Dozier v. Haveman
| Decision Date | 29 October 2014 |
| Docket Number | Case No. 14-12455 |
| Parties | MAYA DOZIER, KRICKETT LUCKHARDT, and MICHELLE MACKAY Plaintiffs, v. JAMES K. HAVEMAN, in his official capacity as Director of the Michigan Department of Community Health; and MAURA D. CORRIGAN, in her official Capacity as Director of the Michigan Department of Human Services Defendants. |
| Court | U.S. District Court — Eastern District of Michigan |
Honorable Laurie J. Michelson
OPINION AND ORDER GRANTING PLAINTIFFS' MOTION FOR PRELIMINARY INJUNCTION [3]
This case arises out of the State of Michigan's winding down of the Plan First! Family Planning Program, a Medicaid program that covered family-planning services, and the ramping up of the Healthy Michigan Plan, a Medicaid program that provides more comprehensive healthcare benefits. Plaintiffs Maya Dozier, Michelle Mackay, and Krickett Luckhardt allege that the Michigan Department of Community Health and the Michigan Department of Human Services ("the Departments") violated federal law by terminating the Plan First! program without first determining whether each Plan First! enrollee was eligible for another Medicaid program such as Healthy Michigan. Plaintiffs further allege that the notices the Departments sent to Plan First! enrollees informing them of the program's termination and its effect on their Medicaid eligibility lacked details required by the Medicaid Act, its implementing regulations, and the Due Process Clause. Plaintiffs believe that the notices should have provided a detailed explanation forthe Plan First! enrollee's ineligibility for other Medicaid programs such as Healthy Michigan. This, Plaintiffs assert, would have allowed the enrollee to make an informed decision about whether to appeal the Departments' Medicaid eligibility determination.
Having granted Plaintiffs' motion for class certification (Dkt. 2), the Court now turns to Plaintiffs' motion for a preliminary injunction (Dkt. 3). The Court finds that Plaintiffs are likely to succeed on their claims that the Department's notice of termination of their Medicaid benefits was inadequate under the relevant provision of the Medicaid Act and implementing regulations and that they are likely to succeed on their claim that the Department was obligated under the Act to conduct an ex parte redetermination of eligibility. Because Plaintiffs are likely to succeed on their claims under the Medicaid statute, the Court does not reach their constitutional claims. The Court also finds that Plaintiffs are likely to suffer irreparable harm if they are denied Medicaid benefits in the absence of the injunction, that the balance of the equities favors injunctive relief, and that an injunction serves the public interest. As such, Plaintiffs' motion for preliminary injunction will be GRANTED as set forth below.
This lawsuit involves the Medicaid Act and related regulations, two Medicaid waiver programs, allegations regarding the phase out of one of those waiver programs, and five named Plaintiffs who purport to represent the class of individuals negatively affected by the phase out. The Court discusses each component in turn.
Congress created the Medicaid program in 1965 by adding Title XIX to the Social Security Act "for the purpose of providing federal assistance to States that choose to reimburse certain costs of medical treatment for needy persons." Harris v. McRae, 448 U.S. 297, 301(1980). The program provides assistance to "families with dependent children and of the aged, blind, or disabled individuals" who cannot afford medical care. 42 U.S.C. § 1396-1. The United States Department of Health and Human Services ("HHS") has the authority to promulgate federal regulations to implement the Medicaid statute. 42 U.S.C. § 1302(a). HHS exercises this authority through a unit called the Center for Medicare and Medicaid Services ("CMS"). At the state level, Michigan authorizes its Medicaid program under Michigan Compiled Law § 400.105, which delegates the administration of the program to the Department of Community Health ("DCH") and the Director of DCH. Through an interdepartmental agreement, the Michigan Department of Human Services ("DHS") determines Medicaid eligibility. "Although participation in the [Medicaid] program is voluntary, participating States must comply with certain requirements imposed by the Act and regulations promulgated by the Secretary of Health and Human Services." Westside Mothers v. Olszewski, 454 F.3d 532, 535 (6th Cir. 2006). For example, state plans "must provide coverage for the 'categorically needy' and, at the state's option, may also cover the 'medically needy.'" Pharm. Research and Mfrs. Of Am. v. Walsh, 538 U.S. 644, 650-51 (2003).
The required "categorically needy" group includes "individuals eligible for cash benefits under the Aid to Families with Dependent Children (AFDC) program, the aged, blind, or disabled individuals who qualify for supplemental security income (SSI) benefits, and other low-income groups such as pregnant women and children entitled to poverty-related coverage." Walsh, 538 U.S. at 651 n.4. The optional category of "medically needy" includes "individuals who meet the nonfinancial eligibility requirements for inclusion in one of the groups covered under Medicaid, but whose income or resources exceed the financial eligibility requirements for categorically needy eligibility." Id. at 651 n.5.
States may choose to offer coverage to additional populations via a Medicaid waiver program. See Portland Adventists Medical Ctr. v. Thompson, 399 F. 3d 1091, 1096 (9th Cir. 2005) ( (citing Jewish Hosp., Inc. v. Sec'y of Health & Human Servs., 19 F.3d 270, 274 (6th Cir.1994)).
Plan First!, the Medicaid waiver program at issue in this case, was geared toward providing family planning services for women ages 19 to 44 who were not pregnant, had income below 185% of the federal poverty level, and who would not otherwise be eligible for Medicaid coverage. DCH submitted a waiver request for the program in October 2004, which the Secretary granted on March 1, 2006. In order to help Michigan effectuate the program, the Secretary waived the following statutory requirements:
• 1396a(a)(10)(B) [Comparability Requirement];
• 1396a(a)(43) [Early and Periodic Screening, Diagnostic, and Treatment];
• 1396a(a)(34) [Retroactive Coverage];
• 1396a(a)(15) [Prospective Payment System for Federally Qualified Health Centers and Rural Health Clinics].
(Plan First! Approval at 2.) Otherwise, "[a]ll Medicaid requirements appl[ied] . . . ." (Id.)
The program was initially authorized for a five-year period, but CMS granted extensions in three month increments starting from April 1, 2011 through June 30, 2013 (Dkt. 18-5, Asman Aff. at ¶ 3.) Finally, DCH obtained a year-long extension to continue coverage through June 30, 2014. Plan First! provided eligible women witha number of services pertaining to reproductive health and family planning, such as education and counseling, physical examinations, pap smears, contraceptive management, and other necessary medications. However, the program did not cover sterilization reversals, infertility treatment, or abortions. (Id.)
The Affordable Care Act ("ACA") amended the Medicaid statute to expand coverage for certain adults under the age of 65, who were not pregnant, with income below 133% of the federal poverty level, and who would not otherwise be entitled to or enrolled in another Medicaid category. 42 U.S.C. § 1396a(a)(10)(i)(VIII). (Compl. ¶ 113.) Michigan implemented this expanded coverage through another waiver program or "alternative benefits package," the Healthy Michigan Plan ("HMP"). Mich. Comp. Laws § 400.105d. Accordingly, the program is available to adults under the age of 65, who are not pregnant, with income below 133% of the federal poverty level, who would not otherwise be entitled to or enrolled in another Medicaid category. 42 U.S.C. § 1396a(a)(10)(i)(VIII). Coverage under HMP is more expansive than Plan First! coverage, and it includes family planning services, meaning (Dkt. 1-5, HMP Approval, at PageID 59.)
C. Plan First! Phaseout
As noted above, Plan First! was scheduled to expire on June 30, 2014; thus, coverage would end on July 1, 2014. DCH declined to seek further extension of Plan First! coverage because of "the expanded coverage available under the ACA, which include[d] family planning services to HMP recipients" and the fact that HMP applications could first be submitted on April 1, 2014 (Asman Aff., at ¶ 6-8.)
Accordingly, DCH submitted a to CMS on March 10, 2014. (Defs.' Resp. Br. at 5.) An initial letter informing beneficiaries of the termination of the program, approved by CMS, was mailed to Plan First! enrollees on March 18, 2014. (Id. at 6.) CMS approved the phase out plan on April...
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