Leocata ex rel. Gilbride v. Wilson-Coker

• Decision Date: 03 November 2004
• Docket Number: No. 3:02 CV 1066 CFD.,3:02 CV 1066 CFD.
• Citation: 343 F.Supp.2d 144
• Parties: Michela LEOCATA, Through Matthew T. GILBRIDE, Esq., Conservator over her Estate and Next of Friend, Plaintiff, v. Patricia WILSON-COKER, Commissioner, Connecticut Department of Social Services; and Tommy G. Thompson, Secretary of the U.S. Department of Health and Human Services, Defendants
• Court: U.S. District Court — District of Connecticut

343 F.Supp.2d 144

Michela LEOCATA, Through Matthew T. GILBRIDE, Esq., Conservator over her Estate and Next of Friend, Plaintiff, v. Patricia WILSON-COKER, Commissioner, Connecticut Department of Social Services; and Tommy G. Thompson, Secretary of the U.S. Department of Health and Human Services, Defendants

No. 3:02 CV 1066 CFD.

United States District Court, D. Connecticut.

November 3, 2004.

COPYRIGHT MATERIAL OMITTED

Raymond J. Rigat, Clinton, CT, for Plaintiff.

Carolyn Aiko Ikari, U.S. Attorney's Office, Richard J. Lynch, Tanya Feliciano, Hartford, CT, for Defendant.

RULING ON MOTIONS TO DISMISS AND MOTION FOR PRELIMINARY INJUNCTION

DRONEY, District Judge.

Plaintiff Michela Leocata ("Leocata") brought this action against Patricia Wilson-Coker, Commissioner of the Department of Social Services of the State of Connecticut ("Commissioner") and Tommy G. Thompson, Secretary of the United States Department of Health and Human Services ("Secretary") in connection with their roles in administering the Title XIX ("Medicaid") program.¹ Leocata alleges violations of 42 U.S.C. § 1983, Title II of the Americans with Disabilities Act ("ADA"), and the Due Process and Equal Protection clauses of the Fifth and Fourteenth Amendments. She seeks declaratory and injunctive relief, attorney's fees and costs. The Secretary and the Commissioner have filed motions to dismiss the complaint for lack of standing and for failure to state a claim upon which relief can be granted. The plaintiff has filed a motion for a preliminary injunction seeking temporary relief during the pendency of this case and its appeal, if applicable. For the reasons that follow, the motions to dismiss are granted and the motion for a preliminary injunction is denied.

I. Facts²

Leocata is an elderly woman with advanced dementia who resides at Arden Courts in Farmington, Connecticut. Arden Courts is an assisted living facility ("ALF") that provides residential care to elderly persons with various forms of dementia who do not need the extent of skilled nursing care provided at a traditional nursing home. Leocata pays for her care at Arden Courts; her assets, however, are rapidly depleting and soon will be insufficient to cover the cost of that care.

Leocata contends that the Medicaid program under Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., and the relevant state statutes only allow benefits to be paid to skilled nursing care facilities ("NF") and disallow payments to ALFs, even though the cost of care is more expensive at skilled nursing care facilities. Once Leocata cannot afford to pay for her care at Arden Courts, she will be forced to relocate to a skilled nursing care facility despite the fact that she does not require all the extensive medical services such facilities provide. Moreover, Leocata alleges that a skilled nursing care facility will not be able to address her special needs adequately. She contends that other recipients of state and federal aid pursuant to the Medicaid program have their specialized medical care needs met.

Leocata maintains that she will be forced to move out of Arden Courts to a skilled nursing care facility because of her poverty and the unfairness of Medicaid paying for skilled nursing facilities, but not assisted living facilities. She also will suffer emotional distress as a result of being forced to relocate to another facility.

II. Motion to Dismiss Standard

When considering a Rule 12(b)(6) motion to dismiss, the Court accepts as true all factual allegations in the complaint and draws inferences from these allegations in the light most favorable to the plaintiff. See Scheuer v. Rhodes, 416 U.S. 232, 236, 94 S.Ct. 1683, 40 L.Ed.2d 90 (1974), overruled on other grounds, Davis v. Scherer, 468 U.S. 183, 104 S.Ct. 3012, 82 L.Ed.2d 139 (1984); Easton v. Sundram, 947 F.2d 1011, 1014-15 (2d Cir.1991), cert. denied, 504 U.S. 911, 112 S.Ct. 1943, 118 L.Ed.2d 548 (1992). Dismissal is warranted only if, under any set of facts that the plaintiff can prove consistent with the allegations, it is clear that no relief can be granted. See Hishon v. King & Spalding, 467 U.S. 69, 73, 104 S.Ct. 2229, 81 L.Ed.2d 59 (1984); Frasier v. General Elec. Co., 930 F.2d 1004, 1007 (2d Cir.1991). "The issue on a motion to dismiss is not whether the plaintiff will prevail, but whether the plaintiff is entitled to offer evidence to support his or her claims." United States v. Yale New Haven Hosp., 727 F.Supp. 784, 786 (D.Conn.1990) (citing Scheuer, 416 U.S. at 232, 94 S.Ct. 1683). Thus, a motion to dismiss under 12(b)(6) should not be granted "unless it appears beyond doubt that the plaintiff can prove no set of facts in support of his claim which would entitle him to relief." Sheppard v. Beerman, 18 F.3d 147, 150 (2d Cir.1994) (citations and internal quotations omitted), cert. denied, 513 U.S. 816, 115 S.Ct. 73, 130 L.Ed.2d 28 (1994). In its review of a 12(b)(6) motion to dismiss, the Court may consider "only the facts alleged in the pleadings, documents attached as exhibits or incorporated by reference in the pleadings and matters of which judicial notice may be taken." Samuels v. Air Transport Local 504, 992 F.2d 12, 15 (2d Cir.1993).

III. Standing

The defendants allege that Leocata lacks standing to bring this action, since she currently does not receive Medicaid benefits, nor has she demonstrated that she will become Medicaid-eligible at any given time. Defendants further allege that Leocata has shown no actual injury, since she continues to reside at Arden Courts, and that her injury may not be redressable, since it is unlikely that Arden Courts would qualify as a service provider under the Medicaid regulations.

The Supreme Court has held that "a plaintiff must meet three requirements in order to establish Article III standing," those of injury in fact, causation and redressability. Vermont Agency of Natural Res. v. United States ex rel. Stevens, 529 U.S. 765, 771, 120 S.Ct. 1858, 146 L.Ed.2d 836 (2000). First, a plaintiff must demonstrate an "injury in fact" which is "concrete, distinct and palpable," and "actual or imminent, not conjectural or hypothetical." Whitmore v. Arkansas, 495 U.S. 149, 155, 110 S.Ct. 1717, 109 L.Ed.2d 135 (1990) (internal quotation marks and citations omitted). Second, a plaintiff must establish "a causal connection between the injury and the conduct complained of — the injury has to be `fairly traceable to the challenged action of the defendant, and not ... the result [of] some third party not before the court.'" Lujan v. Defenders of Wildlife, 504 U.S. 555, 560-61, 112 S.Ct. 2130, 119 L.Ed.2d 351 (1992) (quoting Simon v. Eastern Ky. Welfare Rights Org., 426 U.S. 26, 41-42, 96 S.Ct. 1917, 48 L.Ed.2d 450 (1976)). Third, a plaintiff must demonstrate a "`substantial likelihood' that the requested relief will remedy the alleged injury in fact." Stevens, 529 U.S. at 771, 120 S.Ct. 1858 (quoting Simon, 426 U.S. at 45, 96 S.Ct. 1917).

The Court finds that Leocata has presented facts sufficient to give her standing in the instant case. Due to the rapid depletion of her personal funds, she faces the imminent injury of being forced to leave Arden Courts.³ It is undeniably true that Leocata would seek to stay at Arden Courts if Medicaid would reimburse her room and board costs there. It is also true that the declaratory and injunctive relief Leocata seeks, requiring Medicaid to provide such reimbursement, would redress her situation fully. Article III requires that a party's standing be determined prior to reaching the merits of his or her claims. Therefore, regardless of the likelihood of success of Leocata's complaint, the Court finds that she has sufficient standing to pursue that complaint here.

IV. Discussion

A. The Challenged Statute

The Medicaid program, established under Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., is a "co-operative federal/state cost-sharing program designed to enable participating states to furnish medical assistance to persons whose income and resources are insufficient to meet the costs of necessary medical care and services." DeJesus v. Perales, 770 F.2d 316, 318 (2d Cir.1985).

States choosing to participate in Medicaid are required to comply with Title XIX's requirements and implementing regulations. 42 U.S.C. § 1396a(a) sets forth the requirements of state plans for medical assistance. Participating states must agree to fund medical services to the "categorically needy" in five general areas: (1) inpatient hospital services; (2) outpatient hospital services; (3) other laboratory and X-ray services; (4) skilled nursing facilities services, periodic screening and diagnosis of children, and family planning services; and (5) services of physicians. See 42 U.S.C. §§ 1396a(a)(13)(B), 1396d(a)(1)-(5). While states do not have to fund all medical services within those five categories, they must establish "reasonable standards ... for determining... the extent of medical assistance under the plan which are consistent with the objectives of [Title XIX]." 42 U.S.C. § 1396a(a)(17). Once a state plan is approved by the federal Department of Health and Human Services, "the federal government partially reimburses the state for the state's expenditures in subsidizing medical services for needy citizens covered by its plan." Lewis v. Thompson, 252 F.3d 567, 570 (2d Cir.2001).

Because Medicaid only covers categorically needy persons, individuals do not become eligible for Medicaid assistance until they "spend down" their private assets below a income ceiling set by state statute. See Schweiker v. Gray Panthers, 453 U.S. 34, 37-40, 101 S.Ct. 2633, 69 L.Ed.2d 460 (1981). A Medicaid-eligible individual may receive any of three basic types of inpatient services that provide room and board: hospitals, NFs, or intermediate care facilities for the mentally retarded ("ICF/MRs"). 42 U.S.C. §§ 1396d(a)(1), (4), (14)-(16). The statute also sets forth...