In a case involving failure to timely process Medicaid applications, the Ohio district court held that even though each of the named plaintiffs had obtained a decision, the problem of delays was capable of repetition and not moot.
The court denied a motion to dismiss claims brought under 42 U.S.C. § 1983, preemption, the Americans with Disabilities Act (ADA), and due process. The Ability Center of Greater Toledo v. Lumpkin, 2011 WL 767878 (N.D. Ohio Feb. 28, 2011). The judge was nominated by Clinton. The plaintiffs are represented by Advocates for Basic Legal Equality.
The 9 named plaintiffs applied for Medicaid based on their disabilities. Many of their applications were not processed for over a year. Six of them were not processed until after the litigation was filed. The court held that the claims of 2 plaintiffs were moot, due to their having been found disabled by the Social Security Administration and thereby not needing to reapply. The court held that the other plaintiffs’ claims were not moot. Some were given a period of eligibility and would have to reapply in the future. Therefore, for these plaintiffs, the problem of untimely processing was capable of repetition. One person’s claim was denied, and he was likely to reapply. Another was explicitly told to reapply. The court further found that the plaintiffs met the standing requirement, since prospective relief would remedy delays in their future applications. The court also held that The Ability Center of Greater Toledo had associational standing to sue on behalf of its members and rejected the state’s contention that the organization lacked prudential standing.
The court summarily rejected the state’s contention that the claims could not be pursued under § 1983. The court relied upon the holding in Westside Mothers v. Olszewski, 454 F.3d 532 (6th Cir. 2006), that claims under 42 U.S.C. 1396a(a)(8) and (10) were enforceable via § 1983. The court held that regulations which provide the authoritative interpretation of a statute are enforceable under the § 1983 private right of action.
Turning to the ADA claims, the court rejected the disparate impact claim, alleging that applicants with disabilities were treated differently from applicants without disabilities. The court held that the complaint did not adequately plead this claim. The court stated: “plaintiffs have failed to make the barest of factual comparisons between the Medicaid application processes or statutorily imposed timelines for processing applications for disabled and non-disabled applicants.”
Nevertheless, the court denied the motion to dismiss with regard to plaintiffs’ claims that the state failed to reasonably accommodate their disabilities, explaining that a reasonable accommodation “may exist.” The court held that it was premature for the state to allege, during a motion to dismiss, that accommodation would be difficult and costly.
The court also denied the motion to dismiss as regards the Supremacy Clause claim. The court found that the plaintiffs adequately alleged a policy of failing to timely process applications. The court stated: “Defendant’s apparently systematic and pervasive failure to make disability determinations within ninety days and corresponding failure to ensure the availability of medical assistance appears to be the result of policy-based under-enforcement, and as such is strongly in disaccord with the federal regime. The defendant has, through his conduct implemented an implicit, albeit unwritten policy (but one as effective as if he had issued a formal proclamation) that directly contravenes federal law. That law, in turn, is pre-emptive vis-a-vis the defendant’s de facto policy.”
Finally, the court held that plaintiffs had adequately pled a due process claim that the failure to provide a hearing during the pendency of the application deprived them of hearing rights. The court explained: ”The crux of plaintiffs’ argument is that due process requires notice of the right to obtain a hearing not only when the state agency takes action which affects the applicant’s claim, but also when the state agency so delays any action on an applicant’s process that the applicant’s claim is effectively denied.”