp., 394 F.2d 36, 40 (6th Cir. 1968) (“[A] Court may take judicial notice of the
rules, regulations and orders of administrative agencies issued pursuant to their delegated authority.”);
Dweidary v. City of Cincinnati, No. 1:13-cv-911, 2014 WL 5588796, at *2 n.4 (S.D. Ohio Nov. 3, 2014)
(taking judicial notice of administrative determinations).
3
could access the value of the life insurance policy” and that “even if [Graham’s] son was
her financial power of attorney, the son could not immediately liquidate the insurance
policy to access the money.” (Doc. 10, PageId 104). The appeal officer concluded that
the “rule provides that [a] life insurance policy is considered an available resource and
there is no provision for the amount of time it takes to liquidate the policy.” (Id.). Given
that the value of the life insurance policy exceeded the Medicaid resource limit and was
not otherwise exempt, the appeal officer affirmed the decision of the state hearing
officer. (Id.).
Plaintiff then appealed the decision of the administrative tribunal to the Court of
Common Pleas for Warren County, Ohio. (Doc. 10, PageId 106-15). 5 In that appeal,
Plaintiff argued “there is insufficient evidence to conclude that Graham had the ability to
convert the life insurance policy to cash, either by herself or through an attorney-in-fact;
and Graham was in no mental or physical state to complete such a transaction.” (Id.,
PageId 108). The Magistrate determined that “[n]othing in the record indicates that
Graham had an irrevocable preneed funeral contract” or that “Graham was incompetent,
or otherwise unable to access the life insurance policy to liquidate it.” (Doc. 10, PageId
109). The Magistrate further noted that Plaintiff was not arguing that Graham was
incompetent when she signed the January 18, 2014 designation of authorized
representation. (Id.). As “[t]he only thing that is clearly established by the record is that
Graham, at her death, possessed a life insurance policy with a cash surrender value of
5
The Court may take judicial notice of the prior state court proceedings. Rodic v. Thistledown Racing
Club, Inc., 615 F.2d 736, 738 (6th Cir. 1980) (quoting Granader v. Public Bank, 417 F.2d 75, 82-83 (6th
Cir. 1969)) (“Federal courts may take judicial notice of proceedings in other courts of record.”) (internal
quotations omitted); Lyons v. Stovall, 188 F.3d 327, 333 n. 3 (6th Cir. 1999) (taking judicial notice of state
appellate briefs filed by petitioner).
4
$6,460.65, a countable resource in excess of $1,500[,]” the Magistrate affirmed the
denial of Plaintiff’s Medicaid application because she was ineligible for the requested
benefits. (Id., PageId 109-10). That decision was affirmed by the Common Pleas Court
Judge over the objections of Plaintiff on August 16, 2016. (Id., PageId 111-15).
On January 13, 2017, Plaintiff filed the original Complaint in this Court. (Doc. 1).
On January 26, 2017, Plaintiff filed its Amended Complaint, asserting seven counts for
relief. (Doc. 3). In Count One, Plaintiff requests a declaratory judgment on several
grounds. (Id., PageId 27-30). In Count Two, Plaintiff alleges Defendants violated the
Federal Medicaid Act’s medical assistance and nursing facility services mandates, 42
U.S.C. §§ 1396a(a)(10)(A) and 1396d(a)(4)(A), for which it seeks relief under 42 U.S.C.
§ 1983. (Id., PageId 30-31). In Count Three, Plaintiff alleges Defendants violated the
Federal Medicaid Act’s “reasonable promptness” requirement under 42 U.S.C. §
1396a(a)(8) and 42 C.F.R. § 435.930, for which it seeks relief under 42 U.S.C. § 1983.
(Id., PageId 31). In Count Four, Plaintiff alleges Defendants violated the Americans with
Disabilities Act (“ADA”), 42 U.S.C. § 12132, et seq., by failing to afford Graham public
benefits to which she is entitled and by failing to grant her Medicaid benefits as a
reasonable accommodation.
(Id., PageId 32).
In Count Five, Plaintiff alleges
Defendants violated the Rehabilitation Act of 1973, 29 U.S.C. § 794, by denying
Medicaid benefits to Graham.
(Id., PageId 32-33).
In Count Six, Plaintiff alleges
Defendants violated Graham’s due process and equal protection rights for which it
seeks relief under 42 U.S.C. § 1983. (Id., PageId 33-34). Finally, in Count Seven,
Plaintiff requests injunctive relief that requires Defendants to issue payment of
Graham’s approved Medicaid benefits. (Id., PageId 34).
5
II.
Standards of Review
Defendants have moved to dismiss Plaintiff’s Amended Complaint pursuant to
Fed. R. Civ. P. 12(b)(1), or, alternatively, pursuant to Fed. R. Civ. P. 12(b)(6).
A. Subject matter jurisdiction under Rule 12(b)(1)
Motions to dismiss under Rule 12(b)(1) can assert either facial attacks or factual
attacks on a court’s subject matter jurisdiction. Ohio Nat’l Life Ins. Co. v. United States,
922 F.2d 320, 325 (6th Cir. 1990).
Where a facial attack on the subject matter
jurisdiction alleged by the complaint is made, the moving party merely questions the
sufficiency of the pleading. Id. In reviewing such a facial attack, a trial court takes the
allegations in the complaint as true. Id. On the other hand, when a court reviews a
complaint under a factual attack, no presumptive truthfulness applies to the factual
allegations. Id. The court must “weigh the conflicting evidence to arrive at the factual
predicate that subject matter jurisdiction exists or does not exist.” Id.
A motion to dismiss based on subject matter jurisdiction generally must be
considered before a motion brought under Rule 12(b)(6) for failure to state a claim upon
which relief can be granted. Pritchard v. Dent Wizard Int’l Corp., 210 F.R.D. 591, 592
(S.D. Ohio 2002) (citing Moir v. Greater Cleveland Reg’l Transit Auth., 895 F.2d 266,
269 (6th Cir. 1990)) (explaining that a Rule 12(b)(6) challenge becomes moot if the
court lacks subject matter jurisdiction).
B. Failure to state a claim under Rule 12(b)(6)
A motion to dismiss pursuant to Rule 12(b)(6) operates to test the sufficiency of
the claims. The Court is required to construe the complaint in the light most favorable to
the plaintiff and accept all well-pleaded factual allegations in the complaint as true.
Lewis v. ACB Business Servs., 135 F.3d 389, 405 (6th Cir. 1998). A court, however,
6
will not accept conclusions of law or unwarranted inferences that are presented as
factual allegations. Id. A complaint must contain either direct or reasonable inferential
allegations that support all material elements necessary to sustain a recovery under
some viable legal theory. Id. at 406. “While a complaint attacked by a Rule 12(b)(6)
motion to dismiss does not need detailed factual allegations, a plaintiff’s obligation to
provide the ‘grounds’ of his ‘entitlement to relief’ requires more than labels and
conclusions, and a formulaic recitation of the elements of a cause of action will not do.”
Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 555 (2007) (internal citations and
alterations omitted). Factual allegations therefore “must be enough to raise a right to
relief above the speculative level on the assumption that all of the allegations in the
complaint are true (even if doubtful in fact).” Id. (citations omitted).
III.
Analysis
Defendants contend that dismissal of Plaintiff’s Amended Complaint is
appropriate on multiple grounds under both Rule 12(b)(1) and Rule 12(b)(6). In the
interests of judicial economy, the Court will not reach the arguments on the merits
because dismissal of Plaintiff’s Amended Complaint is appropriate on multiple
procedural grounds.
A. Plaintiff’s claims are moot.
Mootness is a threshold issue because the existence of a live case or
controversy is a constitutional prerequisite to federal court jurisdiction. Kentucky v.
United States, 759 F.3d 588, 595 (6th Cir. 2014). “When—for whatever reason—the
dispute discontinues or we are no longer able to grant meaningful relief to the prevailing
party, the action is moot, and we must dismiss for lack of jurisdiction.” Id. (quoting
United States v. Blewett, 746 F.3d 647, 661 (6th Cir. 2013)) (internal quotations
7
omitted). “Ordinarily, one would expect that the death of a plaintiff requires dismissal of
a case for mootness, since that plaintiff is no longer in a position to have [her] injury
redressed by the courts.” Allen v. Mansour, 928 F.2d 404, 1991 WL 37832, at *1 (6th
Cir. 1991) (unpublished table decision). “Mootness applies also to situations where, as
here, the plaintiff seeks a declaratory judgment invalidating or modifying a state policy,
since death prevents the plaintiff from benefitting in any way from the requested relief.”
Allen, 1991 WL 37832, at *1 (citing Rhodes v. Stewart, 488 U.S. 1 (1988)). It further
applies to declaratory and injunctive relief regarding an individual’s eligibility for
Medicaid. Immel v. Lumpkin, 408 F. App’x 920, 921 (6th Cir. 2010) (holding that the
plaintiff “sought only declaratory and injunctive relief regarding her eligibility for
Medicaid, and therefore, upon her death, she no longer has a ‘legally cognizable
interest in the outcome.’”) (quoting United States v. City of Detroit, 401 F.3d 448, 450
(6th Cir. 2005)); see also Pecha-Weber v. Lake, 700 F. App’x 840, 842 (10th Cir. July
25, 2017) (“This case presents the question of whether a plaintiff’s death moots his
request for an injunction ordering certain officials of the State of Oklahoma to determine
him eligible for Medicaid benefits. We answer yes. The claim for injunctive—that is,
prospective—relief is moot because there is no concrete threat of a continuing or
repeated injury to the plaintiff-appellant . . . because he is dead. Any harm to [the
plaintiff-appellant] lies squarely in the past.”).
Nonetheless, a case will not be
considered moot if the challenged activity is capable of repetition, yet evading review.
Kentucky, 759 F.3d at 595. This exception applies only where the challenged action is
in its duration too short to be fully litigated prior to expiration or cessation, and there is a
8
reasonable expectation that the same complaining party will be subject to the same
action again. Id.
Here, the Court agrees with Defendants that the claims asserted by Plaintiff are
moot. Graham died on February 14, 2014. She therefore is unable to proceed in this
Court on her own behalf to assert her claims either for past or future injuries. Further,
the requests for declaratory and injunctive relief seek to invalidate or modify a state
policy on Medicaid eligibility determinations relating to a life insurance policy and seek a
determination that Graham is eligible for Medicaid benefits. 6
Given that she is
deceased, Graham cannot benefit from the requested declaratory or injunctive relief and
there is no threat of a continuing or repeated injury to Graham. Graham therefore lacks
a legally cognizable interest in the outcome. 7
Plaintiff claims, however, that it continues to have a legally cognizable interest in
the outcome as the authorized representative of Graham, even though Graham is
deceased.
As an authorized representative, the permissible scope of Plaintiff’s
representation of Graham is governed by federal and state regulations. For the reasons
discussed below, the Court finds that those regulations do not extend to Plaintiff the
authority to maintain a federal lawsuit on Graham’s behalf after her death and after a
final decision on Graham’s Medicaid eligibility has been made.
6
In particular, Plaintiff seeks a declaratory judgment “requiring Defendants to adhere to the requirements
of the Medicaid Act, the Americans with Disabilities Act, and the Rehabilitation Act,” requests the Court to
enjoin “Defendants from subjecting [Graham] to practices that violate her rights under the Medicaid Act,
the Americans with Disabilities Act, and the Rehabilitation Act,” and requests the Court to order injunctive
relief “requiring the Defendants to arrange for medical assistance and nursing services to [Graham]” and
to “issue payment of [Graham’s] approved Medicaid benefits.” (Doc. 3, PageId 34-35).
7
As Graham’s estate is not a party to this lawsuit, the Court need not opine on how or if its inclusion
would alter the mootness analysis.
9
Plaintiff relies on the definition of “applicant” in the federal regulations to suggest
it may proceed in this federal lawsuit on behalf of Graham after her death. Under 42
C.F.R. § 400.203, “applicant” means:
an individual whose written application for Medicaid has been submitted to
the agency determining Medicaid eligibility, but has not received final
action. This includes an individual (who need not be alive at the time of
application) whose application is submitted through a representative or a
person acting responsibly for the individual.
This definition reflects only that a representative may submit an application for benefits
to the agency on behalf of an individual after her death. The individual remains the
“applicant.”
Further, it does not provide that an entity appointed as an authorized
representative is legally entitled to serve as the representative of the individual in any
and all matters, including federal court proceedings, after the individual’s death or in
contravention to threshold constitutional requirements.
In fact, the definition places
limits on any purported authority of an authorized representative by indicating that an
individual remains an “applicant” only until her application has received “final action.”
Under Ohio law, the administrative appeal decision is the “final decision” that is binding
on the agency unless it is reversed or modified by the state court on appeal. Ohio Rev.
Code § 5101.35 (“An administrative appeal decision is the final decision of the
department and . . . is binding upon the department and agency, unless it is reversed or
modified on appeal to the court of common pleas.”).
As Graham’s application
proceeded through both the administrative and state court of common pleas appeal
process, she received a final action on her application as contemplated by the
regulation. Therefore, Graham is no longer an applicant under that definition, which
10
terminates any authority the authorized representative arguably may have under that
definition to proceed on Graham’s behalf following her death. 8
Similarly, Plaintiff’s reliance on provisions relating to “authorized representatives”
under federal and Ohio law does not persuade the Court that Plaintiff has the authority
to proceed on Graham’s behalf in this lawsuit after Graham’s death. Under 42 C.F.R. §
435.923, the following applies to authorized representatives:
(a) The agency must permit applicants and beneficiaries to designate an
individual or organization to act responsibly on their behalf in assisting
with the individual's application and renewal of eligibility and other ongoing
communications with the agency. Such a designation must be in
accordance with paragraph (f) of this section, including the applicant's
signature, and must be permitted at the time of application and at other
times.
(2) Authority for an individual or entity to act on behalf of an applicant or
beneficiary accorded under state law, including but not limited to, a court
order establishing legal guardianship or a power of attorney, must be
treated as a written designation by the applicant or beneficiary of
authorized representation.
(b) Applicants and beneficiaries may authorize their representatives to—
(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.
(c) The power to act as an authorized representative is valid until the
applicant or beneficiary modifies the authorization or notifies the agency
that the representative is no longer authorized to act on his or her behalf,
or the authorized representative informs the agency that he or she no
longer is acting in such capacity, or there is a change in the legal authority
upon which the individual or organization's authority was based.
8
Any other interpretation would allow every individual who is denied Medicaid benefits through the
administrative and state court process to forever remain an “applicant.”
11
Although Plaintiff claims that the clause allowing it to “[a]ct on behalf of the applicant or
beneficiary in all other matters with the agency” is sufficiently broad to authorize the
filing of this federal lawsuit, that clause plainly limits the authorized representative’s
authority to actions on behalf of the “applicant.” 9 As previously discussed, Graham was
no longer an “applicant” as that term is defined in the federal regulations when this
lawsuit was filed. That clause therefore cannot authorize Plaintiff to file this lawsuit on
Graham’s behalf.
Likewise, the Ohio regulation provides that the authorized representative only
“stands in place of the individual” with respect to the individual’s responsibilities under
the state Medicaid provisions. Ohio Admin. Code § 5160:1-1-01(B)(6). 10 It does not
indicate that the authorization applies for matters beyond the scope of the state
Medicaid processes nor does it expressly extend to representation of the individual after
her death. To the extent that representation after death is permitted, it is permitted only
by the definition of “applicant” in 42 C.F.R. § 435.923, which is no longer applicable to
Graham.
In an analogous situation where a person was given power of attorney for a
Medicaid applicant, which would make that person an authorized representative under
42 C.F.R. § 435.923, the power of attorney has been held to lapse upon the individual’s
death such that any claims asserted by the attorney-in-fact in the state appellate court
were moot. Santa v. Ohio Dep’t of Human Servs., 136 Ohio App. 3d 190, 194 (Ohio
App. Ct. Jan. 31, 2000) (holding that power of attorney lapsed upon death of individual
9
As no argument is made with respect to authorized representation of a beneficiary, the Court need not
address that aspect of the regulation.
10
The former Ohio regulation pertaining to authorized representatives is in accord. Ohio Admin. Code §
5160:1-1-55.1.
12
who was denied Medicaid benefits and that the person who had held power of attorney
was not proper party to maintain appeal of common pleas court’s decision affirming the
denial of Medicaid benefits to applicant). In that case, the proper representative of the
deceased individual was the administrator of the estate, not the authorized
representative. Id.; see also Latimore v. Hartford Life & Acc. Ins. Co., No.
2011CA00227, 2012 WL 382932, at *4 (Ohio App. Ct. Jan. 30, 2012) (concluding that
an individual’s “authority under the power of attorney lapsed upon [the insured’s] death”
and that she “lacks legal authority to represent [the insured]” in the judicial proceeding
where she was not the executor of the estate).
The Eastern District of Kentucky
recently has applied similar reasoning to circumstances that are virtually identical to
those in this case. Diversicare v. Glisson, No. 16-141, 2017 WL 4873510, at *4 (E.D.
Ky. Oct. 27, 2017).
Specifically, the district court determined that a nursing home
serving as an authorized representative could not continue to represent that resident
after her death in a federal lawsuit because “only an administrator of [the deceased’s]
estate could bring a federal claim on her behalf[.]” Id. These holdings reflect that an
authorized representative does not have unbridled authority to continue representing an
individual after her death and after a final decision on her Medicaid eligibility in any and
all court proceedings in which it may have some ongoing interest. 11
None of the cases on which Plaintiff relies undermine the above conclusion.
First, Plaintiff contends that Doctors Nursing & Rehabilitation Center v. Norwood, Case
No. 1:16-cv-9837, 2017 WL 2461544 (N.D. Ill. June 7, 2017), demonstrates that an
authorized representative has the authority to pursue federal litigation on behalf of a
11
Consistently, 42 C.F.R. § 435.923(c) places limits on authorized representation by recognizing that the
power to act can be invalidated by a change in the legal authority upon which the individual or
organization's authority originally was based.
13
Medicaid recipient pursuant to 42 C.F.R. § 435.923. (Doc. 21, PageId 211). That case,
however, is distinguishable from the present case.
In Norwood, the district court
determined that the authorized representative could pursue litigation in federal court to
secure Medicaid benefits for individuals who still were awaiting Medicaid eligibility
determinations and individuals who received Medicaid approval but were still awaiting
benefits. Id. at *4. Unlike the individuals who were represented in Norwood, however,
Graham is deceased and already has been denied Medicaid eligibility benefits in a final
administrative decision affirmed by the state court of common pleas. Norwood thus
does not extend the scope of authorized representation to the facts of this case.
Plaintiff also relies on Tiggs v. Ohio Department of Job & Family Services, Case
No. CV-17-874398 (Ohio Ct. C.P. July 11, 2017), for the proposition that an authorized
representative has the authority to pursue federal litigation on behalf of a Medicaid
recipient. (Doc. 23, PageId 236). Similar to Norwood, Tiggs does not extend the scope
of authorized representation to this case. In Tiggs, the court of common pleas relied on
Norwood to support a finding that the authorized representative could pursue an appeal
of a Medicaid eligibility determination to that court to receive a “final determination” as to
the appellant’s benefits. (Doc. 23-1, PageId 245). Tiggs, however, does not stand for
the proposition that an authorized representative may assert vicarious claims in federal
court proceedings on behalf of a deceased individual even after a final determination is
made by the state court of common pleas.
In the alternative, Plaintiff argues that it has associational standing to assert
claims on behalf of its residents. But Plaintiff did not seek to proceed as a
representative of its members in the Amended Complaint.
14
(See generally Doc. 3).
Instead, the Amended Complaint demonstrates that Plaintiff is proceeding as an
authorized representative of Graham only with the claims being personal to Graham
and relating entirely to the denial of Graham’s Medicaid eligibility.
(See id.).
Its
argument on associational standing therefore lacks merit. 12
For these reasons, the undersigned finds that Plaintiff’s claims must be
dismissed as moot.
B. Plaintiff’s claims are barred by the Rooker-Feldman doctrine.
Even if Plaintiff’s claims were not moot, they would be barred by the RookerFeldman doctrine. Under the Rooker-Feldman doctrine, a federal district court lacks
subject matter jurisdiction to review final adjudications of a state court. See D.C. Court
of Appeals v. Feldman, 460 U.S. 462, 483 n. 16 (1983); Rooker v. Fidelity Trust Co.,
263 U.S. 413, 415-16 (1923); Exec. Arts Studio, Inc. v. City of Grand Rapids, 391 F.3d
783, 793 (6th Cir. 2004). The Rooker-Feldman doctrine is confined to:
cases brought by state-court losers complaining of injuries caused by
state-court judgments rendered before the district court proceedings
commenced and inviting district court review and rejection of those
judgments.
12
Even if Plaintiff had sought to proceed based on associational membership (which it did not), the Court
is not persuaded by the non-binding decision in Westminster Nursing Ctr. v. Cohen, Case No. 5:17-cv-96
(E.D.N.C. Nov. 22, 2017), on which Plaintiff relies. (Doc. 29-1). Unlike in that case, Plaintiff has not
demonstrated that one of its members has standing in his or her own right to pursue the claims. Nor has
it demonstrated that it is organized for purposes germane to the subject of these claims, which, in broad
strokes, concerns the Medicaid eligibility of an individual with a life insurance policy that allegedly could
not be liquidated. Plaintiff is not a voluntary trade organization or association formed to advocate for
individuals seeking Medicaid benefits; rather, it is a limited liability company that operates a skilled
nursing facility at which it has residents. (Doc. 3, PageId 21). Plaintiff maintains a business relationship
with those residents. This relationship is insufficient for purposes of associational standing. Diversicare v.
Glisson, No. 16-141, 2017 WL 4873510, at *4 (E.D. Ky. Oct. 27, 2017) (finding no associational standing
for a for-profit nursing home that had residents akin to customers and that was not formed to advocate for
residents); Group Health Plan, Inc. v. Philip Morris, Inc., 86 F. Supp. 2d 912, 918 (D. Minn. 2000)
(denying associational standing to health maintenance organizations (HMOs) because its members did
not have indicia of membership and HMO instead maintained a business-consumer relationship with
those members); Allstate Ins. Co. v. City of Chicago, No. 02C5456, 2003 WL 1877570, at *4 (N.D. Ill. Apr.
14, 2003) (finding a business-consumer relationship between the insurance company and its insureds did
not show sufficiently collective views to confer associational standing on insurance company). Plaintiff’s
mere interest in the subject does not confer associational standing upon it.
15
Exxon Mobil Corp. v. Saudi Basic Indus. Corp., 544 U.S. 280, 284 (2005). That means
that a claim is barred by the doctrine when the state court judgment is the source of the
alleged injury. McCormick v. Braverman, 451 F.3d 382, 392 (6th Cir. 2006). “If there is
some other source of injury, such as a third party’s actions, then the plaintiff asserts an
independent claim.” Lawrence v. Welch, 531 F.3d 364, 368-69 (6th Cir. 2008). While
“these independent claims may deny a legal conclusion of the state court . . . this fact
does not lead to a divestment of subject matter jurisdiction in the federal courts.”
McCormick, 451 F.3d at 392. However, even where an independent claim is made, the
state proceedings may foreclose the federal claim under the doctrine of res judicata. Id.
at 392-93.
Here, the Court finds that Plaintiff’s claims assert injuries caused by the statecourt judgment. Plaintiff lost its case in state court when the state court affirmed the
denial of Graham’s eligibility for Medicaid benefits, finding that the life insurance policy
was a countable resource and stating that “nothing in the record indicates that Graham
was incompetent, or otherwise unable to access the life insurance policy to liquidate it.”
(Doc. 10, PageId 109). After that state-court loss, Plaintiff filed its lawsuit in this Court in
which it complains that “both under Federal law and Ohio law, the life insurance policy
at issue is not a resource and that due to Plaintiff’s incapacity and disability, she was
not able to liquidate any insurance policy.” (Doc. 11, PageId 133-34). In other words,
Plaintiff invites the Court to directly reject the state-court’s judgment denying Medicaid
eligibility based on whether the life insurance policy is a countable resource, whether
Graham was incompetent, and whether Graham had the ability to otherwise liquidate
the life insurance policy. The Court is unable to find in favor of Plaintiff on any claims
16
unless that judgment of the state court is overturned. These are precisely the type of
claims that are barred by Rooker-Feldman. 13
The declaratory and injunctive relief sought by Plaintiff further demonstrates that
the alleged source of injury is the state-court judgment. Plaintiff requests that the Court
declare unlawful Defendants’ denial of Medicaid benefits to Graham, and order
Defendants to comply with the Medicaid Act, the ADA, and the Rehabilitation Act. But,
as explained above, the Court cannot do so without overturning the state-court
judgment that affirms Defendants’ denial of Medicaid benefits to Graham. Plaintiff also
requests that the Court require Defendants to arrange for medical assistance and
nursing facility services for Graham and to issue payment of Graham’s past Medicaid
benefits. In substance, these requests do nothing more than seek relief from the statecourt judgment under which Defendants currently have no obligation to arrange for
services for Graham or to issue payment for Graham’s past Medicaid benefits.
For these reasons, these claims are not the type of “independent claims” that
may generally deny a legal conclusion of the state court but do not seek relief of
overturning or setting aside the state court ruling. See McCormick, 451 F.3d at 392
(finding claims challenging the general constitutionality of a state statute and actions of
third parties in relation to the state court action were independent claims). The mere
fact that Plaintiff couches its claims in federal law and constitutional terms does not
transform them into independent claims that avoid the Rooker-Feldman bar. 14
13
Plaintiff also complains that some of the alleged injuries are ongoing, but it fails to allege any separate
wrongful conduct by Defendants since the original denial of Graham’s Medicaid application. As such, the
only possible source of ongoing injury is the state-court judgment affirming the denial of Medicaid benefits
to Graham.
14
But even if these claims could be considered independent, they are barred on the other grounds
discussed herein.
17
C. Any claims not barred by the Rooker-Feldman doctrine are barred by
res judicata.
The purpose of res judicata “is to promote the finality of judgments and thereby
increase certainty, discourage multiple litigation, and conserve judicial resources.”
Westwood Chem. Co., Inc. v. Kulick, 656 F.2d 1224, 1227 (6th Cir. 1981). This Court
gives “‘the same preclusive effect, under the doctrine[] of res judicata . . . to state court
judgments that those judgments would receive in courts of the rendering state.’” ABS
Indus., Inc. v. Fifth Third Bank, 333 F. App’x 994, 998 (6th Cir. 2009) (quoting Ingram v.
City of Columbus, 195 F.3d 579, 593 (6th Cir. 1999)). The Court therefore must look “to
the state’s law to assess the preclusive effect it would attach to that judgment.” Id.
“Under Ohio law, the doctrine of res judicata consists of ‘the two related concepts
of claim preclusion, also known as res judicata or estoppel by judgment, and issue
preclusion, also known as collateral estoppel.’” Doe ex rel. Doe v. Jackson Local Schs.
Sch. Dist., 422 F. App’x 497, 500 (6th Cir. 2011) (quoting O'Nesti v. DeBartolo Realty
Corp., 113 Ohio St.3d 59 (2007)). In this case, it is evident that claim preclusion is the
asserted basis for dismissal.
For claim preclusion to apply, the moving party must show: (1) a prior final, valid
decision on the merits by a court of competent jurisdiction; (2) a second action involving
the same parties, or their privies, as the first; (3) a second action raising claims that
were or could have been litigated in the first action; and (4) a second action arising out
of the transaction or occurrence that was the subject matter of the previous action.
Hapgood v. City of Warren, 127 F.3d 490, 493 (6th Cir.1997) (citations omitted). When
each of these elements is shown to exist, the second action must be dismissed. Grava
v. Parkman Twp., 73 Ohio St. 3d 379, 382 (1995). Here, the parties do not raise a
18
substantive dispute as to the first, second, or fourth elements. The key issue is whether
the claims asserted in this case could have been litigated in the administrative hearings
and the state court appeal.
Upon careful review, the Court finds that any claims not otherwise barred by the
Rooker-Feldman doctrine are barred by res judicata.
In affirming the denial of
Graham’s Medicaid eligibility, the state court made specific findings that Graham’s life
insurance policy was a countable resource, that her resources exceed $1,500, and that
no evidence supported the contention that Graham was incompetent or otherwise
unable to access her insurance policy. Plaintiff now is claiming that Defendants violated
and continue to violate federal statutes and constitutional provisions by including
Graham’s life insurance policy as a countable resource when she was incompetent or
otherwise unable to access that policy to liquidate it. These claims are premised upon
the same facts and circumstances as the state court action. The only difference is the
theory of substantive law under which relief is sought.
Plaintiff could have, but did not, present these federal statutory and constitutional
claims in the administrative and state court proceedings that addressed the same
factual issues.
Under Ohio Rev. Code § 5101.35, which applies to administrative
actions relating to Medicaid, an individual may request a state hearing on an agency’s
determination and may make an administrative appeal of the state hearing decision. In
those administrative appeals, the individual may assert grounds for relief under both
“federal or state law[.]” Ohio Rev. Code § 5101.35(B); see also Wymsylo v. Bartec, Inc.,
132 Ohio St. 3d 167, 174 (recognizing that “an as-applied [constitutional] challenge
depends upon a particular set of facts” and “must be raised before the administrative
19
agency to develop the necessary factual record”). If the individual disagrees with an
administrative appeal decision, then she may further appeal to the state court of
common pleas. Ohio Rev. Code § 5101.35(C), (E). On appeal to the state court, the
individual may assert federal claims and constitutional challenges relating to the
administrative decision. Columbus Rehab. & Subacute Inst. v. Franklin Cnty. Dep’t of
Job & Family Servs., No. 2:08-cv-103, 2008 WL 5273924, at *5-6 (S.D. Ohio Dec. 17,
2008) (holding that individual may raise § 1983 claims and constitutional issues relating
to state procedures for Medicaid eligibility determinations on appeal to state court); Ohio
Civil Rights Comm’n v. Dayton Christian Schs., Inc., 477 U.S. 619, 629 (1986)
(recognizing that constitutional claims may be raised in state-court judicial review of
administrative proceedings). This procedure has been found to provide a full and fair
opportunity to raise federal claims and constitutional challenges. Columbus Rehab. &
Subacute Inst., 2008 WL 5273924, at *5-6.
Plaintiff’s citation to the administrative
hearing procedure for her claims (Doc. 11, PageId 130-32) does not demonstrate that
her claims could not have been asserted at the administrative level. Nor does Plaintiff
provide any authority to show that the state court could not have adjudicated her federal
or constitutional claims had she presented them on appeal. 15
For these reasons, the Court finds that the claims asserted herein are barred by
res judicata. Migra v. Warren City Sch. Dist. Bd. of Educ., 465 U.S. 75, 84-85 (1984)
(finding that federal claims under § 1983 asserted after a state court judgment were
barred by res judicata because they could have been raised in state court, and stating
15
As this Court has recognized (albeit under the Younger abstention doctrine), the Ohio state court has a
significant interest in adjudicating claims such as these that concern how the State of Ohio administers
the Medicaid program, and more specifically, whether that Medicaid program is administered in
accordance with applicable law. Columbus Rehab. & Subacute Inst. v. Franklin Cnty. Dep’t of Job &
Family Servs., No. 2:08-cv-103, 2008 WL 5273924, at *4 (S.D. Ohio Dec. 17, 2008).
20
that “it is more important to give full faith and credit to state-court judgments than to
ensure separate forums for federal and state claims”); Krauss v. City of Reading, 810 F.
Supp. 212, 215 (S.D. Ohio 1992) (barring constitutional claims based on res judicata
where the Ohio Court of Common Pleas could have adjudicated those claims on appeal
from the administrative agency). 16
D. Plaintiff’s § 1983 claims are not viable due to Graham’s death.
To state a viable claim under 42 U.S.C. § 1983, a plaintiff must allege that: 1) he
was deprived of a right, privilege, or immunity secured by the federal Constitution or
laws of the United States, and 2) the deprivation was caused by a person while acting
under color of state law. Flagg Bros. v. Brooks, 436 U.S. 149, 155 (1978); Harbin-Bey
v. Rutter, 420 F.3d 571, 575 (6th Cir. 2005). Although § 1983 is not itself a source of
any substantive rights, it provides a remedy for deprivations of rights elsewhere
conferred. Albright v. Oliver, 510 U.S. 266, 271 (1994). In the Sixth Circuit, a § 1983
action is “entirely personal to the direct victim of the constitutional tort.” Claybrook v.
Birchwell, 199 F.3d 350, 357 (6th Cir. 2000). “[O]nly the purported victim, or his estate’s
representative, may prosecute a [S]ection 1983 claim.”
Id.
Further, “[i]t is well
established that Section 1983 provides no cause of action on behalf of a deceased
person when the purported violation of his or her civil rights occurred after death.”
Skipper v. Clark, 150 F. Supp. 3d 820, 826 (W.D. Ky. 2015); see also Guyton v. Phillips,
606 F.2d 248, 250 (9th Cir. 1979) (“We find that the Civil Rights Act, 42 U.S.C. §§ 1983
16
The decision in Shalala v. Ill. Council on Long Term Care, Inc., 529 U.S. 1, 23 (2000), also is
instructive on asserting claims before an administrative agency. In that case, the Court stated: “The fact
that the agency might not provide a hearing for that particular contention, or may lack the power to
provide one is beside the point because it is the ‘action’ arising under the Medicare Act that must be
channeled through the agency. . . . And a court reviewing an agency determination . . . has adequate
authority to resolve any statutory or constitutional contention that the agency does not, or cannot
decide[.]” (internal citations omitted).
21
and 1985, does not provide a cause of action on behalf of a deceased based upon
alleged violation of the deceased's civil rights which occurred after his death. A
‘deceased’ is not a ‘person’ for the purposes of 42 U.S.C. §§ 1983 and 1985, nor for the
constitutional rights which the Civil Rights Act serves to protect.”); Whitehurst v. Wright,
592 F.2d 834, 840 (5th Cir. 1979) (“After death, one is no longer a person within our
constitutional and statutory framework, and has no rights of which he may be
deprived.”); Estate of Conner by Conner v. Ambrose, 990 F. Supp. 606, 618 (N.D. Ind.
1997) (“It is clear that § 1983 does not provide a cause of action on behalf of a
deceased based upon alleged violations of the deceased's civil rights which occurred
after his death.”); Love v. Bolinger, 927 F. Supp. 1131, 1136 (S.D. Ind. 1996) (following
Whitehurst). When a civil rights claim accrues prior to an individual’s death, however,
the survival of a § 1983 claim is determined by state law if it would not be “inconsistent
with the Constitution and laws of the United States.” Robertson v. Wegmann, 436 U.S.
584, 588-90 (1978) (citing 42 U.S.C. § 1988(a)).
Although there is authority that arguably could support Plaintiff’s contention that §
1983 claims pertaining to an individual’s eligibility for state-provided Medicaid benefits
that accrue prior to death could constitute a property interest in Ohio that survives
death, 17 Plaintiff’s § 1983 claims nonetheless must be dismissed on two separate
grounds. First, Plaintiff is not the proper party to pursue the claims on Graham’s behalf.
Graham is the purported victim. Graham, however, is deceased and cannot legally
17
See Price v. Medicaid Dir., 310 F.R.D. 345, 359–60 (S.D. Ohio 2015) (holding that plaintiffs have a
property interest in state-provided Medicaid benefits for which they hope to qualify and that a claim for
property interest would survive under Ohio’s survivorship statute, Ohio Rev. Code § 2305.21), rev'd and
remanded on other grounds, 838 F.3d 739 (6th Cir. 2016). But see Bernard v. Kan. Health Policy Auth.,
No. 09-1247, 2012 WL 941674 (D. Kan. Mar. 20, 2012) (holding under Kansas survival statute, which is
similar to Ohio’s survival statute, that § 1983 claims based on the denial of Medicaid eligibility did not
survive death).
22
assert her own claims in this Court. Her claims therefore must be asserted through her
estate’s representative. As Plaintiff is not the estate’s representative, it has no legal
authority to assert these claims on Graham’s behalf. 18
Second, even if Plaintiff could legally assert these claims on Graham’s behalf,
the alleged violations of Graham’s rights occurred after her death. Plaintiff’s § 1983
claims are premised on various violations stemming from the determination that
Graham was ineligible for Medicaid benefits. (Doc. 3, PageId 26-27, 31, 33-34). The
earliest an alleged violation could have occurred is on April 22, 2014 when Graham
initially was found ineligible for Medicaid benefits. (Doc. 3, PageId 23, 31). This date is
more than two months after Graham’s death.
(Id.).
To the extent Plaintiff alleges
ongoing violations by Defendants (Doc. 3, PageId 31, 33), those violations also must
have occurred after Graham’s death. As a deceased person has no civil rights that may
be violated, Plaintiff cannot maintain the § 1983 claims against Defendants that are
based entirely on actions occurring after Graham’s death.
For these reasons, Plaintiff’s § 1983 claims against Defendants must be
dismissed.
E. Plaintiff’s claims under the ADA, Rehabilitation Act, and § 1983 are
barred by the two-year statute of limitations.
It is undisputed that the ADA, Rehabilitation Act, and § 1983 claims are governed
by a two-year statute of limitations. McCormick v. Miami Univ., 693 F.3d 654, 662-64
(6th Cir. 2012) (ADA and Rehabilitation Act claims); Hull v. Cuyahoga Valley Joint
Vocational Sch. Dist. Bd. of Educ., 926 F.2d 505, 510 (6th Cir. 1991) (§ 1983 claims).
18
Even if Plaintiff could somehow inherit these personal claims of Graham after her death, Plaintiff’s
authorized representation terminated before this lawsuit was filed when Graham received a final eligibility
determination that denied her Medicaid application.
23
Federal law governs the question of when the limitations period begins to run. Sharpe
v. Cureton, 319 F.3d 259, 266 (6th Cir. 2003). The general rule is that the statute of
limitations begins to run when the plaintiff knows or has reason to know of the injury that
is the basis of his action. Cooey v. Strickland, 479 F.3d 412, 416 (6th Cir. 2007). A
plaintiff has reason to know of her injury when she should have discovered it through
the exercise of reasonable diligence. Id.; Roberson v. Tennessee, 399 F.3d 792, 794
(6th Cir. 2005). The test is an objective one under which the Court determines “‘what
event should have alerted the typical lay person to protect his or her rights.’” Sharpe,
319 F.3d at 266 (quoting Dixon v. Anderson, 928 F.2d 212, 215 (6th Cir. 1991)).
Here, Graham’s eligibility for Medicaid benefits originally was denied on April 22,
2014. (Doc. 3, PageId 23). At that time, Plaintiff should have been alerted to the need
to protect both the federal and state rights of Graham with respect to that denial. 19 The
limitations period for Graham’s ADA, Rehabilitation Act, and § 1983 claims therefore
expired on April 22, 2016. As Plaintiff did not file this lawsuit until January 13, 2017, her
claims are time barred. 20
Plaintiff’s attempt to avoid the statute-of-limitations bar by asserting a “continuing
violation” lacks merit. Mere adherence to an original decision is not enough to establish
a continuing violation. Tolbert v. State of Ohio Dep’t of Transp., 172 F.3d 934, 940 (6th
Cir. 1999) (holding that ODOT’s adherence to its decision on a parkway project was not
a continuing course of conduct that would support a continuing violation theory). A
19
As discussed previously, Ohio’s administrative procedures permit appeals of the agency’s decision
based on both federal and state law grounds. Ohio Rev. Code § 5101.35(B).
20
Even if the Court were to use the November 19, 2014 date of the final administrative decision denying
Graham’s eligibility for Medicaid benefits as the accrual date, the statute of limitations still would have run
approximately two months before Plaintiff filed this action. See (Doc. 10, PageId 105); Ohio Rev. Code §
5101.35 (indicating that the “administrative appeal decision is the final decision of the department and . . .
is binding upon the department and agency”).
24
continuing violation exists only when there are “continued unlawful acts” rather than
“continued ill effects from the original violation.” Kovacic v. Cuyahoga Cnty. Dep’t of
Children & Family Servs., 606 F.3d 301, 308 (6th Cir. 2010), cert. denied, 562 U.S.
1095 (2010); Dixon v. Clem, 492 F.3d 665, 672 (6th Cir. 2007).
Plaintiff has not
identified any distinct unlawful act of Defendants upon which the alleged continuing
violation is based.
(Doc. 11, PageId 138).
Instead, Plaintiff claims that every day
Defendants adhere to the April 22, 2014 decision to deny Medicaid benefits to Graham,
they violate her constitutional and federal statutory rights. In particular, Plaintiff states
that there is a “continuing pattern of discrimination and violations of the Federal
Medicaid Act, which continue to this day”; that “Defendants’ acts of counting the life
insurance policy as a resource of Plaintiff, for which she was entirely unable to access,
had and continues to have the effect of denying her the medical care for which
Defendants are mandated to provide to eligible persons”; that Defendants continue to
be in violation of the Federal Medicaid Act by failing to provide services to Plaintiff with
“reasonable promptness”; and that its continued failure to afford her Medicaid benefits
constitutes discrimination. (Doc. 11, PageId 136-38). 21 This argument plainly reflects
that Plaintiff’s continuing violation theory is based on “continuing ill effects” from the
original eligibility decision rather than on any continuing unlawful acts of Defendants.
Indeed, the denial of Medicaid benefits to Graham was a discrete event after which the
injury from the denial was complete. This is underscored by the fact that Graham was
deceased at the time of denial, which meant that the amount of past benefits to which
she could be entitled had already accrued. To allow Defendants’ continued adherence
21
The allegations in her Amended Complaint are in accord. (Doc. 3, PageId 31) (alleging “repeated” acts
and “repeated, ongoing failure”).
25
to its decision to constitute a continuing violation would effectively eliminate any time
bar on actions arising from the denial of Medicaid benefits because a new violation
would occur every day that the denial stays in place.
As for Plaintiff’s argument that the statute of limitations should be tolled as a
result of Graham being of “unsound mind,” the Court finds that Ohio’s tolling statute is
inapplicable in this case. Under Ohio Rev. Code § 2305.16, if a person entitled to bring
actions set forth in certain sections of the Ohio Revised Code is “at the time the cause
of action accrues, . . . of unsound mind, the person may bring it within the respective
times limited by those sections, after the disability is removed.” As discussed above,
none of Graham’s claims could have accrued until April 22, 2014. That accrual date is
more than two months after Graham’s death. Graham therefore could not have been of
“unsound mind” as contemplated by the tolling statute at the time or at any time after
her claims accrued because any disability she could have asserted terminated at the
time of her death. See Fetterolf v. Hoffmann-LaRoche, Inc., 104 Ohio App. 3d 272, 280
(Ohio App. Ct. 1995) (disability of a minor removed at death and the statute of
limitations began to run).
Accordingly, the Court finds that Plaintiff’s ADA, Rehabilitation Act, and § 1983
claims are barred by the statute of limitations.
F. Dismissal of Plaintiff’s requests for declaratory relief based on Eleventh
Amendment immunity is not appropriate.
Generally, the Eleventh Amendment to the United States Constitution bars suit
against a State or its agencies or departments in federal court regardless of the nature
of the relief sought.
Seminole Tribe of Florida v. Florida, 517 U.S. 44, 58 (1996);
Pennhurst State Sch. v. Halderman, 465 U.S. 89, 100 (1984). There are exceptions to
26
Eleventh Amendment immunity, however. Carten v. Kent State University, 282 F.3d
391, 397 (6th Cir. 2002). An exception to Eleventh Amendment immunity applies where
a plaintiff seeks prospective relief to compel state officials to comply with federal law.
See Ex parte Young, 209 U.S. 123 (1908); S&M Brands, Inc. v. Cooper, 527 F.3d 500,
508 (6th Cir. 2008). When this exception applies, a “court may enter a prospective
injunction that costs the state money, but only if the monetary impact is ancillary, i.e.,
not the primary purpose of the suit.” Barton v. Summers, 293 F.3d 944, 950 (6th Cir.
2002) (citing Edelman v. Jordan, 415 U.S. 651, 668 (1974)). An injunction ordering
retroactive benefits for past violations of federal law is prohibited by the Eleventh
Amendment. Edelman, 415 U.S. at 666-69.
A second exception applies to claims for which the Eleventh Amendment
immunity of the State has been waived or validly abrogated by Congress. Carten, 282
F.3d at 397; Robinson v. Univ. of Akron Sch. of Law, 307 F.3d 409, 413 (6th Cir. 2002);
Nihiser v. Ohio E.P.A., 269 F.3d 626, 627-28 (6th Cir. 2001).
In the Amended Complaint, Plaintiff requests that the Court:
1. Issue a Declaratory Judgment in favor of Plaintiff, requiring Defendants
to adhere to the requirements of the Medicaid Act, the Americans with
Disabilities Act, and the Rehabilitation Act;
2. Declare unlawful the Defendants’ failure to arrange for medical
assistance and nursing facility services to Plaintiff;
(Doc. 3, PageId 34). Plaintiff further requests an order “requiring the Defendants to
automatically issue payment of Plaintiff’s Medicaid benefits.” (Id., PageId 34).
Placed in the full context of this case, Plaintiff’s requests can reasonably be
characterized only as requests for retroactive relief disguised in prospective
terminology. Graham died almost three years prior to the filing of this lawsuit. Any
27
future adherence to federal laws by Defendants with respect to Graham provides no
actual relief to her. What Plaintiff actually is requesting is that the Court find Defendants
violated the ADA, Rehabilitation Act, and Medicaid Act in the past and to overturn
Defendants’ past decision to deny Graham Medicaid benefits. Plaintiff’s request for
relief in the form of payments of the Medicaid benefits to which Graham may have been
entitled in the past also makes clear that Plaintiff is requesting retroactive relief in this
case. 22
Generally, a court may not order state officials to pay out public benefits
wrongly withheld in the past such that the requested retroactive relief would be barred
by the Eleventh Amendment. However, Plaintiff also raises at least one claim for which
Eleventh Amendment immunity may have been waived or abrogated, which potentially
could allow some portions of that retroactive relief to avoid the Eleventh Amendment
bar. Carten v. Kent State University, 282 F.3d 391, 397 (6th Cir. 2002) (recognizing that
Ohio has waived Eleventh Amendment immunity for Rehabilitation Act claims and
indicating that state immunity may have been abrogated for claims under Title II of the
ADA based on denial of due process only). As neither party has addressed this issue,
the Court declines to conclude that all of the retroactive relief requested by Plaintiff is
barred by the Eleventh Amendment. 23
22
These requests are distinguishable from the prospective requests in Pierce v. Medicaid Director, 838
F.3d 739, 747 (6th Cir. 2016). There, the plaintiffs sought a prospective injunction that provided benefit
recipients with notice of how the benefits would be awarded going forward and of the beneficiaries’ right
to pursue state administrative benefits in accordance with that injunction. Here, Plaintiff is not requesting
notice of how the benefits will be awarded going forward or of how to pursue state administrative benefits
in the future; it is requesting a determination of wrongful withholding of benefits in the past and is seeking
a direct award of past public benefits to which it claims Graham was entitled.
23
Nonetheless, the Court concludes that all claims asserted and relief requested by Plaintiff, whether
construed to be prospective or retroactive in nature, must be dismissed on the other grounds discussed
herein.
28
G. Plaintiff’s claims against ODJFS are not subject to dismissal based on
Ohio Rev. Code § 5162.03.
In the Amended Complaint, Plaintiff alleges that Defendant Dungey is the
Director of ODJFS, “which is the state agency which processed Ms. [Graham’s]
Medicaid application.” (Doc. 3, PageId 22). It further alleges that Defendant Dungey
“acted under color of state law in administering the regulations, customs, policies, and
practices material herein.” (Id.). Defendant Dungey is sued in her official capacity only.
(Id.).
Defendants argue that the claims against Director Dungey in her official capacity
as ODJFS’s Director must be dismissed because ODM became the sole administrator
of the Medicaid program in 2013. (Doc. 10, PageId 69). Defendants contend that ODM
has given ODJFS the authority to adjudicate disputes regarding Medicaid eligibility but
not the authority to make initial determinations of Medicaid eligibility, which is what is at
issue in this lawsuit. (Id.). Plaintiff responds that it “has no objection to dismissing
Defendant Dungey if warranted under the circumstances” but that “initial discovery
relevant to the Ohio agency responsible for administering the Medicaid program during
the relevant time periods is warranted.” (Doc. 11, PageId 134). Defendants reply that
discovery is not helpful or relevant because ODM became the sole administrator of the
Ohio Medicaid program as a matter of law in 2013. (Doc. 14, PageId 171).
As of September 29, 2013, Ohio law provides that “the department of medicaid
shall act as the single state agency to supervise the administration of the medicaid
program.” Ohio Rev. Code § 5162.03. This provision does not indicate that no other
agency may be involved in the administration of the program; instead, it identifies the
ODM as the supervisor overseeing the administration of the program.
29
While
Defendants point the Court to Ohio Rev. Code § 5160.31, that provision indicates only
that the ODM may contract with the ODJFS to hear appeals of Medicaid eligibility
decisions, as it did in this case. It does not foreclose the possibility that ODJFS may
have been involved in the initial eligibility determination for Graham. In fact, the state
hearing decision pertinent to this case indicates that the issue on appeal was “whether
the Warren County Department of Job and Family Services (Agency) correctly denied”
Graham’s February 3, 2014 Medicaid application. (Doc. 10, PageId 97). This language
is sufficient to warrant further discovery on ODJFS’s involvement in the initial eligibility
decision made on Graham’s application.
Therefore, having considered the foregoing favorably to Plaintiff, the Court finds
that the claims against ODJFS cannot be dismissed as a matter of law under Ohio Rev.
Code § 5162.03. 24
IV.
Conclusion
Consistent with the foregoing, IT IS ORDERED that Defendants’ Motion to
Dismiss the Amended Complaint (Doc. 10) is GRANTED, and this case shall be
terminated on the docket of this Court.
s/ Stephanie K. Bowman
Stephanie K. Bowman
United States Magistrate Judge
24
However, these claims must be dismissed on the other grounds discussed herein.
30
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