Canfield v. Fucillo

Filing 36

MEMORANDUM OPINION AND ORDER granting plaintiff's #8 MOTION to Remand Case to Circuit Court of Kanawha County. Signed by Judge John T. Copenhaver, Jr. on 7/23/2013. (cc: attys; any unrepresented parties) (tmh)

UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF WEST VIRGINIA
AT CHARLESTON
DWIGHT CANFIELD,
Plaintiff,
v.

Civil Action No. 2:12-09110

ROCCO S. FUCILLO,
West Virginia Department of Health
and Human Resources, in his official
capacity,
Defendant.
MEMORANDUM OPINION AND ORDER
Pending is the plaintiff’s motion to remand, filed January
24, 2013, contending that the ground on which this action was removed
from state court — federal question — does not exist in this case.
I.

Factual and Procedural Background

Medicaid was established in 1965 by Title XIX of the Social
Security Act, 42 U.S.C. §§ 1396-1396w-5.

The program seeks to ensure

that “necessary medical services” are available to impoverished
families with dependent children, as well as elderly, blind, or
disabled individuals, by allocating federal funds to qualifying
States.

42 U.S.C. § 1396-1.

To be eligible for funding, each

participating State must submit a plan outlining the structure of
its proposed Medicaid program to the Secretary of the U.S. Department
of Health and Human Services.

Id. §§ 1396-1, 1396d.

Title XIX

requires all plans to cover certain individuals, see id. §
1396a(a)(10)(A)(i), and permits States the option of expanding
coverage to include other categories of beneficiaries, see id. §
1396a(a)(10)(A)(ii).
The Medicaid plan submitted by West Virginia, and approved
by the Secretary of the U.S. Department of Health and Human Services,
provides benefits to several classes of optional beneficiaries.
Pl.’s V. Pet. ¶ 15.1

The non-mandatory classes covered include the

“Optional Categorically Needy, Disabled” and the “Medically Needy,
Disabled,” as defined by federal regulations.
C.F.R. §§ 435.210, .301.

Id.; see also 42

The former classification — in which the

plaintiff says he falls — encompasses all individuals who “meet the
income and resource requirements of the appropriate cash assistance
program for their status,” 42 C.F.R. § 435.210, such as the
Supplemental Security Income (“SSI”) program.

In contrast, the

latter classification — in which the plaintiff says he was placed
— requires applicants with income exceeding a predetermined
threshold to incur medical expenses equal to the amount of surplus
income before receiving Medicaid benefits.

1

Id. § 435.301.

Neither party has tendered a complete copy of West Virginia’s
approved Medicaid plan. The defendant does not dispute, however,
that the plan encompasses the non-mandatory categories of recipients
discussed by the plaintiff. See Def.’s Mot. to Dismiss 1-2.
2

The plaintiff, Dwight Canfield, filed a verified
petition for writ of mandamus in the Circuit Court of Kanawha County,
West Virginia, on November 15, 2012.

He alleges that the defendant,

as the state official responsible for administering West Virginia’s
Medicaid program, failed to enact regulations providing benefits to
the “categorically needy, disabled” in contravention of the State’s
Medicaid plan.

Pl.’s V. Pet. ¶ 22.

The plaintiff avers that, had

the appropriate regulations been promulgated, he would qualify as
“categorically needy, disabled.”

Id. ¶¶ 25-28.

To receive

benefits as “medically needy, disabled” the plaintiff purportedly
would have been required to incur $1,982.40 in medical expenses,
which he could not afford.

Id. ¶ 30.

Thus, the plaintiff alleges

that he was forced to forsake necessary medications and treatments.
Id. ¶ 31.

As a result, he was eventually “admitted to the emergency

room, causing him to incur significant medical expense[s] that would
otherwise be covered had he been enrolled in the Optional
Categorically Needy Disabled group.”

Id. ¶ 32.

Accordingly, he

requests that a writ of mandamus be issued compelling the defendant
to “administer the West Virginia Medicaid program in conformity with
the approved West Virginia State Medicaid Plan.”

Id. § 4(a).

On December 17, 2012, the defendant removed, asserting
that the plaintiff’s sole cause of action, which arises from state
law, presented a federal question.

3

Notice of Removal 2-3.

The

plaintiff filed a motion to remand, arguing that no substantial and
actually contested question of federal law need be resolved.

Mem.

of Law in. Supp. of Pet’r’s Mot. to Remand (“Pl.’s Mem.”) 1.

The

plaintiff notes that he only challenges the defendant’s failure to
comply with the State’s own plan, rather than asserting a violation
of federal law.

Id. at 7.

In response, the defendant asserts that

the plaintiff’s claim necessarily relies on federal law to “determine
whether the State has the discretion to craft such categories as it
sees fit.”

Resp’t’s Opp’n to Mot. for Remand (“Def.’s Resp. Mem.”)

3.
II.

Analysis

Any civil action initiated in state court may be removed,
should federal district courts be vested with original jurisdiction.
28 U.S.C. § 1441(a).

Congress has granted federal courts original

jurisdiction over all civil actions arising under the Constitution,
laws, or treaties of the United States.

Id. § 1331.

A civil action

arises under federal law if the “‘well-pleaded complaint establishes
either that federal law creates the cause of action or that the
plaintiff’s right to relief necessarily depends on resolution of a
substantial question of federal law.’”

Empire Healthchoice

Assurance, Inc. v. McVeigh, 547 U.S. 677, 689-90 (2006) (quoting
Franchise Tax Bd. of Cal. v. Constr. Laborers Vacation Trust for S.
Cal., 463 U.S. 1, 27-28 (1983)).
4

Thus, should a cause of action arise under state law,
federal jurisdiction is proper only if the claim “necessarily
raise[s] a stated federal issue, actually disputed and substantial,
which a federal forum may entertain without disturbing any
congressionally approved balance of federal and state judicial
responsibilities.”

Grable & Sons Metal Products, Inc. v. Darue

Eng’g & Mfg., 545 U.S. 308, 314 (2005).

This particular grant of

jurisdiction has been described as “special and small,” see McVeigh,
547 U.S. at 699, which places an onerous burden on the defendant,
see Blair v. Schott Scientific Glass Co., 945 F. Supp. 123, 126
(S.D.W. Va. 1996) (quoting ELCO Mech. Contractors, Inc. v. Builders
Supply Ass’n of W. Va., 832 F. Supp. 1054, 1057 (S.D.W. Va. 1993))
(stating that the removing party bears the burden of establishing
subject matter jurisdiction).

Any doubts concerning the propriety

of removal should be resolved in favor of remand.

Mulcahey v.

Columbia Organic Chemicals Co., Inc., 29 F.3d 148, 151 (4th Cir. 1994)
(citations omitted).
In this case, the plaintiff asserts a sole claim under West
Virginia law.

To obtain a writ of mandamus, the plaintiff must

establish:
(1) the existence of a clear right in the petitioner to
the relief sought; (2) the existence of a legal duty on
the part of the respondent to do the thing the petitioner
seeks to compel; and (3) the absence of another adequate
remedy at law.
5

Cooper v. Gwinn, 298 S.E.2d 781, syllabus ¶ 3 (W. Va. 1981).

His

claim is predicated entirely upon the defendant’s alleged violation
of the State’s own Medicaid plan.

Pl.’s V. Pet. ¶ 23.

The

provisions of the plan do not constitute federal laws or regulations,
even once approved by the U.S. Secretary of the Department of Health
and Human Services.

Concourse Rehab. & Nursing Ctr. Inc. v. DeBuono,

179 F.3d 38, 44 (2d Cir. 1999).

Moreover, the plaintiff acknowledges

that federal law does not require the defendant to provide coverage
for the “categorically needy” or the “medically needy.”
7.

Pl.’s Mem.

Rather, federal regulations merely grant States the option of

covering those classes of non-mandatory beneficiaries.

See 42

U.S.C. § 1396(a)(10)(A)(ii); 42 C.F.R. §§ 435.210, .301.
Absent allegations that a State’s plan or practices
conflict with a specific federal mandate, no substantial federal
question exists.

Concourse Rehab., 179 F.3d at 44-45 (citing

Oberlander v. Perales, 740 F.2d 116, 119 (2d Cir. 1984)); Concourse
Rehab. & Nursing Ctr. Inc. v. Wing, 150 F.3d 185, 189 (2d Cir. 1998);
James ex rel. James v. Richman, 465 F. Supp. 2d 395, 401 n.2 (M.D.
Pa. 2006) (“While this case does not fall within the class of Medicaid
cases involving a state plan that allegedly conflicts with the
federal Medicaid Act, which would certainly present a federal
question, neither does it fall in the class of cases in which it is

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only alleged that a state has violated its own Medicaid plan, which
do not present a federal question.” (internal citations omitted)).2
Inasmuch as the plaintiff’s claim is grounded in state law
and premised solely on the defendant’s failure to comply with its
own Medicaid plan, a substantial federal question is not raised in
this action.
III.

Conclusion

In summary, the defendant has failed to establish removal
as proper, given the lack of federal subject matter jurisdiction.
The plaintiff’s motion to remand is granted.

The Clerk is requested to transmit this order to all
counsel of record and to any unrepresented parties.
DATED:

July 23, 2013

John T. Copenhaver, Jr.
United States District Judge

2

See also Mertz ex rel. Mertz v. Houstoun, 155 F. Supp. 2d 415, 422-24
(E.D. Pa. 2001) (concluding that federal jurisdiction was proper,
given evidence that the State routinely assessed eligibility in a
manner that conflicted with federal law); Johnson v. Guhl, 91 F. Supp.
2d 754, 766 (D.N.J. 2000) (determining that a federal question
existed because “Plaintiffs specifically assert that state law
conflicts with federal law”).
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