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Jones v. District of Columbia

June 24, 2010


Appeals from the Superior Court of the District of Columbia (CAB 5079-06) (Hon. Lynn Leibovitz, Trial Judge).

The opinion of the court was delivered by: Oberly, Associate Judge

Argued April 7, 2010

Before RUIZ and OBERLY, Associate Judges, and KING, Senior Judge.

Title XIX of the Social Security Act, 42 U.S.C. § 1396, et seq., commonly known as the Medicaid Act, requires the District of Columbia to recover certain funds from deceased beneficiaries' estates, but limits the circumstances under which the funds may be recovered. Plaintiffs in this case filed a class action suit alleging that the District ran afoul of the Act's limitations. The Superior Court denied plaintiffs' motion for class certification, but entered summary judgment for the named plaintiffs in the exact amount they had sought from the District, and awarded plaintiffs attorneys' fees and costs pursuant to 42 U.S.C. § 1988. The plaintiffs and the District have filed cross-appeals. The plaintiffs argue that the Superior Court erred in denying their motion for class certification. The District, which voluntarily and repeatedly tried to repay the named plaintiffs the funds that it had recovered long before the Superior Court ordered that it do so, appeals only the award of attorneys' fees and costs.

We resolve this case by deciding the threshold question whether the provisions of the Medicaid Act that plaintiffs have invoked create privately enforceable rights. Answering this question in the negative, we hold that the Superior Court erred in concluding that plaintiffs were prevailing parties entitled to attorneys' fees. And, given our holding that the provisions of the Medicaid Act do not create enforceable rights, we dismiss as moot plaintiffs' appeal of the Superior Court's order denying their motion for class certification. Because the District has no quarrel with the order granting summary judgment to plaintiffs, it did not appeal that order, and we do not disturb it. We do, however, remand the case to the Superior Court with instructions to dismiss plaintiffs' complaint with prejudice.


Passed in 1965, the Medicaid Act established "a cooperative federal-state program through which the Federal Government provides financial assistance to States so that they may furnish medical care to needy individuals." Wilder v. Virginia Hosp. Ass'n, 496 U.S. 498, 502 (1990). State participation in the program is voluntary. The States that choose to participate, however, "must comply with certain requirements imposed by the Act and regulations promulgated by the Secretary of Health and Human Services." Id. A State that fails to comply substantially with the requirements imposed by the Act and its implementing regulations risks having its federal funding revoked by the Secretary. 42 U.S.C. § 1396c. The District participates in the Medicaid program.

"Before 1993, the Medicaid Act permitted states, under certain circumstances, to recover medical costs paid by Medicaid from the beneficiary's estate." West Virginia v. United States Dep't of Health & Human Servs., 289 F.3d 281, 284 (4th Cir. 2002). But in 1993, "in the face of rapidly escalating medical-care costs, Congress amended the act to require states to recover certain Medicaid costs from the estates of certain deceased beneficiaries." Id. (citing Omnibus Budget Reconciliation Act of 1993, Pub. L. No. 103-66, § 13612, 107 Stat. 312, 627-28, codified at 42 U.S.C. § 1396p (b)(1)). There are limits, however, on what a State may recover from the estate of a deceased beneficiary. See generally 42 U.S.C. § 1396p.

Given our conclusion that Congress has not created a private right of action to enforce §§ 1396p (b)(1)(B), (b)(2)(A), and (b)(3)(A), we can be brief in reciting the facts of this case. Named plaintiffs in this case are Sharon P. Jones, Joseph A. Powell, and Carolyn Russell, co-personal representatives of the estates of their parents - Susie Powell and Joseph A. Powell. The District of Columbia and several individual governmental officials sued in their official capacities are the defendants. The trial court granted summary judgment to the individual defendants, see Kentucky v. Graham, 473 U.S. 159, 166 (1985), and the plaintiffs have not appealed that aspect of the trial court's summary judgment order.

The crux of plaintiffs' complaint is that the District violated the Medicaid Act - more on the specific provisions that plaintiffs invoke later - by seeking and recovering funds from the estates of their parents following their parents' death. In due course, plaintiffs moved to certify a class of similarly situated personal representatives of probate estates in the District. In an Omnibus Order entered on July 1, 2008, the Superior Court denied class certification, but entered summary judgment in favor of the named plaintiffs, requiring the District to refund the money that it had collected from their parents' estates.

In its opinion explaining the order, the court concluded that plaintiffs had a right to enforce the Medicaid Act under 42 U.S.C. § 1983.

The plaintiffs then noted an appeal from that portion of the Omnibus Order denying class certification, and the parties proceeded to litigate plaintiffs' request for attorneys' fees and costs. See Dyer v. William S. Bergman & Assocs., Inc., 635 A.2d 1285, 1288 n.6 (D.C. 1993) ("the pendency of a request for attorney's fees after the entry of judgment on the merits does not affect the finality of that judgment") (citing Budinich v. Beckton Dickinson & Co., 486 U.S. 196, 202-03 (1988)). Plaintiffs requested, pursuant to 42 U.S.C. § 1988, over $600,000 in attorneys' fees and costs - more than four times the $141,000 that the District was ordered to repay the plaintiffs. Plaintiffs argued that they were entitled to such an award because they had persuaded the court to conclude "that the rights conferred by Section 1396p may be enforced" under 42 U.S.C. § 1983.

The District argued that plaintiffs were not entitled to fees under § 1988because the Omnibus Order "awarded plaintiffs the exact sum of money the District offered to them over eighteen . . . months earlier without a court order." To that end, the District noted that in its motion to dismiss plaintiffs' amended complaint, recognizing that it had a "fiduciary duty to its citizens," the District "acknowledged the need" to repay the funds that it had collected from the Powell Estates. But although the District attempted to repay the funds with interest, plaintiffs' lawyers declined to accept the District's offer. The District then filed a motion in Probate Court, seeking to return the money to plaintiffs (again, with interest). Plaintiffs opposed the motion, arguing that the District should not be permitted to "pick off" the named class representatives in order to scuttle a class suit. See Deposit Guar. Nat'l Bank v. Roper, 445 U.S. 326, 339 (1980). The Probate Court denied the District's motion. And, on June 30, 2008, the day before the Omnibus Order was entered, the District made an Offer of Judgment, offering to repay to the plaintiffs the amounts collected from the Powell Estates, and to pay attorneys' fees up to $85,000. Thus, as the District saw things, the plaintiffs were not entitled to fees because they achieved nothing in litigation that the District was not willing to give up voluntarily.

The Superior Court sided in significant part with the plaintiffs. The court reasoned that "plaintiffs' success in recovering wrongfully-collected Medicaid reimbursement involved a novel issue of law and served the public's interest in preventing further wrongful collection." The court trimmed the amount of plaintiffs' fee request, however, and ultimately ordered the District to pay $355,050.66 in attorneys' fees, and $21,302.49 in costs. The District noted a timely appeal.

In a pre-argument order, we directed the parties to file supplemental briefs addressing a question conspicuously absent from the parties' briefs - i.e., whether the provisions of the Medicaid Act under which the plaintiffs sued create private rights that are enforceable under § 1983. We also ordered the parties to address: (1) whether we needed to decide the § 1983 issue as a precondition to deciding the issues raised by the parties' cross-appeals; and (2) whether the District forfeited its right to challenge the ...

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