William T. ex rel. Gigi T. v. Taylor
| Decision Date | 01 March 2000 |
| Docket Number | No. Civ.A. 1:95-2901A-JEC.,Civ.A. 1:95-2901A-JEC. |
| Citation | 465 F.Supp.2d 1267 |
| Parties | WILLIAM T., et al., Plaintiffs, v. William R. TAYLOR, M.D., et al., Defendants. |
| Court | U.S. District Court — Northern District of Georgia |
Lewis Golinker, Office of Lewis Golinker, Ithaca, NY, Naomi Tsipors Walker, Georgia Advocacy Office, Decatur, GA, for Plaintiffs.
Kevin Matthew, O'Connor, Office of State Attorney General, Atlanta, GA, Philip Brian Campbell, Office of P.Brian Campbell, Roswell, GA, for Defendants.
This case is presently before the Court on plaintiffs' Motion for Summary Judgement [56], plaintiffs' Motion to Exceed Page Limitation [58], defendants' Cross—Motion for Summary Judgement [59], defendants' Motion to Exceed Page Limitation [61], plaintiffs' Motion to Enforce the February 5, 1998 Stipulation and Order [62], Lawrence "Kirby" H.'s Motion for Summary Judgement [63], Lawrence "Kirby" H.'s Motion to Intervene [64], plaintiffs' Motion to Exceed Page Limitation [66], defendants' Motion for Authorization to File a Reply Memorandum in Support of Their Motion for Summary Judgement [73], and defendants' Motion for Authorization to File a Sur-Reply to Plaintiffs' Reply Memorandum in Support of Their Motion for Intervention [78]. The Court has reviewed the record and the arguments of the parties and, for the reasons set forth below, concludes that plaintiffs' Motion for Summary Judgement [56] should be GRANTED IN PART AND DENIED WITHOUT PREJUDICE IN PART, plaintiffs' Motion to Exceed Page Limitation [58] should be GRANTED, defendants Cross-Motion for Summary Judgement [59] should be DENIED, defendants' Motion to Exceed Page Limitation [61] should be GRANTED, plaintiffs' Motion to Enforce the February 5, 1998 Stipulation and Order [62] should be DENIED, Lawrence "Kirby" H.'s Motion for Summary Judgement [63] should be GRANTED IN PART AND DENIED WITHOUT PREJUDICE IN PART, Lawrence "Kirby" H.'s Motion to Intervene [64] should be GRANTED, plaintiffs' Motion to Exceed Page Limitation [66] should be GRANTED, defendants' Motion for Authorization to File a Reply to Plaintiffs' Reply Memorandum in Support of Their Motion for Summary Judgement [73] should be GRANTED, and defendants' Motion for Authorization to File a Sur-Reply to Plaintiffs' Reply Memorandum in Support of Their Motion for Intervention [78] should be GRANTED.
This case revolves around the determination of whether "augmentative" and alternative communication devices" (hereinafter "ACDs") should be covered under Georgia's medicaid plan pursuant to the Medicaid Act and its regulations. Plaintiffs1 brought suit pursuant to a number of federal statutes but agree that the lawsuit is appropriately analyzed as a 42 U.S.C. § 1983 claim, alleging that the Georgia Department of Medical Assistance's (hereinafter "GDMA") policy violates the Medicaid Act's "reasonable promptness" provision (42 U.S.C. § 1396a(a)(8)), its "reasonable standards" provision (42 U.S.C. § 1396a(a)(17)), and Medicaid's methods and procedures regarding utilization of covered services (42 U.S.C. § 1396a(a)(30)). (Pis.' Reply Br. [65] at 3.) Moreover, plaintiffs assert that GDMA's exclusion of ACDs violates the Medicaid regulations governing the required "amount, duration, and scope" of covered Medicaid services (42 C.F.R. § 440.230(b)-(d)). (Id.) Plaintiffs argue that, under the Medicaid Act, GDMA is required to provide ACDs to those determined to have a medical necessity. Through this lawsuit, plaintiffs seek "a declaration that ACDs meet the standards of coverage by Georgia Medicaid, and injunctive relief that prohibits Georgia Medicaid from using any decision making standard for ACD funding requests that is not based on and consistent with current standards of knowledge, policy and practice related to ACD treatment." (Pis.' Br. in Supp. of Mot. for Summ. J. [56] at 6.)
Defendants, on the other hand, contend that plaintiffs may not maintain this lawsuit for three reasons. First, defendants argue that plaintiffs lack standing to assert a cause of action pursuant to 42 U.S.C. § 1983 as they are "third-party beneficiaries to a federal-state funding program." (Defs.' Cross-Mot. for Summ. J. [59] at 6.) Second, defendants contend that plaintiffs' claims are barred by the Eleventh Amendment to the United States Constitution. (Id. at 12.) Finally, defendants argue that GDMA has wide discretion in determining the amount, duration, and scope of medical care that is provided under its medical program and that because ACDs fall within one of several optional classes of assistance, GDMA has the discretion to limit the services it provides under the given optional classes of assistance. (Id. at 18, 20.)
The material facts in this case are not in dispute. The GDMA does not dispute that it has consistently denied funding for ACDs under its Medicaid program. (Defs.' Cross-Mot. for Summ. J. [59] at 3.) Accordingly, the Court is faced solely with a question of law.
ACDs are "electronic and non-electronic devices that allow individuals to overcome, to the maximum extent possible, communication limitations that interfere with their daily activities." (Pis.' Br. in Supp. of Mot. for Summ. J. [56] at 1 n. 1.) These devices help individuals communicate who have lost their ability to speak due to a range of medical problems. These problems may include: amyotropic lateral sclerosis (Lou Gehrig's disease), cerebral palsy, multiple sclerosis, cancer, and other medical diagnoses. See generally Ellen M. Saideman, Helping the Mute to Speak: The Availability of Augmentative Communication Devices Under Medicaid, 17 N.Y.U. Rev. L & Soc. Change 741 (1989/1990).
It is helpful at this point to set out the general description of the Medicaid program. Medicaid is a federal-state partnership, where states can opt to accept federal funds in return for their agreement to provide Medicaid benefits to its citizens. As the Eleventh Circuit has explained:
Medicaid is a cooperative venture of the state and federal governments. A state which chooses to participate in Medicaid submits a state plan for the funding which is approved by the federal government. The federal government then subsidizes a certain portion of the financial obligations which the state has agreed to bear. A state participating in Medicaid must comply with the applicable statute, Title XIX of the Social Security Act of 1965, as amended, 42 U.S.C. § 1396, et seq., and the applicable regulations.
Silver v. Baggiano, 804 F.2d 1211, 1215 (11th Cir.1986). See also Harris v. James, 127 F.3d 993, 996 (11th Cir.1997). A state, like Georgia, which chooses to participate in the federal-state program, must provide certain required services to its citizens. See Tallahassee Memorial Reg. Med. Ctr. v. Cook, 109 F.3d 693, 698 (11th Cir. 1997)(per curiam). In addition, the state may elect to provide certain optional services to its citizens. Three of these optional services are at issue in this case: home health care services, prosthetic devices, and speech-language pathology services.2 It is undisputed that Georgia has elected to cover these services.
The central issue in this case is whether ACDs fit into the three optional services that Georgia has agreed to provide to its citizens. Plaintiffs filed a motion for summary judgment, arguing that ACDs fall into all three of these optional categories, and that, as such, Georgia must provide these services to those who are determined to be medically needy and to those who otherwise qualify for Medicaid. Plaintiffs also ask the Court to fashion injunctive relief. Defendants have also filed a motion for summary judgment, arguing that they are entitled to summary judgment for the three reasons articulated supra at 4.
The Court will first address defendants' "defenses" to plaintiffs' claim. As the Court determines that defendants may not prevail on the three "defenses," the Court must then decide whether ACDs fit into the three optional services classifications; it concludes that ACDs do so fit and should be covered under Medicaid. This conclusion does not terminate this litigation, however, as several issues remain to be determined either through negotiation between the parties or through a subsequent order in this case.
Lawrence "Kirby" H. has filed a motion to intervene in this action pursuant to Rule 24(b) of the Federal Rules of Civil Procedure, the permissive intervention provision. This rule provides:
Upon timely application anyone may be permitted to intervene in an action: (1) when a statute of the United States confers a conditional right to intervene; or (2) when an applicant's claim or defense and the main action have a question of law or fact in common.
FED. R. CIV. P. 24(b). Because the Court finds that Kirby H. has sufficiently demonstrated that his claims are identical to the claims of the other named plaintiffs in this case and that allowing Kirby H. to intervene will not "unduly delay or prejudice the rights of the original parties," the Court GRANTS Kirby H.'s motion to intervene.3 Kirby H. has also filed a motion for summary judgment. In this motion, Kirby H. simply incorporates plaintiffs' motion. The Court finds that defendants will not be prejudiced by allowing Kirby H. to join this motion. The Court's decision regarding ACD coverage is not specific to any one plaintiff in this case and does not rely on the facts surrounding any one plaintiff. Moreover, as the Court will eventually remand these plaintiffs for administrative review in consideration of the ACD funding criteria to be developed by the parties to this case, any final order of this Court is not likely to grant specific relief for Kirby H., except to remand his case for further administrative consideration. Accordingly, the Court will consider Kirby H.'s motion for summary judgment in...
To continue reading
Request your trial
-
Conley v. Dep't of Health
...any equipment, including SACDs, that the speech pathologist deemed necessary to correct the speech disorder); William T. v. Taylor, 465 F.Supp.2d 1267, 1285–87 (N.D.Ga.2000) (stating that because Georgia elected to cover home health services, prosthetic devices, and speech language services......
-
Meridian Fin. Advisors, Ltd. v. Purchase (In re Shubh Hotels Pittsburgh, LLC)
...sought). However, courts have not required strict compliance with Rule 24(c) in certain circumstances. See, e.g., William v. Taylor, 465 F.Supp.2d 1267, 1273 n. 3 (N.D.Ga.2000) (motion to intervene granted despite failure to attach complaint where intervenor's claims were identical to plain......