Flack, Cody et al v. Wisconsin Department of Health Services et al

Filing 249

JUDGMENT entered in favor of plaintiffs Cody Flack, Marie Kelly, Sara Ann Makenzie, and Courtney Sherwin against defendants Wisconsin Department of Health Services and Andrea Palm declaring Wis. Admin. Code §§ DHS 107.03(23)-(24), 10 7.10(4)(p) ("the Challenged Exclusion") null and void under Section 1557 of the Patient Protection and Affordable Care Act, 42 U.S.C. § 18116; the Medicaid Act's availability requirement, 42 U.S.C. § 1396a(a)(10)(A); the Medi caid Act's comparability requirement, 42 U.S.C. § 1396a(a)(10)(B); and the Equal Protection Clause of the Fourteenth Amendment to the United States Constitution; permanently enjoining defendants from enforcing the Challenged Exclusion. (WMC/PAO) (kwf)

IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF WISCONSIN
CODY FLACK, SARA ANN MAKENZIE,
MARIE KELLY, and COURTNEY SHERWIN,
Indi vidual[y rind on behrilf of all others sim ilar[y situated,
Case No. l 8-cv-309-vvmc
Pl aintiffs,
V.

WISCONSIN DEPARTMENT OF HEALTH SERVICES
and ANDREA PALM ,
Defendants.

JUDGMENT IN A CIVIL CASE

IT IS ORDERED AND ADJUDGED that judgment is entered in favor of plaintiffs
Cody Flack, Sara Ann Maken zie, Marie Kelly, and Courtn ey Sherwin against defendants
Wisconsin Departm ent of H ea lth Servi ces and Andrea Palm declaring Wi s. Admin. Cod e
§§ DI-IS 107 .03(23)- (24), 107.10 (4)(p) ("the Challenged Exclusion") null and void under

Section 1557 of the Patient Protection and Affordable Care Act, 42 U.S.C. § 18116; th e
Medi ca id Act's ava ilability requirement, 42 U.S.C. § I 396a(a)( l0)(A); the M edicaid Act's
con1pa rability req uirement , 42 U.S.C. § 1396a(a)( I0) (B); and the Equal Protection Clause
of the Fourteenth Amendm ent to the United States Co nstitution .
IT IS FURTHER ORDERED AND ADJUDGED that judgment is entered as follows:
1. Defendants are perm a nently enjoined from enforcing the Challenged Exclusion.
2. Within 180 days of this court's Final Order on Permanent Injunctive and
Equitable Relief, dkt. #248, defendants shall publi sh a coverage policy rega rding
services previously excluded und er the Challenged Exclusion.

Judgment in a C ivi l Case

Page 2

3. Wi t hin 90 d ays o f t he order, defe ndants shall:
a. iss ue a Fo rwa rd H ea lt h U pd ate t hat in clud es a notice of t he o rd er
perm a nentl y enj o ining e n fo rce men t o f t he C hall enged Exclu sio n and
ex pl ain s t hat curren t W isco nsin M edi caid benefi ciari es m ay be eligible fo r
se rvi ces that were previ o usly exclud ed fr o m coverage und er t he Ch allenged
Exclusio n , and previo usly m ay have been deni ed ;
b. prov id e notice to th e social servi ce providers o n Appendi x A o f plain t iffs'
ame nded p ro posed o rde r (Pi s.' Am . P ro posed O rder, App . A (dkt. #237 -1 )
p. 12) th at t hi s court has perm a nen tly enj o in ed en fo rcem en t of th e
C hall enged Excl usio n and providin g t hat cu rre nt Wi sco nsin M edi ca id
benefi ciaries m ay be eli gibl e for cove rage for se rvices th at we re prev iously
exclud ed fro rn cove rage und er t he C hall enged Excl usion , and previo usly
n1 ay have bee n d eni ed;
c.

prov ide notice to a ll W isco nsin M edi ca id H ea lt h M aintena nce
Orga ni za ti o n s ("the HMOs" ) t hat t hi s court has pe rm a ne n t ly enj o in ed
en fo rcem ent of t he C hallenged Exclusio n and t hat individual a utho ri zatio n
requ ests fo r se rvi ces previously exclud ed fr o m coverage un de r t he
C ha ll enged Exclusio n are subj ect to t he Wi scon sin D epartm ent of H ea lt h
Se rvices' sta ndard rev iew, pri or au t hori zati o n procedures, a n d
determin atio n s for m edi ca l necess ity, and en co urage t he HMO s t o co nsid er
notify ing in d ividuals previ o usly deni ed cove rage fo r services beca use of t he
C hall enged Exclusio n t hat they m ay be eli gibl e to requ est coverage fo r a
se rvice or services previo usly foun d to be excluded from coverage; and

Page 3

Judgm ent in a Civil Case

d. consider notifying fee-for-service beneficiaries previously denied coverage
because of the Challenged Exclusion that they may be eligible to request
coverage for a service or services previously found to be excluded from
coverage.

Approved as to form this

Peter Oppeneer
Clerk of Court

<i? t"'L- day of November, 2019.

Date