Mykonos v. United States

• Decision Date: 22 July 2014
• Docket Number: Civil Action No. 13–1845 JDB
• Citation: 59 F.Supp.3d 100
• Court: U.S. District Court — District of Columbia
• Parties: Stephanie Mykonos, Plaintiff, v. United States of America, et al., Defendants.

59 F.Supp.3d 100

Stephanie Mykonos, Plaintiff

v.United States of America, et al., Defendants.

Civil Action No. 13–1845 JDB

United States District Court, District of Columbia.

Signed July 22, 2014

Stephanie Mykonos, Washington, DC, pro se.

Rafique Omar Anderson, Robert N. Englund, U.S. Attorney's Office, Kimberly Katzenbarger, Office of the Attorney General, Washington, DC, for Defendants.

MEMORANDUM OPINION

JOHN D. BATES, United States District Judge

Plaintiff Stephanie Mykonos brings this action against a large group of District of Columbia and United States government defendants: the United States of America; Sylvia Mathews Burwell, in her official capacity as the United States Secretary of Health and Human Services;¹ Vincent Gray, in his official capacity as the Mayor of the District of Columbia; Irvin Nathan, in his official capacity as the Attorney General of the District of Columbia; and Mila Kofman, in her official capacity as the Executive Director of D.C. Health Link (collectively “defendants”). Mykonos claims she was denied reduced cost health insurance in violation of the Americans with Disabilities Act (“ADA”) and the Patient Protection and Affordable Care Act (“ACA”), and seeks (1) “enforcement of [her] rights to reduced cost health insurance,” and (2) “fiscal reimbursements for out of pocket medical costs.” See Second Am. Compl. [ECF No. 6] at 6. Defendants have filed motions to dismiss on several grounds, including (1) mootness and (2) failure to exhaust administrative remedies. For the reasons discussed below, the Court will grant defendants' motions to dismiss.

BACKGROUND

The administration of Medicaid in the District of Columbia is governed by a patchwork of federal and local statutes and agencies. The D.C. Department of Health Care Finance is primarily responsible for administering the D.C. Medicaid plan. See 42 U.S.C. § 1396a(a)(5) ; D.C. Code § 7–771.07. As relevant here, the D.C.Code authorizes an entity called the D.C. Health Benefit Exchange Authority to make Medicaid eligibility decisions. See D.C. Code § 31–3171.04(a)(13). To implement that directive, the D.C. Health Benefit Exchange Authority uses a computer system called D.C. Health Link, which makes automated determinations on an applicant's eligibility for coverage. See Second Am. Compl. at 6. The system's rules are approved by the D.C. Health Benefit Exchange Authority and the D.C. Department of Health Care Finance. See 42 C.F.R. §§ 155.110, 155.302.

D.C. Health Link, unsurprisingly, is not perfect—but if an applicant is dissatisfied with D.C. Health Link's eligibility decision, the applicant may request an administrative appeal. This administrative remedy originates from D.C. Code § 4–210.01, which provides that “[a]n applicant for, or recipient of, public assistance aggrieved by the action or inaction of the Mayor shall be entitled to a hearing.” See D.C. Code § 4–210.01. A request for an administrative appeal prompts a two-phase review process, consisting of an informal review by the Department of Human Services followed by a formal review by the D.C. Office of Administrative Hearings. See Second Am. Compl. Ex. 2 [ECF No. 6] at 1. At either stage of this review process, an applicant may be reclassified as eligible for Medicaid and be reimbursed for medical expenses incurred during the period they were not covered. See 42 C.F.R. § 435.915(a)(1).

Mykonos alleges that on November 6, 2013, she was wrongfully denied enrollment in Medicaid by D.C. Health Link. Second Am. Compl. at 2. In response, she filed an administrative appeal to have her eligibility reconsidered. Second Am. Compl. Ex. 2 at 1. On December 13, 2013, Mykonos was approved for Medicaid through the informal review process, retroactive to the first day of the month in which she applied: November 1, 2013.See Second Am. Compl. at 3. Then, on January 6, 2014, she withdrew her administrative appeal before the Offices of Administrative Hearings because her reimbursement claim was “before Federal District Court.” See Def. Mot. to Dismiss Ex. 1 [ECF No. 10–1] at 6.

Mykonos filed her initial complaint on November 6, 2013, claiming a denial of reduced cost health insurance in violation of the ACA and the ADA. See Compl. [ECF No. 1] at 1. In her second amended complaint, filed on December 17, 2013, Mykonos maintains her ADA/ACA claim, and also seeks reimbursement of out-of-pocket medical expenses incurred during the month she was not covered. See Second Am. Compl. at 5. Defendants filed motions to dismiss on Rule 12(b)(1) and Rule 12(b)(6) grounds.

LEGAL STANDARD

As an initial matter, this Court is mindful that complaints submitted by plaintiffs proceeding pro se are reviewed under “less stringent standards than formal pleadings drafted by lawyers.” Haines v. Kerner, 404 U.S. 519, 520, 92 S.Ct. 594, 30 L.Ed.2d 652 (1972). Nevertheless, a pro se complaint must still plead “ ‘factual matter’ that permits the court to infer more than the ‘mere possibility of misconduct.’ ” Jones v. Horne, 634 F.3d 588, 596 (D.C.Cir.2011) (internal citation omitted).

a) Motion to Dismiss for Lack of Subject–Matter Jurisdiction

“[I]n passing on a motion to dismiss, whether on the ground of lack of jurisdiction over the subject matter or for failure to state a cause of action, the allegations of the complaint should be construed favorably to the pleader.” Scheuer v. Rhodes, 416 U.S. 232, 236, 94 S.Ct. 1683, 40 L.Ed.2d 90 (1974) ; see also Leatherman v. Tarrant Cnty. Narcotics Intelligence & Coordination Unit, 507 U.S. 163, 164, 113 S.Ct. 1160, 122 L.Ed.2d 517 (1993). Therefore, the factual allegations must be presumed true, and plaintiffs must be given every favorable inference that can be drawn from them. See Scheuer, 416 U.S. at 236, 94 S.Ct. 1683 ; Sparrow v. United Air Lines, Inc., 216 F.3d 1111, 1113 (D.C.Cir.2000). The court need not, however, accept as true “a legal conclusion couched as a factual allegation” or make inferences that are unsupported by the facts set out in the complaint. Trudeau v. FTC, 456 F.3d 178, 193 (D.C.Cir.2006) (quoting Papasan v. Allain, 478 U.S. 265, 286, 106 S.Ct. 2932, 92 L.Ed.2d 209 (1986) ).

Under Rule 12(b)(1), this Court has an affirmative obligation to ensure that it is acting within the scope of its jurisdictional authority. Grand Lodge of Fraternal Order of Police v. Ashcroft, 185 F.Supp.2d 9, 13 (D.D.C.2001). “[A] court must dismiss a case when it lacks subject matter jurisdiction.” Randolph v. ING Life Ins. & Annuity Co., 486 F.Supp.2d 1, 4 (D.D.C.2007). “[P]laintiff's factual allegations in the complaint ... will bear closer scrutiny in resolving a 12(b)(1) motion than in resolving a 12(b)(6) motion for failure to state a claim.” Grand Lodge, 185 F.Supp.2d at 13–14. Moreover, “[a] court may appropriately dispose of a case under 12(b)(1) ... on mootness grounds.” Comm. in Solidarity with the People of El Sal. v. Sessions, 929 F.2d 742, 744 (D.C.Cir.1991). A court may consider material other than allegations in the complaint in determining whether it has jurisdiction to hear the case, as long as it still accepts the factual allegations in the complaint as true. See, e.g., Settles v. U.S. Parole Comm'n, 429 F.3d 1098, 1107 (D.C.Cir.2005) ; Jerome Stevens Pharm., Inc. v. FDA, 402 F.3d 1249, 1253 (D.C.Cir.2005) ; E . E . O . C . v. St. Francis Xavier Parochial Sch., 117 F.3d 621, 624 n. 3 (D.C.Cir.1997).

b) Motion to Dismiss for Failure to State a Claim

To survive a motion to dismiss under Rule 12(b)(6), a complaint need only contain “ ‘a short and plain statement of the claim showing that the pleader is entitled to relief,’ ” such that the defendant has “ ‘fair notice of what the ... claim is and the grounds upon which it rests.’ ” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007) (quoting Conley v. Gibson, 355 U.S. 41, 47, 78 S.Ct. 99, 2 L.Ed.2d 80 (1957) ). Although “detailed factual allegations” are not necessary to withstand a Rule 12(b)(6) motion to dismiss, a plaintiff must supply “more than labels and conclusions” or “a formulaic recitation of the elements of a cause of action” to provide the “grounds” of “entitle[ment] to relief.” Twombly, 550 U.S. at 555–56, 127 S.Ct. 1955 ; see also Papasan, 478 U.S. at 286, 106 S.Ct. 2932. Instead, “a complaint must contain sufficient factual matter, accepted as true, to ‘state a claim to relief that is plausible on its face.’ ” Ashcroft v. Iqbal, 556 U.S. 662, 678, 129 S.Ct. 1937, 173 L.Ed.2d 868 (2009) (quoting Twombly, 550 U.S. at 570, 127 S.Ct. 1955 ). “In determining whether a complaint fails to state a claim, [the Court] may consider only the facts alleged in the complaint, any documents either attached to or incorporated in the complaint, and matters of which [the Court] may take judicial notice.” St. Francis Xavier, 117 F.3d at 624.

DISCUSSION

Defendants move to dismiss Mykonos's complaint under Rule 12(b)(1) for lack of subject-matter jurisdiction (1) due to mootness and (2) for failure to exhaust administrative remedies. The Court will first examine whether Mykonos's claim for Medicaid coverage is moot, and then turn to defendants' argument that Mykonos failed to exhaust administrative remedies in seeking reimbursement of her medical costs.² The Court concludes that Mykonos's claim for Medicaid coverage is moot and that she failed to exhaust her administrative remedies for her reimbursement claim.

I. Mykonos's Claim for Medicaid Coverage is Moot.

When a party alleges that a court lacks jurisdiction on mootness grounds, the burden of demonstrating mootness “is a heavy one” that falls on the party asserting such a claim. United States v. W.T. Grant Co., 345 U.S. 629, 632–33, 73 S.Ct. 894, 97 L.Ed. 1303 (1953). A case is considered moot either “when the issues presented are no longer live or the parties lack a legally cognizable interest in the outcome.” Powell v. McCormack, 395 U.S. 486, 496, 89 S.Ct. 1944, 23 L.Ed.2d 491 (1969) ; see also Pharmachemie B.V. v. Barr Labs., 276 F.3d 627,...