Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

N.B. v. District of Columbia

United States District Court, District of Columbia

March 26, 2017

N.B. et al., Plaintiffs,
v.
THE DISTRICT OF COLUMBIA et at., Defendants.

          MEMORANDUM OPINION

          RICHARD J. LEAN United States-District Judge

         Plaintiffs in this case are residents of the District of Columbia ("the District" or "D.C.") who are eligible for Medicaid benefits and who unsuccessfully sought coverage for specific drug prescriptions. In their Amended Complaint, they allege that the District, the Mayor of D.C., and the Director of the Division of Health Care Finance ("DHCF") have systematically failed to provide Medicaid recipients with "adequate and timely notice, the opportunity for a fair hearing, and the opportunity for reinstated coverage pending a hearing decision" when they are denied coverage for specific prescriptions, in violation of the Fifth Amendment to the U.S. Constitution, Title XIX of the Social Security Act, and local D.C. law. Am. Compl. ¶ 1 [Dkt. # 43].

         Following remand from our Circuit Court, this Court is now faced with defendants' Updated Motion to Dismiss [Dkt. # 64] the Amended Complaint for failure to state a claim. NB ex rel. Peacock v. District of Columbia, 794 F.3d 31, 35-36 (D.C. Cir. 2015). Although plaintiffs' claims under Title XIX have been dismissed, plaintiffs continue to allege violations of the Due Process Clause of the Fifth Amendment to the Constitution 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. Upon consideration of the pleadings and relevant law, and for the reasons explained below, defendants' Motion to Dismiss is GRANTED in part and DENIED in part.

         BACKGROUND

         I. Legal and Factual Framework

         The factual and legal issues underlying this case are described in painstaking detail in the earlier opinions of both this Court and our Circuit Court, so a more concise background summary will suffice here. See N.B. ex rel. Peacock v. Dist. of Columbia, 800 F.Supp.2d 51, 52-54 (D.D.C. 2011); N.B. ex rel. Peacock v. Dist. of Columbia, 682 F.3d 77, 80-81 (D.C. Cir. 2012); N.B. ex rel Peacock v. Dist. of Columbia, 34 F.Supp.3d 146 (D.D.C. 2014); N.B ex rel. Peacock v. Dist. of Columbia, 794 F.3d 31, 35-36 (D.C. Cir. 2015).

         In 1968, Congress established Medicaid as a "cooperative federal-state program that provides federal funding for state medical services to the poor." Title XIX of the Social Security Act ("Grants to States for Medical Assistance Programs"), 42 U.S.C. § 1396 et seq.; Frew v. Hawkins, 540 U.S. 431, 433 (2004). Although funding comes from both federal and state governments (including the District of Columbia), Medicaid is administered by state agencies. See 42 U.S.C. § 1396a(a)(2), (a)(5); 42 C.F.R. §430.0.

         The District's Department of Health Care Finance ("DHCF") administers the D.C. Medicaid program, which provides, inter alia, certain prescription drug benefits to qualified beneficiaries. D.C. CODE § 7-771.07(1). In order to manage its prescription coverage benefit, DHCF contracts with Xerox, a third-party company, to operate an electronic claims management system and process Medicaid prescription drug coverage claims at the point of sale. See Am. Compl. ¶¶ 33-34; Defs.' Updated Mot. to Dismiss at 3n.2.

         The plaintiffs in this case[1] all receive Medicaid benefits in the District and suffer from conditions that require prescription drug treatment. Am. Compl. ¶¶ 5-13, 17. They allege that on various occasions their prescription drug coverage under Medicaid was "denied, terminated, or reduced, " and the District failed to provide them with any "notice of the denial, the reason for the denial, the right to a hearing, or the circumstances under which Medicaid will continue providing coverage during the appeal process." Am. Compl. ¶¶ 47, 58, 61, 74, 80, 84, 141, 154, 172. Specifically, plaintiffs allege multiple instances in which they attempted to fill prescriptions at pharmacies, were told that Medicaid would not cover the prescriptions, and were not given notice of the reasons for the rejections or their procedural rights for challenging the denial. Id. ¶¶ 57, 58, 61, 77, 80, 140, 141, 154, 165, 172.

         II. Procedural History

         Five of the plaintiffs initiated this action in 2010. See Compl. [Dkt # 3]. In 2011, ' I held that plaintiffs lacked Article III standing and granted defendants' motion to dismiss the case. See NB v. District of Columbia, 800 F.Supp.2d 51 (D.D.C. 2011). In 2012, our Circuit Court reversed on appeal, holding that the plaintiffs' complaint included sufficient factual allegations to establish that at least one plaintiff, John Doe, had standing on a procedural injury theory. See NB ex rel. Peacock v. District of Columbia, 682 F.3d 77, 82 (D.C. Cir. 2012). On remand, plaintiffs amended their complaint to add four new plaintiffs and new facts, without changing their legal causes of action. Am. Compl. In 2014, 1 determined that plaintiffs' Amended Complaint failed to state a claim under either Title XIX or the Fifth Amendment, dismissed the D.C. law claims for lack of pendent jurisdiction, and again dismissed the case. NB ex rel. Peacock v. District of Columbia, 34 F.Supp.3d 146 (D.D.C. 2014). On appeal, our Circuit Court affirmed in part and reversed in part, holding that though plaintiffs failed to state a claim under Title XIX, they had alleged that D.C. had deprived them of their protected property interests in prescription coverage, and remanded to this Court to consider what process the plaintiffs are entitled to under the Fifth Amendment. NB ex rel. Peacock v. District of Columbia, 794 F.3d 31, 40-44, (D.C. Cir. 2015). In light of the partial reversal, the Circuit also noted that I could reconsider this Court's jurisdiction over the D.C. law claims on remand. Id. at 44.

         STANDARD OF REVIEW

         When deciding a motion to dismiss under Rule 12(b)(6) for failure to state a claim upon which relief can be granted, the Court must determine whether the complaint contains "sufficient factual matter, accepted as true, to state a claim to relief that is plausible on its face." Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (internal quotation marks and citations omitted). The complaint must include "more than labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do"; instead, the complaint must include factual allegations that "raise a right to relief above the speculative level." Bell Atlantic Co v. Twombly, 550 U.S. 544, 555 (2007) (internal quotation marks and citation omitted).

         Under the Rule 12(b)(6) standard, Court must read the complaint's factual allegations in the light most favorable to the plaintiff, id, but the Court is not required to accept plaintiffs legal conclusions, even if they are framed as factual assertions. Browning v. Clinton, 292 F.3d 235, 242 (D.C. Cir. 2002). As a result, a claim that is rooted in a faulty legal theory must be dismissed, "whether it is based on an outlandish legal theory or on a close but ultimately unavailing one." Nietzke v. Williams, 490 U.S. 319, 327(1989).

         At the motion to dismiss stage, the Court "may consider only the facts alleged in the complaint, any documents either attached to or incorporated in the complaint[, ] and .matters of which [the court] may take judicial notice." EEOC v. St. ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.