Payne v. Becerra

• Decision Date: 11 May 2023
• Docket Number: Civil Action 22-00869 (RC)
• Parties: DON ALBERT PAYNE, Plaintiff, v. XAVIER BECERRA et al., Defendants.
• Court: U.S. District Court — District of Columbia

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DON ALBERT PAYNE, Plaintiff, v. XAVIER BECERRA et al., Defendants.

Civil Action No. 22-00869 (RC)

United States District Court, District of Columbia

May 11, 2023

MEMORANDUM OPINION

RUDOLPH CONTRERAS, UNITED STATES DISTRICT JUDGE

I. INTRODUCTION

In a pro se “Verified Complaint for Mand[am]us] Declaratory, and Other Relief,” Plaintiff, a resident of San Antonio, Texas, sues in their official capacities the Secretary of Health and Human Services (HHS), the Administrator of HHS's Centers for Medicare & Medicaid Services (CMS), and the Regional Manager of HHS's Office of Civil Rights (OCR) in Texas. Pending before the Court is Defendants' Motion to Dismiss under Federal Rules of Civil Procedure 12(b)(1) and 12(b)(6). For the reasons explained below, the motion is granted.

II. BACKGROUND

Plaintiff is “a Medicaid/Medicare beneficiary” who “challenges a statutorily prescribed conclusion in regard to an ineligibility determination, impeding rights prejudiced by a decision.” Compl. ¶ 1. Although the prolix complaint is far from clear, Plaintiff does not dispute that this action arises from a June 5, 2021, notice he received from the Texas Health and Human Services Commission (“Texas HHS”), stating:

A federal public health emergency was declared on Jan. 27, 2020, which allows your Medicaid coverage to continue for the duration of the federally declared emergency. Since the federal public health emergency has been extended, HHSC will continue your coverage until the public health emergency ends. You are getting this notice because a review of your most recent information indicates you will not be eligible for Medicaid coverage when the public health emergency ends. Your Medicaid coverage will end the last day of the month in which the public health emergency ends. While you have coverage, you should continue to report any changes and HHSC will review your eligibility based on the changes you report. Compl. Ex. B, ECF No. 1-2 at 35; Defs.' Mem., ECF No. 11-2 at 1-2; see also Defs.' Mem. at 24 (overview of Medicaid benefits and the 2020 CARES Act). At some point thereafter, Plaintiff filed a discrimination complaint against Texas HHS with OCR, which “enforces civil rights laws [that] prohibit discrimination in the delivery of health and human services based on race, . . . disability,” and other listed classifications. Compl. Ex. A, ECF No. 1-2 at 34. By letter of October 13, 2021, OCR informed Plaintiff that after “a thorough and detailed review” of his complaint, it “determined not to further investigate [his] allegation[.]” Id. In November 2021, Plaintiff requested further explanation and reconsideration of OCR's determination. In its response dated December 14, 2021, OCR described its handling of the complaint as follows:

Prior to closing your complaint, OCR interviewed you by phone on June 11, 2021, to clarify your allegations. You did not describe a causal relationship between the alleged act(s) of discrimination and your membership in a protected class (e.g., persons with disabilities). On November 23, 2021, in response to your request for a reconsideration, we asked that you provide us with additional information to support your allegations of discrimination against THHS. You responded on December 8, 2021.

We carefully reviewed the complaint file, as well as the information contained in your correspondence received on November 9, and December 8, 2021. Your correspondence did not provide any new or additional information to support changing OCR's determination in this case.

Compl. Ex. A, ECF No. 1-2 at 51. OCR “affirmed” its initial decision and provided contact information for the “THHS Appeals Division” and the “THHS Office of the Ombudsman.” Id. at 51-52.

On January 11, 2022, Plaintiff submitted a form request to HHS for a hearing before an Administrative Law Judge. He indicated that he was appealing “ineligibility for medical benefits” on “06/05/2021; 01/22/2021; 01/07/2021” by “Texas Health & Human Services,” but wrote that “HHS's OCR” failed to adequately explain “its actions and/or the agency explanation showed no rational connection between the facts” he provided and “the choices made by” OCR. Compl. Ex., ECF No. 1-2 at 12-13. By letter dated January 25, 2022, HHS's Office of Medicare Hearings and Appeals informed Plaintiff that it could not process the request “because a search of our database indicates that there is no match for you as having received a Qualified Independent Contractor (QIC) decision, which is the 2nd level of the Medicare Appeals Process.” Compl. Ex. DD, ECF No. 1-2 at 9. The Office returned Plaintiff's ALJ hearing request to permit him to “request an appeal from the appropriate level[.]” Id.

Claiming to be “fed up by delays in the administrative-appeals process” and realizing that “Medicare Hearings & Appeals are non-existent for Medicaid individual recipients,” Compl. ¶ 1, Plaintiff filed this lawsuit seeking equitable relief under the mandamus statute, 28 U.S.C. § 1361, and the Administrative Procedure Act (APA), 5 U.S.C. § 706. See id. at 34-40. Plaintiff alleges, among other wrongs, that “the Texas Medicaid agency twice denied him an opportunity for a hearing” on his belief that the Texas HHS Commission had “erroneously denied his claim for eligibility after the public emergency ends.” Compl. ¶ 42.

Plaintiff sets out the following claims: (1) Fifth Amendment Substantive Due Process Violation, id. ¶¶ 48-53; (2) Ultra Vires Agency Action, id. ¶¶ 54-60; (3) §§ 1396a(a)(3) and 1396a(a)(10)(A) enforceable under 42 U.S.C. § 1983, id. ¶¶ 61-77; and (4) Unreasonable Agency Delay, id. ¶¶ 78-86.

III. LEGAL STANDARDS

A. Motion to Dismiss

Under Rules 12(b)(1) and 12(h)(3) of the Federal Rules of Civil Procedure, courts must dismiss any claim over which they lack subject-matter jurisdiction. Rule 12(b)(6), by contrast, requires courts to dismiss any claim upon which relief could not be granted even if jurisdiction was proper. Fed.R.Civ.P. 12(b)(6). When Rules 12(b)(1) and 12(b)(6) are invoked together, as they are here, a court must first address the issues encompassed by Rule 12(b)(1), as those issues implicate the court's ability to hear the case. See Lovitky v. Trump, 949 F.3d 753, 763 (D.C. Cir. 2020) (“[W]hen a court lacks subject-matter jurisdiction . . . it has no authority to address the dispute presented.”) (internal quotation marks and citation omitted)).

It is the plaintiff's burden to establish that the court has subject-matter jurisdiction. Lujan v. Defenders of Wildlife, 504 U.S. 555, 561 (1992). To determine whether jurisdiction exists, a court may “consider the complaint supplemented by undisputed facts evidenced in the record, or the complaint supplemented by undisputed facts plus the court's resolution of disputed facts.” Coal. for Underground Expansion v. Mineta, 333 F.3d 193, 198 (D.C. Cir. 2003). As part of a court's obligation to construe pro se filings liberally, see Erickson v. Pardus, 551 U.S. 89, 94 (2007), and absent undue prejudice to a party, “all factual allegations by a pro se litigant, whether contained in the complaint or other filings in the matter, should be read together in considering whether to grant a motion to dismiss,” Hill v. Smoot, 308 F.Supp.3d 14, 19 (D.D.C. 2018) (citing Richardson v. United States, 193 F.3d 545, 548 (D.C. Cir. 1999)). While pro se pleadings are held to a “less stringent standard than formal pleadings drafted by lawyers.” Erickson v. Pardus, 551 U.S. 89, 94 (2007) (citation omitted), pro se plaintiffs must still comply with the Federal Rules of Civil Procedure and the Court may not assume the role of the plaintiff's advocate. See Jarrell v. Tisch, 656 F.Supp. 237, 239 (D.D.C. 1987); Sun v. D.C. Gov't, 133 F.Supp.3d 155, 168 n.6 (D.D.C. 2015) (“[I]t is not the Court's job to canvass the record for documents supporting a pro se party's position.”).

B. Medicaid Act

Medicaid was established under Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 et seq., as a “ ‘cooperative federal-state program that provides federal funding for state medical services to the poor.' ” NB ex rel. Peacock v. D.C., 794 F.3d 31, 35 (D.C. Cir. 2015) (quoting Frew ex rel. Frew v. Hawkins, 540 U.S. 431, 433 (2004)). Although “States participate in Medicaid on a voluntary basis,” their ability to receive federal funds is contingent upon compliance with “conditions imposed by federal law” that include providing “a core set of mandatory services to qualified beneficiaries.” Id. (citations omitted). “Title XIX and its implementing regulations afford certain procedural protections to Medicaid beneficiaries,” including “an opportunity for a fair hearing before the State agency” when “a claim for medical assistance” is denied or “not acted upon with reasonable promptness,” id. at 36 (quoting 42 U.S.C. § 1396a(a)(3), or when a beneficiary “believes the agency has taken an action erroneously,” id. (quoting 42 C.F.R. § 431.220(a)(1)-(2)). An “action” is defined as a “termination, suspension, or reduction of Medicaid eligibility or covered services.” Id. (quoting 42 C.F.R. § 431.201).

IV. DISCUSSION

“No action on behalf of either party can confer subject-matter jurisdiction on a federal court because subject-matter jurisdiction is both a statutory requirement and an Article III constitutional requirement.” Sweigert v. Podesta, 334 F.Supp.3d 46, 51 (D.D.C. 2018), aff'd, No. 18-7156, 2019 WL 1245593 (D.C. Cir. Mar. 14, 2019) (citing Akinseye v. District of Columbia, 339 F.3d 970, 971 (D.C. Cir. 2003)). Defendants argue, among other grounds for dismissal, that (1) Plaintiff lacks constitutional standing and (2) sovereign immunity bars his statutory claims. See Defs' Mem. at 13-15, 18-19. The Court agrees.

A. Constitutional Standing

Article III of the...