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NB v. District of Columbia

United States District Court, D. Columbia.

March 31, 2014

NB, et al., Plaintiffs,
THE DISTRICT OF COLUMBIA, et al., Defendants

Decided Date: March 30, 2014.

For Nb, by her parent and next friend, Michelle Peacock, Michelle Peacock, Delilah Wynn, John Doe, Elaine Anderson, Norman Rucker, on their own behalf and on behalf of a class similarly situated individuals, Plaintiffs: Jane M. Liu, LEAD ATTORNEY, DRINKER BIDDLE & REATH, LLP, Washington , DC; Bruce J. Terris, Kathleen Lillian Millian, TERRIS, PRAVLIK & MILLIAN, LLP, Washington , DC.

For District of Columbia, a municipal corporation, Adrian Fenty, in his official capacity as Mayor of the District of Columbia, Julie Hudman, in her official capacity as Director of the District of Columbia, Defendants: Keith David Parsons, LEAD ATTORNEY, DISTRICT OF COLUMBIA OFFICE OF THE ATTORNEY GENERAL, Washington , DC; Matthew Robert Blecher, OFFICE OF THE ATTORNEY GENERAL FOR THE DISTRICT OF COLUMBIA, Washington , DC.

Page 147


RICHARD J. LEON, United States District Judge.

Nine Medicaid recipients (" plaintiffs" ) bring this suit against the District of Columbia,

Page 148

the Mayor of D.C., and the Director of D.C.'s Department of Health Care Finance (collectively, " defendants" ), alleging that defendants denied Medicaid coverage of their prescription drugs without providing the procedural protections required by law. See generally Am. Compl. [Dkt. # 43]. In particular, plaintiffs allege that D.C. " denied, terminated, reduced, or delayed" their prescription drug coverage, and did so without giving them adequate written notice, the opportunity for a fair hearing, and the opportunity for reinstated coverage pending a hearing decision, in violation of federal and D.C. law. See Am. Compl. ¶ ¶ 1-2. Plaintiffs, therefore, allege violations of the Due Process Clause of the Fifth Amendment of the Constitution, Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., and District of Columbia law, D.C. Code § 4-201.01, et seq., and they seek declaratory and injunctive relief under 42 U.S.C. § 1983. See Am. Compl. ¶ ¶ 181-195; id. at 49.

This Court previously granted defendants' Motion to Dismiss (" Defs.' First Mot." ) [Dkt. # 10] on the ground that plaintiffs lacked standing, see NB v. District of Columbia, 800 F.Supp.2d 51 (D.D.C. 2011), but plaintiffs successfully appealed that ruling, see NB ex rel. Peacock v. District of Columbia, 682 F.3d 77, 401 U.S.App.D.C. 184 (D.C. Cir. 2012). Following remand from our Circuit Court, now pending before this Court are the remaining grounds in defendants' first Motion to Dismiss, as well as defendants' subsequent Motion to Dismiss, or, in the Alternative, for Summary Judgment (" Defs.' Second Mot." ) [Dkt. # 46] and Memorandum of Points and Authorities in Support (" Defs.' Second Mem." ) [Dkt. # 46-1]. Upon consideration of the pleadings and relevant law, defendants' Motions to Dismiss are GRANTED.


I. Medicaid Statutory and Regulatory Framework

Congress established the Medicaid program under Title XIX of the Social Security Act (" Grants to States for Medical Assistance Programs" ), 42 U.S.C. § 1396 et seq. Medicaid is a " cooperative federal-state program that provides federal funding for state medical services to the poor." Frew v. Hawkins, 540 U.S. 431, 433, 124 S.Ct. 899, 157 L.Ed.2d 855 (2004). Rather than directly providing health care services to eligible individuals or providing them with funds to purchase health care, Medicaid typically functions as a provider payment program, wherein the program reimburses approved providers for their services. See 42 U.S.C. § 1396a(a)(32); Am. Compl. ¶ 21.

Medicaid is financed by both the federal and state governments and is administered by state agencies that are responsible for deciding eligibility, services provided, and all related procedures. See 42 U.S.C. § 1396a(a)(2), (5); 42 C.F.R. § 430.0. In the District of Columbia, the Department of Health Care Finance (" DHCF" ) is the state agency responsible for administering D.C.'s Medicaid program. See 42 U.S.C. § 1396a(a)(5); 42 C.F.R. § 431.10; D.C. Code § 7-771.07(1).

States electing to participate in Medicaid must comply with requirements imposed by federal law, including procedural protections for Medicaid recipients. NB ex rel. Peacock, 682 F.3d at 80. As relevant in this case, the state must provide a Medicaid recipient with written notice of his right to a hearing " at the time" the state takes " any action affecting his . . . claim." 42 C.F.R. ยง 431.206(b), (c)(2). Such notice must contain a statement of what action the state ...

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