John B. v. Goetz
Decision Date | 30 November 2010 |
Docket Number | No. 09-6145,09-6145 |
Citation | 626 F.3d 356 |
Parties | JOHN B., et al., Plaintiffs-Appellees, v. Dave GOETZ, Commissioner, Tennessee Department of Finance and Administration; Darin Gordon, Deputy Commissioner, Bureau of TennCare; Viola Miller, Commissioner, Tennessee Department of Children's Services, Defendants-Appellants. |
Court | U.S. Court of Appeals — Sixth Circuit |
ARGUED: Michael W. Kirk, Cooper & Kirk, PLLC, Washington, D.C., for Appellants. Andrew R. Dunlap, Kirkland & Ellis LLP, New York, New York, for Appellees. ON BRIEF: Michael W. Kirk, Charles J. Cooper, Brian S. Koukoutchos, Derek L. Shaffer, Cooper & Kirk, PLLC, Washington, D.C., Robert E. Cooper, Jr., Linda A. Ross, Office of the Attorney General, State of Tennessee, Nashville, Tennessee, for Appellants. Andrew R. Dunlap, Katherine L. McDaniel, Kirkland & Ellis LLP, New York, New York, Michele M. Johnson, G. Gordon Bonnyman, Jr., Tennessee Justice Center, Nashville, Tennessee, for Appellees.
Before: GIBBONS, ROGERS, and KETHLEDGE, Circuit Judges.
1
This appeal arises from the district court's denial of defendants' motion to vacatea consent decree entered in a 1998 class-action challenge to Tennessee's managed care program, TennCare, under the Medicaid Act. Plaintiffs alleged that defendants, Tennessee officials charged with implementing TennCare, failed to provide early and periodic screening, diagnosis and treatment (EPSDT) services in violation of the Medicaid Act, and the parties' consent decree imposes systemic remedies for these alleged violations. Defendants argue that the consent decree must be vacated under Federal Rule of Civil Procedure 60(b) because this court's intervening decisions render such systemic remedies unenforceable. Defendants also request reassignment of the case. We decline to vacate the consent decree in its entirety, but we vacate a portion of the consent decree in light of intervening decisions, and we remand the case for reassignment and further proceedings.
In December of 2001, the district court determined that defendants were not in compliance with the consent decree and EPSDT requirements, and appointed a special master to assist the parties in addressing TennCare's deficiencies. In February of 2006, after the defendants alleged that Judge Nixon had engaged in improper ex parte communications with the special master, Judge Nixon voluntarily recused himself and the case was reassigned to Judge William J. Haynes, Jr. In March of 2006, Judge Haynes relieved the special master of his special master's duties, but retained the special master as a technical advisor under the district court's inherent authority and barred inquiry into the special master's ex parte communications with Judge Nixon. Defendants moved the district court to reconsider this ruling, primarily arguing that the special master's appointment as technical advisor was inappropriate given the allegations of improper ex parte communications and the court's ruling that the defendants could not investigate these communications. Defendants also noted that relief beyond that granted in the consent decree "could not be predicated, even in theory, upon any violations of underlying EPSDT law because recent jurisprudence from the Supreme Court makes clear that the Medicaid statute in this context does not confer a right that is privately enforceable by the beneficiaries." To support this argument, defendants cited Gonzaga University v. Doe, 536 U.S. 273, 282, 122 S.Ct. 2268, 153 L.Ed.2d 309 (2002), in which the Supreme Court held that "it is rights, not the broader or vaguer 'benefits' or 'interests,' that may be enforced under the authority of [§ 1983]." Therefore that statute is enforceable under § 1983 only if "Congress intended to confer individual rights upon a class of beneficiaries." Id. at 285, 122 S.Ct. 2268.
In a hearing on April 17, 2006, the district court denied defendants' motion for reconsideration and stated that appointing the former special master as technical advisor avoided "los[ing] the benefit of [his] extensive study and review of the matters." The district court rejected defendants' Gonzaga-based argument because defendants had not analyzed Gonzaga in their filing and the Sixth Circuit had not applied Gonzaga to the Medicaid Act. The district court also noted that a motion under Federal Rule of Civil Procedure 60(b) was the appropriate method for a Gonzaga-based challenge to the consent decree, but that defendants had failed to make a Rule 60(b) motion and that such a motion would be untimely at that point, more than one year after Gonzaga was decided.
Id. at 536. We affirmed the district court's conclusion that plaintiffs had failed to state a claim upon which relief could be granted for defendants' "alleged failure ... to ensure the actual provision of, or arrangement for, medical services." Id. at 539-41. Although states must "provide for making medical assistance available," 42 U.S.C. § 1396a(a)(10), and "provide that ... medical assistance ... be furnished with reasonable promptness to all eligible individuals," 42 U.S.C. § 1396a(a)(8), we held that a state's obligation is only to pay for services actually rendered, not ensure the reasonably prompt provision of services, because the Medicaid Act defines "medical assistance" as "payment of part or all of the cost of the [enumerated] services," 42 U.S.C. § 1396d(a).2
Id. at 540 (insertion in original). We also dismissed plaintiffs' claim that would require the State to ensure comparable service availability because the underlying provision, 42 U.S.C. § 1396a(a)(30), was not privately enforceable under § 1983. Id. at 541-43. However, we also held that plaintiffs' allegation that defendants " 'refused or failed to effectively inform Plaintiffs and their caretakers of the existence of [EPSDT services]' " stated a claim for relief for violation of 42 U.S.C. § 1396a(a)(43). Id. at 543-44.
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