J.E. v. Wong, Civil No. 14-00399 HG-KJM
| Decision Date | 12 August 2016 |
| Docket Number | Civil No. 14-00399 HG-KJM |
| Parties | J.E., through his parent SUZANNE EGAN, for themselves and on behalf of a class of those similarly situated; and the HAWAII DISABILITY RIGHTS CENTER, in a representative capacity on behalf of its clients and all others similarly situated, Plaintiffs, v. RACHAEL WONG, in her official capacity as Director of the State of Hawaii, Department of Human Services, Defendant. |
| Court | U.S. District Court — District of Hawaii |
ORDER GRANTING, IN PART, AND DENYING, IN PART, PLAINTIFFS' MOTION FOR SUMMARY JUDGMENT (ECF No. 100)
and
GRANTING, IN PART, AND DENYING, IN PART, DEFENDANT'S MOTION FOR SUMMARY JUDGMENT (ECF No. 98)
Plaintiffs J.E., through his parent, Suzanne Egan, and the Hawaii Disability Rights Center filed a Complaint alleging that the State of Hawaii, Department of Human Services, violated provisions of the Medicaid Act, 42 U.S.C. § 1396 et seq.
Plaintiffs claim that the Department of Human Services has been precluding the state Medicaid program from covering Applied Behavior Analysis ("ABA") as a treatment for autistic children and young adults, in violation of the Medicaid Act's early and periodic screening, diagnostic, and treatment ("EPSDT") services mandate. Plaintiffs also allege that the Department has failed to inform eligible persons that ABA is an available early and periodic screening, diagnostic, and treatment service.
Plaintiffs seek a declaratory ruling stating that:
(1) the State of Hawaii, through the Department of Human Services, violated the Medicaid Act by failing to cover ABA treatment pursuant to the EPSDT services mandate;
Plaintiffs also seek an injunction:
(2) ordering the Department to include ABA as a covered treatment under the state Medicaid program for persons eligible for EPSDT services;
(3) compelling the Department to publicize the Medicaid program's coverage of ABA treatment; and
(4) instructing the Department to submit a State Plan Amendment memorializing a policy that adds ABA treatment as a covered EPSDT benefit.
Defendant seeks dismissal of Plaintiffs' action as moot and declaratory judgment in its favor as to the following:
(1) the Department has always covered medically necessary autism treatment under Medicaid law;
(2) the Department does not have an obligation pursuant to theMedicaid Act to inform persons eligible for EPSDT services about ABA treatment; and
(3) the Defendant is not required to submit a State Plan Amendment to the Centers for Medicare and Medicaid Services that specifically memorializes coverage for ABA treatment.
Plaintiffs' Motion for Summary Judgment (ECF No. 100) and Defendant's Motion for Summary Judgment (ECF No. 98) are each GRANTED, IN PART, AND DENIED, IN PART.
On September 5, 2014, Plaintiffs J.E. and the Hawaii Disability Rights Center (collectively, "Plaintiffs") filed a Complaint. (ECF No. 1).
On December 1, 2014, Plaintiffs filed their First Amended Complaint. (ECF No. 8).
On June 19, 2015, the Magistrate Judge approved a stipulation by the parties for Plaintiffs to file a Second Amended Complaint. (ECF No. 42).
On June 22, 2015, Plaintiffs filed a Second Amended Complaint. (ECF No. 44).
On July 6, 2015, Defendant Rachael Wong, Director of the State of Hawaii, Department of Human Services ("Defendant") filed a Motion to Dismiss Plaintiffs' Second Amended Complaint. (ECF No. 46).
On August 27, 2015, the Court denied Defendant's Motion to Dismiss. (ECF No. 62).
On December 10, 2015, Plaintiffs filed a Motion for Class Certification. (ECF No. 78).
On February 10, 2016, Plaintiffs filed PLAINTIFFS' MOTION FOR SUMMARY JUDGMENT and PLAINTIFF'S CONCISE STATEMENT OF FACTS IN SUPPORT OF PLAINTIFFS' MOTION FOR SUMMARY JUDGMENT. (ECF Nos. 100; 101).
On February 10, 2016, Defendant filed DEFENDANT RACHAEL WONG, IN HER OFFICIAL CAPACITY AS DIRECTOR OF THE STATE OF HAWAII, DEPARTMENT OF HUMAN SERVICE'S MOTION FOR SUMMARY JUDGMENT and SEPARATE AND CONCISE STATEMENT OF FACTS IN SUPPORT OF DEFENDANT'S MOTION FOR SUMMARY JUDGMENT. (ECF Nos. 98; 99). On the same date, Defendant also filed a Motion to Seal Exhibits 4, 7, 8, and 9. (ECF No. 97).
On February 19, 2016, Plaintiffs filed PLAINTIFFS' AMENDED CONCISE STATEMENT OF FACTS. (ECF No. 104). On the same date, Defendant filed DEFENDANT RACHAEL WONG, IN HER OFFICIAL CAPACITY AS DIRECTOR OF THE STATE OF HAWAII, DEPARTMENT OF HUMAN SERVICE'S FIRST AMENDED SEPARATE AND CONCISE STATEMENT OF FACTS IN SUPPORT OF DEFENDANT'S MOTION FOR SUMMARY JUDGMENT. (ECF No. 103).
On February 19, 2016, the Court granted Defendant's Motion to Seal Exhibits 4, 7, 8, and 9. (ECF No. 105).
On February 23, 2016, the Magistrate Judge filed a Findings and Recommendation to deny Plaintiffs' Motion for Class Certification. (ECF No. 108).
On March 10, 2016, Defendant filed DEFENDANT RACHAEL WONG'S, IN HER OFFICIAL CAPACITY AS DIRECTOR OF THE STATE OF HAWAII, DEPARTMENT OF HUMAN SERVICES, MEMORANDUM IN OPPOSITION TO PLAINTIFFS' MOTION FOR SUMMARY JUDGMENT. (ECF No. 109). On the same date, Defendant also filed DEFENDANT RACHAEL WONG'S, IN HER OFFICIAL CAPACITY AS DIRECTOR OF THE STATE OF HAWAII, DEPARTMENT OF HUMAN SERVICES, STATEMENT IN OPPOSITION TO PLAINTIFFS' AMENDED CONCISE STATEMENT OF FACTS IN SUPPORT OF PLAINTIFFS' MOTION FOR SUMMARY JUDGMENT. (ECF No. 110).
On March 10, 2016, Plaintiffs filed PLAINTIFFS' MEMORANDUM IN OPPOSITION TO [ECF NO. 98] DEFENDANT RACHAEL WONG, IN HER OFFICIAL CAPACITY AS DIRECTOR OF THE STATE OF HAWAII, DEPARTMENT OF HUMAN SERVICES' MOTION FOR SUMMARY JUDGMENT, FILED FEBRUARY 10, 2016. (ECF No. 111). On the same date, Plaintiffs also filed PLAINTIFFS' CONCISE STATEMENT OF FACTS IN OPPOSITION TO DEFENDANT'S MOTION FOR SUMMARY JUDGMENT. (ECF No. 112).
On March 17, 2016, the Court adopted the Magistrate Judge's Findings and Recommendation to deny Plaintiffs' Motion for Class Certification. (ECF No. 113).
On April 25, 2016, the Plaintiffs filed PLAINTIFFS' REPLY IN SUPPORT OF [ECF NO. 100] MOTION FOR SUMMARY JUDGMENT. (ECF No. 118). On the same date, Defendant filed DEFENDANT RACHAEL WONG, IN HER OFFICIAL CAPACITY AS DIRECTOR OF THE STATE OF HAWAII, DEPARTMENT OF HUMAN SERVICE'S REPLY IN SUPPORT OF HER MOTION FOR SUMMARY JUDGMENT. (ECF No. 117).
On May 5, 2016, the Court held a hearing on the parties'cross-motions for summary judgment. (ECF No. 119). At the hearing, the Court instructed the parties to file supplemental memoranda addressing the Hawaii Disability Rights Center's standing.
On May 13, 2016, Defendant filed DEFENDANT RACHAEL WONG, IN HER OFFICIAL CAPACITY AS DIRECTOR OF THE STATE OF HAWAII, DEPARTMENT OF HUMAN SERVICE'S SUPPLEMENTAL BRIEF ON HAWAII DISABILITY RIGHTS CENTER'S STANDING. (ECF No. 120).
On May 20, 2016, Plaintiffs filed PLAINTIFFS' RESPONSE TO DEFENDANT'S SUPPLEMENTAL MEMORANDUM ON STANDING OF THE HAWAII DISABILITY RIGHTS CENTER. (ECF No. 122).
Plaintiff J.E. ("J.E.") is a seven-year-old boy who was first diagnosed with autism spectrum disorder ("autism") at age four.1 (Egan Decl. at ¶¶ 3-6; 18-19, ECF No. 104-2). J.E. lives in the State of Hawaii and receives Medicaid benefits. (Id. at ¶ 4).
The Hawaii Disability Rights Center ("the HDRC") is a non-profit "Protection and Advocacy" organization that serves Hawaii's disabled residents. (Erteschik Supp. Decl. at ¶ 3, ECF No. 122-1). A Protection and Advocacy organization defends and supports the legal and human rights of individuals with disabilities. See 29 U.S.C. § 794e; Haw. Rev. Stat. § 333F-8.5. The HDRC is the designated Protection and Advocacy organization for the State of Hawaii. (Erteschik Supp. Decl. at ¶ 3).
The HDRC has constituents instead of members. (Id. at ¶ 4). During the calendar years 2014 and 2015, the HDRC had a least 181 Medicaid-eligible constituents with an autism diagnosis. (Id. at ¶ 8). J.E. is a constituent of the HDRC. (Id. at ¶¶ 9-13).
The State of Hawaii, Department of Human Services ("the Department") is the agency responsible for administering the Medicaid program in Hawaii. See 42 U.S.C. § 1396a(a)(5); 42 C.F.R. § 431.10; Haw. Rev. Stat. §§ 346-7; 346-14. The Department provides Medicaid services through a managed care system. .
Under the managed care system, the Department contracts with third-party health plans to provide Medicaid coverage to eligible beneficiaries. (Id. at 40:3-42:6). It also relies on the health plans to communicate directly with Medicaid beneficiaries. (Id. at 53:24-55:16; Dep't of Human Servs. Request for Proposal at pp. 124-128; Ex. 3 of Def. Amended CSF, ECF No. 103-6). If abeneficiary is unsatisfied with a medical coverage decision, he may engage in a grievance or appeals process with the health plan. (Dep't of Human Serv. Request for Proposal at pp. 151-153; 330-333, Ex. 3 of Def. Amended CSF). The Department is informed of grievances and appeals. Unless a grievance or appeal is submitted, the Department does not generally know whether the health plan has denied a particular medical treatment. .
Prior to August 2014, the Department did not view Applied Behavior Analysis ("ABA") as an effective form of treatment for autism.
In January 2013, the State's Legislative Reference Bureau published a report regarding ABA coverage. Citing to an interview with the Department's Medicaid administrator, Dr. Kenneth Fink ("Dr. Fink"), the report stated that ABA treatment was not covered by Medicaid, as it was not considered "evidence[]-based and, therefore, not medically necessary." (Ex. 6 of Plas Amended CSF, ECF No. 104-9).
In April 2013, the then-director of the Department, Patricia McManaman ("Director McManaman"), testified before the state legislature in opposition to a bill that would require health insurers to provide coverage for...
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