Opinion
1:19-CV-05087-ELR
2021-08-27
Vincent THOMPSON, BY AND THROUGH his legal guardian, Charles BAILEY, Plaintiff, v. Judy FITZGERALD, in her official capacity as Commissioner of the Georgia Department of Behavioral Health and Developmental Disabilities, et al., Defendants.
Joshua H. Norris, Law Office of Joshua H. Norris, Decatur, GA, for Plaintiff. Mark J. Cicero, Office of State Attorney General, Calandra A. Harps, Michelle LeGrande, State of Georgia Law Department, Atlanta, GA, for Defendants.
Joshua H. Norris, Law Office of Joshua H. Norris, Decatur, GA, for Plaintiff.
Mark J. Cicero, Office of State Attorney General, Calandra A. Harps, Michelle LeGrande, State of Georgia Law Department, Atlanta, GA, for Defendants.
ORDER
Eleanor L. Ross, United States District Judge
There are several matters currently pending before the Court. The Court sets forth its rulings and conclusions below.
I. Background
All facts noted herein are undisputed unless otherwise indicated.
This case arises from the alleged mishandling of Plaintiff Vincent "Vinny" Thompson's 2018 and 2019 appeals regarding the intended reductions of his Medicaid benefits. See generally Am. Compl. [Doc. 16]. Plaintiff is a sixty-three (63)-year-old man with developmental and intellectual disabilities, spastic quadriplegia, and a hearing impairment. See Defendants’ Statement of Material Facts ¶ 1 ("Defs.’ SOMF") [Doc. 43-2]; see also Plaintiff's Statement of Material Facts ¶ 1 ("Pl.’s SOMF") [Doc. 44-3]. Plaintiff is non-verbal, incontinent, and non-ambulatory, causing him to rely on a wheelchair for mobility and on caretakers for all life activities. See Pl.’s SOMF ¶ 1.
The Court uses the Parties’ proposed facts and responses as follows. Where one side admits a proposed fact, the Court accepts it as undisputed for purposes of this order and cites only the proposed fact. Where one side admits a proposed fact in part, the Court includes the undisputed part. Where one side denies a proposed fact in whole or in part, and such fact is material, the Court reviews the record and determines whether a factual dispute exists. If the denial is without merit, and the record citation supports the proposed fact, then the Court deems it admitted. Finally, the Court excludes proposed facts that are immaterial, includes facts drawn from its review of the record, and considers all proposed facts in light of the standard for summary judgment. See LR 56.1(B)(2)(a)(2)(iii), NDGa.; see also Fed. R. Civ. P. 56(c)(3).
By and through his legal guardian, Mr. Charles Bailey, Plaintiff brings this action against Defendant Judy Fitzgerald, in her official capacity as Commissioner of the Georgia Department of Behavioral Health and Developmental Disabilities ("DBHDD"), and Defendant Frank Berry, in his official capacity as Commissioner of Georgia Department of Community Health ("DCH"). See generally Am. Compl. The Court provides the substance and context of Plaintiff's allegations below.
A. Overview of Georgia Medicaid Structure
To participate in the Medicaid program, Georgia must have a state plan for medical assistance approved by the Centers for Medicaid and Medicaid Services of the U.S. Department of Health and Human Services (the "state plan"). See Defs.’ SOMF ¶ 3; see also Pl.’s SOMF ¶ 7. Pursuant to the state plan, DCH is the agency that administers the Georgia Medicaid Program. See Defs.’ SOMF ¶ 4; see also Pl.’s SOMF ¶ 7.
One component of the Georgia Medicaid Program is the Comprehensive Supports Waiver ("COMP Waiver"), which provides home and community-based services to people with intellectual and developmental disabilities. See Defs.’ SOMF ¶ 2; see also Pl.’s SOMF ¶ 6. COMP Waivers are intended to provide a participant-centered service plan of care for each COMP Waiver recipient. See Pl.’s SOMF ¶ 10. Individual service plans provided through COMP Waivers are subject to annual review. See id. ¶ 11.
As the Medicaid agency for Georgia, DCH has delegated the day-to-day operation of the COMP Waiver program to DBHDD. See Defs.’ SOMF ¶ 5; see also Pl.’s SOMF ¶ 13. However, DCH "maintains administration of the COMP Waiver [p]rogram and oversees DBHDD's performance" of the daily operational functions. See Defs.’ SOMF ¶ 6; see also Pl.’s SOMF ¶ 13. One responsibility DCH delegates to DBHDD is the annual review of individual service plans for COMP Waiver recipients pursuant to 42 C.F.R. § 331.301(c)(3). See Defs.’ SOMF ¶¶ 5, 7; see also Pl.’s SOMF ¶¶ 11, 13. If DBHDD determines, upon its annual review, that a COMP Waiver recipient should receive funding for fewer hours of care per week, DBHDD must notify the recipient of its intent to reduce his services. See Defs.’ SOMF ¶ 9; see also Pl.’s SOMF ¶ 16.
When a Medicaid recipient's claim for medical assistance is denied, the Medicaid Act entitles him to a "fair hearing." See Defs.’ SOMF ¶ 10; see also Pl.’s SOMF ¶ 17. Requesting a fair hearing is the mechanism by which an individual may appeal the state agency's decision to deny or reduce his benefits. See 42 U.S.C. § 1396a(a)(3). The opportunity to receive a fair hearing applies to those situations where, upon its annual review, DBHDD decides to reduce the number of hours of care provided by an individual's COMP Waiver service plan. See Defs.’ SOMF ¶¶ 9–10; see also Pl.’s SOMF ¶¶ 17, 20. After receiving a fair hearing request, the federal regulations implementing the Medicaid Act require state Medicaid agencies to take "final administrative action" within ninety (90) days. See Defs.’ SOMF ¶ 11; Pl.’s SOMF ¶ 18; see also 42 U.S.C. § 1396a(a)(3) ; 42 C.F.R. § 431.244(f)(1)(ii). In Georgia, DBHDD transmits fair hearing requests to the Office of State Administrative Hearings ("OSAH"), where an administrative law judge ("ALJ") presides over the fair hearing. See Defs.’ SOMF ¶ 27; see also Pl.’s SOMF ¶¶ 23–24. Therefore, except in unusual circumstances, the federal regulations require that "final administrative action" on these appeals occur within ninety (90) days of the date DBHDD receives the fair hearing request. See Defs.’ SOMF ¶ 11; Pl.’s SOMF ¶ 18; see also 42 U.S.C. § 1396a(a)(3) ; 42 C.F.R. § 431.244(f)(1)(ii).
See 42 U.S.C. § 1396a(a)(3) ("A State plan for medical assistance must ... provide for granting an opportunity for a fair hearing before the State agency to any individual whose claim for medical assistance under the plan is denied or is not acted upon with reasonable promptness").
B. Plaintiff's COMP Waiver and CAG Benefits
Plaintiff is a Medicaid recipient and participates in the COMP Waiver program to assist with all his living and daily care needs. See Defs.’ SOMF ¶ 2; see also Pl.’s SOMF ¶ 5. Specifically, Plaintiff receives thirty (30) hours of assistance each week from one state-approved home and community services provider, which are funded by the state through his COMP Waiver service plan. See Pl.’s SOMF ¶¶ 8, 14. These home and community services are known as Community Access Group ("CAG") services. See id. ¶ 15. As part of the COMP Waiver program, CAG Services are "designed to provide oversight, assist with daily living, socialization, communication, [ ] mobility skills building and supports" in a group setting to individuals with certain disabilities. See id.
C. Plaintiff's 2018 Fair Hearing Request
Prior to 2018, pursuant to Plaintiff's COMP Waiver service plan, DBHDD had approved payment for thirty (30) hours per week of one-on-one (or "1:1") services for Plaintiff from a CAG provider. See Defs.’ SOMF ¶ 8; see also Pl.’s SOMF ¶ 14. Following its annual review of Plaintiff's COMP Waiver service plan, on May 18, 2018, DBHDD sent Plaintiff a written notice (the "2018 Notice") informing him that DBHDD had decided to reduce his CAG services from thirty (30) hours of assistance per week to nine (9) hours per week. See Defs.’ SOMF ¶ 9; see also Pl.’s SOMF ¶ 16.
By a letter dated June 18, 2018, Plaintiff responded to DBHDD and requested a fair hearing to appeal its decision (the "2018 Fair Hearing Request"). See Defs.’ SOMF ¶ 12; see also Pl.’s SOMF ¶ 19. DBHDD received Plaintiff's 2018 Fair Hearing Request no later than June 23, 2018. See Pl.’s SOMF ¶ 21.
However, as of November 7, 2018, the DBHDD staff attorney who received Plaintiff's 2018 Fair Hearing Request—Ms. Monica Patel—had failed to forward it to OSAH. See Defs.’ SOMF ¶ 13; see also Pl.’s SOMF 21. This was approximately one hundred thirty-seven (137) days after DBHDD received Plaintiff's 2018 Fair Hearing Request, far outside the ninety (90)-day period provided for the state to take "final administrative action." See Defs.’ SOMF ¶ 13; Pl.’s SOMF ¶¶ 16, 23; [see also Doc. 48-2]. Thus, on November 7, 2018, counsel for Plaintiff sent an email to Ms. Patel, "inquiring regarding a hearing date o[n] Plaintiff's fair hearing request[,] informing her of the [alleged] violation of 42 C.F.R. § 431.244(f)(1) [,] and requesting a withdrawal of [DBHDD'S] the reduction of [Plaintiff's] CAG services." See Pl.’s SOMF ¶ 22; see also Defs.’ SOMF ¶ 14; [Doc. 48-1]. Ms. Patel responded to the November 7, 2018 email from Plaintiff's counsel the same day, whereby she represented: "[Plaintiff] has not experienced the reduction noted in the Adverse Action Notice mailed to him on May 18, 2018. He continues to receive funding for 30 hours per week of 1:1 staffing .... I'll forward the request to OSAH[.]" [See Doc. 48-2 at 2]. On February 22, 2019, DBHDD agreed to rescind the May 18, 2018 decision to reduce Plaintiff's CAG services. See Defs.’ SOMF ¶ 15; see also Pl.’s SOMF ¶ 26.
The only disputed material fact in this matter is whether Plaintiff's services were actually reduced between DBHDD's 2018 Notice to him (indicating the agency's decision to reduce his 1:1 CAG service hours from thirty (30) hours per week to nine (9) hours per week) and the time DBHDD officially rescinded its decision to reduce Plaintiff's hours on February 22, 2019. See Defs.’ SOMF ¶ 16; Pl.’s SOMF ¶ 25; see also Pl.’s Response to Defs.’ SOMF ¶ 16 ("Pl.’s Resp. to Defs.’ SOMF") [Doc. 49]; Defs.’ Response to Pl.’s SOMF ¶ 25 ("Defs.’ Resp. to Pl.’s SOMF") [Doc. 51]. In their statement of material facts, Defendants maintain that they never reduced Plaintiff's CAG services and Plaintiff never experienced any reduction in services during the pendency of his 2018 Fair Hearing Request; however, they subsequently appear to admit Plaintiff "may have actually experienced a reduction in his services." See Defs.’ SOMF ¶ 16; Defs.’ Resp. to Pl.’s SOMF ¶ 25.
In response, Plaintiff proffers that he did, in fact, experience a reduction of his CAG services for several months: from September 2018 until January 2019. See Pl.’s Resp. to Defs.’ SOMF ¶ 16; see also Pl.’s SOMF ¶ 25; Defs.’ Resp. to Pl.’s SOMF ¶ 25; Second Decl. of Jen Keir ("2d Keir Decl.") [Doc. 52-2]. In support, Plaintiff tenders a sworn statement from Ms. Jen Keir, who works as an operations manager for intellectual and development disability services at the organization that provides Plaintiff's CAG services (the Jewish Family & Career Services of Atlanta, hereinafter "JFCS" or simply "the organization"). See 2d Keir Decl.
According to Ms. Keir, JFCS serves Plaintiff pursuant to his COMP Waiver Individual Support Plan ("ISP"), which provided Plaintiff with "30 hours per week of 1:1 [CAG] services" for 2017–2018. See id. ¶ 3. Ms. Keir avers that "JCFS sought authorization from DBHDD to continue to provide [Plaintiff] with ... 30 hours per week of 1:1 CAG services" for 2018–2019. See id. ¶ 4. However, on "May 18, 2018, DBHDD informed ... JFCS that it would only approve 9 hours per week of" CAG services. See id. The organization was aware that Plaintiff's guardian was appealing DBHDD's decision. See id.
Thus, Ms. Keir states that she "checked the active PA (prior authorization) in the Medicaid billing website regularly as [the organization] was billing against this funding ever[y] two weeks[,]" but the "authorized rate [for Plaintiff] continued to be for 9 hours per week of ... 1:1 CAG services" from May 2018 until January 2019. See id. ¶¶ 4–5. Put simply, the organization providing and billing for Plaintiff's CAG services saw (on the Medicaid billing website) that it was only authorized to receive payment for nine (9) hours of staffing per week from May 2018 until January 2019. See id.
A prior authorization (or "PA") "constitutes DBHDD's approval to pay a provider for specific services." See Aff. of Elise Beumer ¶ 2 ("Beumer Aff.") [Doc. 50-1].
Nevertheless, the organization "initially continued to provide [Plaintiff] with 30 hours per week of 1:1 CAG services at its own expense while [his] appeal was pending." See id. ¶ 5. However, because the organization could "only seek reimbursement for ... services that [were] authorized by DBHDD, the organization made the decision in September 2018 to reduce Plaintiff's weekly 1:1 CAG services to "9 hours per week while [his] appeal continued pending." See id. It was not until January 2019 that Plaintiff's "1:1 CAG services were restored by DBHDD to the 30 hours per week [level]" and the organization was able to restore Plaintiff's services "as they had been prior to September 2018." See id. ¶ 6.
Further, the evidence Defendants submit is consistent with Plaintiff's account that DBHDD actually reduced the prior authorization for his number weekly hours of 1:1 CAG services following its 2018 Notice, despite the pendency of Plaintiff's 2018 Fair Hearing Request. See generally Beumer Aff. Specifically, Defendants submit the sworn statement of Ms. Elise Beumer, a DBHDD regional services administrator who is "responsible for supervising staff whose duties include ... extending prior authorizations ‘PA’ for service providers." See id. ¶ 2. According to Ms. Beumer, Plaintiff's prior authorization for 30 hours per week of 1:1 CAG services "had been set to expire on April 3, 2018." See id. ¶ 3. However, Ms. Beumer avers that on June 3, 2018, she and another staff member (Ms. Shelia Stubbs, who is "responsible for extending PAs") received an email from Ms. Patel "directing that the PA for the 30 hours ... for Plaintiff ... be extended until further notice in light of his" 2018 Fair Hearing request. See id. ¶ 4. However, the evidence in the record of this case shows DBHDD did not extend the PA for Plaintiff to receive his thirty (30) hours weekly hours of 1:1 CAG services, even after the June 3, 2018 email from Ms. Patel. See id. ¶¶ 7–8; see also 2d Keir Decl. ¶¶ 5–6.
On January 11, 2019, Ms. Beumer and Ms. Stubbs received a second email from Ms. Patel "instructing [them] to confirm whether Plaintiff's PA had been extended and, if not, to immediately extend [it]." See Beumer Aff. ¶ 6. The following day, Ms. Beumer reports that Ms. Stubbs "extended the PA and provided notice to the provider" of Plaintiff's CAG services. See id. ¶ 7. Ms. Beumer explains:
Plaintiff's PA [was] amended to retroactively cover the time since his PA had expired [April 3, 2018] to address the apparent oversight in the extension of his PA. In my experience, many service providers will continue to provide medical services they deem necessary even after a PA expires. By making the PA retroactive, Plaintiff's service provider was entitled to receive payment for any services provided after April 4, 2018.
See id. ¶ 8.
Thus, due to this "oversight," DBHDD only authorized payment for nine (9) hours of weekly 1:1 CAG services for Plaintiff, rather than the thirty (30) hours Defendants admit Plaintiff should have received during the pendency of his 2018 Fair Hearing Request. See id.; see also Defs.’ SOMF ¶ 16 (citing 42 C.F.R. § 431.230(a) ("the agency may not terminate or reduce services until a decision is rendered after the [fair] hearing")). As noted above, despite Defendants’ preliminary assertion that Plaintiff's hours of 1:1 CAG services were never reduced, Defendants "acknowledge that the prior authorization for Plaintiff's service provider was mistakenly reduced from 30 hours to 9 hours" following Plaintiff's 2018 Fair Hearing Request and they concede that "Plaintiff may have actually experienced a reduction in his services[.]" See Defs.’ Resp. to Pl.’s SOMF ¶ 25; but see Defs.’ SOMF ¶ 16 ("Plaintiff continued to receive the same level of CAG services from the time DBHDD notified Plaintiff in May 2018 that it intended to reduce the 1:1 staffing of CAG services he received to the time DBHDD rescinded that decision in February 2019.").
As also observed above, although the organization providing Plaintiff's CAG services did, indeed, continue to provide Plaintiff thirty (30) hours of services per week until September 2018, it did so largely "at its own expense." See 2d Keir Decl. ¶ 5. DBHDD did not "retroactively" correct the prior authorization for Plaintiff to receive his full amount of weekly 1:1 CAG services until January 12, 2019, at the direction of Ms. Patel. See Beumer Aff. ¶ 8.
Further, the morning of Friday, January 11, 2019—the same date Ms. Patel emailed the DBHDD staff members responsible for extending prior authorizations—counsel for Plaintiff emailed Ms. Patel regarding the reduction in Plaintiff's services and 2018 Fair Hearing Request. [See Doc. 48-3]. In his Friday, January 11, 2019 email to Ms. Patel, Plaintiff's counsel stated:
[Plaintiff's] matter requires immediate attention. I have been proceeding under the assumption that DBHDD had not implemented the reduction in [Plaintiff's] services. You indicate as much in your email from November 7, 2018. I was informed yesterday by [Plaintiff's CAG services] provider, JFCS, that the reduction in staffing from 30 hours to 9 hours has been in effect since May. I need immediate attention to this matter and confirmation that his hours will be restored promptly and that JFCS has been notified of the restoration of hours. Additionally, I need confirmation the appeal of this matter has been forwarded to OSAH[.]
[See id. at 2]. According to the evidence submitted by Defendants, on the morning of Saturday, January 12, 2019, the DBHDD staff members informed Ms. Patel of (1) the "oversight" regarding the prior authorization for Plaintiff's services and (2) the fact that it had been "retroactively" corrected. See Beumer Aff. ¶ 8.
Thus, on Monday, January 14, 2019, Ms. Patel responded to the above email from Plaintiff's counsel, whereby she provided:
Thanks for taking my call on Friday. As discussed, [Plaintiff's] PA has been updated to allow his provider to bill for 30 hours of 1:1 staffing during the times that [Plaintiff] is receiving CAG services. A copy of the PA was emailed to [Plaintiff's CAG services] provider on Saturday morning. I will send the file over to OSAH on this week and I will file something with the Court to let them know that the issue is resolved.
[See Doc. 48-4 at 2]. As indicated above, DBHDD never afforded Plaintiff a fair hearing pursuant to his 2018 Fair Hearing Request regarding the reduction of his 1:1 CAG services. See Pl.’s SOMF ¶ 25. Ultimately, on February 22, 2019, DBHDD agreed to rescind its May 2018 decision to reduce Plaintiff's CAG services. See Defs.’ SOMF ¶ 15; see also Pl.’s SOMF ¶ 26.
D. Plaintiff's 2019 Fair Hearing Request
A few months later, in July 2019, DBHDD once again conducted its annual review of Plaintiff's COMP Waiver service plan. See Defs.’ SOMF ¶ 17; see also Pl.’s SOMF ¶ 27. On July 8, 2019, DBHDD sent Plaintiff a written notice stating its intent to reduce his services from thirty (30) hours of assistance per week to fifteen (15) hours per week (the "2019 Notice"). See Defs.’ SOMF ¶ 17; see also Pl.’s SOMF ¶ 27. By a letter dated August 10, 2019, Plaintiff again requested a fair hearing to appeal DBHDD's decision, which DBHDD received on August 15, 2019 (hereinafter the "2019 Fair Hearing Request"). See Defs.’ SOMF ¶ 19; see also Pl.’s SOMF ¶¶ 28–29. On October 1, 2019, forty-seven (47) days after receiving Plaintiff's 2019 Fair Hearing Request, DBHDD forwarded it to OSAH. See Defs.’ SOMF ¶ 20; see also Pl.’s SOMF ¶ 30. Thereafter, OSAH scheduled a fair hearing (the "2019 Fair Hearing") before Administrative Law Judge Patrick Woodard (or "the ALJ") for November 13, 2019—the 90th day after DBHDD received Plaintiff's 2019 Fair Hearing Request. See Defs.’ SOMF ¶ 22; see also Pl.’s SOMF ¶ 31.
Before the 2019 Fair Hearing took place, on November 8, 2019, Plaintiff filed his Complaint in this action. See Compl. [Doc. 1]. Along with his Complaint, Plaintiff filed a "Motion for Temporary Restraining Order and Preliminary Injunction" (or "TRO motion"). [See Doc. 5]. In support of his TRO motion, Plaintiff asserted Defendants were violating the federal requirement that "Medicaid agencies [ ] take final administrative action within 90 days of receiving a request for a fair hearing." [Id. at 2] (citing 42 C.F.R. § 431.244(f)(1) ). Thus, Plaintiff sought injunctive relief asking this Court to enjoin Defendants from "taking final administrative action more than 90 days after receiving" Plaintiff's 2019 Fair Hearing Request. [See id. at 1].
Plaintiff initially argued that the November 13, 2019 OSAH hearing was untimely because it was scheduled after the expiration of the ninety (90)-day period, but later withdrew this mistaken assertion. [See Doc. 5 at 1]; see also Pl.’s SOMF ¶ 31.
Given the pendency of the fair hearing when Plaintiff requested emergency relief from this Court, the Parties conferred with the ALJ by telephone conference on November 12, 2019. See Defs.’ SOMF ¶ 27; see also Pl.’s SOMF ¶ 35. The undersigned, the Parties, and the ALJ agreed continue the fair hearing for a later date so this Court could hear Plaintiff's TRO motion on November 15, 2019. See Defs.’ SOMF ¶¶ 27–29; see also Pl.’s SOMF ¶ 35.
At the November 15, 2019 hearing before this Court (the "TRO Hearing"), Plaintiff argued that because his 2019 Fair Hearing was set for the 90th day after DBHDD received his request, there was no possible way that "final administrative action" could be accomplished within the ninety (90)-day time limit. [See generally Doc. 21]. Specifically, Plaintiff contended that the ALJ would be unable issue a final, formal, written decision the same day the hearing occurred. [See Doc. 21 at 20:23–21:2]. According to Plaintiff, "final administrative action" as required by 42 C.F.R. § 431.244(f)(1) included receiving the final written decision on the fair hearing, rather than simply holding the fair hearing within the ninety (90) days. [See id. ] Thus, Plaintiff argued he was entitled to injunctive relief. [See id. at 17:14–18:2; 22:14–24:20].
However, the Court disagreed and found an absence of evidence to support Plaintiff's central argument—that it would be impossible for Judge Woodard to issue a decision on the same day as the fair hearing. [See id. at 27:16–28:3]. Accordingly, the Court denied Plaintiff's request for a TRO and preliminary injunction due to Plaintiff's inability to demonstrate likelihood of success on the merits. [Doc. 11].
Thus, the previously-continued fair hearing before the ALJ took place on December 4, 2019. See Pl.’s SOMF ¶ 36; Defs.’ SOMF ¶¶ 29–30. On December 20, 2019, sixteen (16) days after the fair hearing, one hundred six (106) days after DBHDD received Plaintiff's 2019 Fair Hearing Request (excluding the days added to facilitate the TRO hearing before this Court), the ALJ issued his ruling and reversed DBHDD's decision to reduce Plaintiff's COMP Waiver services. See Pl.’s SOMF ¶ 37; Defs.’ SOMF ¶ 31. E. Remaining Procedural History
On December 26, 2019, Plaintiff filed his "First Amended Complaint for Injunctive and Declaratory Relief" (the "Amended Complaint"). See Am. Compl. Plaintiff's Amended Complaint added no new claims, only updated facts. Compare Compl., with Am. Compl.
By an Order dated August 10, 2020, the Court denied Defendants’ "Joint Special Appearance Motion to Dismiss Plaintiff's First Amenced [sic] Complaint" [Doc. 17]. [See Doc. 30]. Subsequently, Defendants timely submitted their joint Answer to the Amended Complaint. See Answer [Doc. 31]. Thereafter, on February 22, 2021, Defendants filed their "Motion for Summary Judgment" [Doc. 43] and Plaintiff submitted his "Motion for Summary Judgment, Declaratory Judgment, and Permanent Injunction." [Doc. 44]. Having been fully briefed, these matters are now ripe for the Court's review.
II. The Parties’ Motions for Summary Judgment [Docs. 43, 44]
The Court first addresses the Parties’ pending cross-motions for summary judgment, beginning with the relevant legal standard. [See Docs. 43, 44].
A. Legal Standard for Summary Judgment
The Court may grant summary judgment only if the record shows "that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." See FED. R. CIV. P. 56(a). A factual dispute is genuine if there is sufficient evidence for a reasonable jury to return a verdict in favor of the non-moving party. See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). A factual dispute is material if resolving the factual issue might change the suit's outcome under the governing law. See id. The motion should be granted only if no rational fact finder could return a verdict in favor of the non-moving party. See id. at 249, 106 S.Ct. 2505.
When ruling on a party's motion, the Court must view all the evidence in the record in the light most favorable to the non-moving party and resolve all factual disputes in the non-moving party's favor. See Reeves v. Sanderson Plumbing Prods., Inc., 530 U.S. 133, 150, 120 S.Ct. 2097, 147 L.Ed.2d 105 (2000). The moving party need not positively disprove the opponent's case; rather, the moving party must establish the lack of evidentiary support for the non-moving party's position. See Celotex Corp. v. Catrett, 477 U.S. 317, 325, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). If the moving party meets this initial burden, in order to survive summary judgment, the non-moving party must then present competent evidence beyond the pleadings to show that there is a genuine issue for trial. See id. at 324–26, 106 S.Ct. 2548. The essential question is "whether the evidence presents a sufficient disagreement to require submission to a jury or whether it is so one-sided that one party must prevail as a matter of law." See Anderson, 477 U.S. at 251–52, 106 S.Ct. 2505. However, the Court is not obligated to "scour the record" to determine whether triable issues exist. See Tomasini v. Mt. Sinai Med. Ctr. of Fla., Inc., 315 F. Supp. 2d 1252, 1260 n.11 (S.D. Fla. 2004).
"The standard of review for cross-motions for summary judgment does not differ from the standard applied when one party files a motion, but simply requires a determination of whether either of the parties deserves judgment as a matter of law on the facts that are not disputed." GEBAM, Inc. v. Inv. Realty Series I, LLC, 15 F. Supp. 3d 1311, 1315–16 (N.D. Ga. 2013) (citing Am. Bankers Ins. Grp. v. United States, 408 F.3d 1328, 1331 (11th Cir. 2005) ); see United States v. Oakley, 744 F.2d 1553, 1555 (11th Cir. 1984) ("Cross-motions for summary judgment will not, in themselves, warrant the court in granting summary judgment unless one of the parties is entitled to judgment as a matter of law on facts that are not genuinely disputed.") (internal quotation omitted). The Court must consider each motion on its own merits, resolving all reasonable inferences against the party whose motion is under consideration. See U.S. ex rel. Saldivar v. Fresenius Med. Care Holdings, Inc., 972 F. Supp. 2d 1339, 1341 (N.D. Ga. 2013). Cross-motions may, however, be probative of the absence of a factual dispute where they reflect general agreement by the parties as to the controlling legal theories and material facts. See id. at 1341 ; accord Oakley, 744 F.2d at 1555–56.
B. Discussion
Having laid out the relevant legal standard, the Court now turns to address the substance of the Parties’ arguments in their cross-motions for summary judgment. Specifically, the Parties raise three (3) main issues for the Court's consideration. [See generally Docs. 43, 44]. First, the Parties dispute the core legal question at issue: whether Plaintiff has a substantive right to a written decision from an ALJ within the ninety (90)-day fair hearing period pursuant to the Medicaid Act and its implementing regulations, or whether simply holding a fair hearing within the ninety (90) days is sufficient. [See Docs. 43-1 at 2, 9; 44-1 at 12–14]. Second, if Plaintiff does have such a right, the Parties disagree regarding whether Plaintiff's claims are moot. [See Docs. 43-1 at 11–12; 44-1 at 15–19; 46 at 3–4, 6–7]. Third, the Parties contest whether Plaintiff can demonstrate the merits of his claims: that Defendants violated 42 U.S.C. § 1983 by depriving him of his rights pursuant to the Medicaid Act and the Fourteenth Amendment. [See Docs. 43-1 at 9–16; 44-1 at 12–14]. The Court addresses these issues in turn.
1. Right to a fair hearing written decision within ninety (90) days
The first issue before the Court is whether the fair hearing provisions of the Medicaid Act and its implementing regulations give Plaintiff the right to receive a fair hearing written decision from an ALJ within the ninety (90)-day period provided for "final administrative action" to take place following a fair hearing request. See 42 U.S.C. § 1396a(a)(3) ; 42 C.F.R. § 431.244(f). By his motion for summary judgment, Plaintiff contends that this Court should adopt the reasoning of the Second Circuit, which has "now confronted this issue twice" and held "that ‘final administrative action’ refers to holding a fair hearing and to the issuance of a fair hearing decision." [See Doc. 44-1 at 13–14] (citing Shakhnes v. Berlin, 689 F.3d 244, 247 (2d Cir. 2012) ; Lisnitzer v. Zucker, 983 F.3d 578 (2d Cir. 2020) (emphasis in original)).
In their motion for summary judgment, Defendants focus their argument on the "minimal requirements for" a fair hearing "decision as set forth in Goldberg v. Kelly, 397 U.S. 254, 90 S.Ct. 1011, 25 L.Ed.2d 287 (1970)" to emphasize that "an administrative law judge easily could have issued a written decision on the same date as the [2019] Fair Hearing[,]" the last day of the ninety (90)-day period. [See Doc. 43-1 at 2, 9]. As context, the Medicaid Act requires that "[a] State plan for medical assistance must ... provide for granting an opportunity for a fair hearing" for any individual whose Medicaid claims are denied. See 42 U.S.C. § 1396a(a)(3). The implementing regulation, under a section titled "Hearing Decisions," mandates that the State Medicaid agency must "take final administrative action ... within 90 days from ... the date the agency receives a request for a fair hearing." See 42 C.F.R. § 431.244(f)(1)(ii). As this Court previously explained in its order denying Defendants’ motion to dismiss:
Notably, Defendants do not cite to any caselaw to support the proposition that merely conducting a fair hearing within ninety (90) days of receipt of a fair hearing request—without the issuance of an accompanying written decision—is sufficient to satisfy the requirements of the Medicaid Act (specifically, 42 C.F.R. § 431.244(f) ). [See generally Docs. 43-1, 46, 50]. Instead, Defendants "contend that no matter how this Court rules on this issue, Plaintiff is not entitled to relief because he has not demonstrated that Defendants violated the Medicaid Act." [See Doc. 46 at 2].
A few "unusual circumstances" may expand the ninety (90)-day deadline for the state agency to "take final administrative action on a fair hearing request[,]" however, the Court finds that none of these "unusual circumstances" exist in the matter at hand, and therefore, this order need not address them. See 42 C.F.R. § 431.244(f)(4)(i)(A)–(B).
The Eleventh Circuit has not yet directly addressed ... whether "final administrative action," as contemplated by [ 42 C.F.R. §] 431.244(f), encompasses not only the right fair hearing but also the issuance of a written decision from the administrative law judge within the ninety (90)-day time limit. However, ... courts in other jurisdictions have held just that. E.g., Shakhnes [ ], 689 F.3d [at] 258 [ ] (citing commentary from an amendment of the Medicaid regulations by the Centers for Medicare & Medicaid Services (CMS), wherein the Centers "referred to the 90–day requirement in § 431.244 as a deadline for the issuance of hearing decisions ," the court held that the "drafting history of the regulation ... demonstrates that the 90-day time frame applies to the issuance of decisions") (emphasis added); Menking ex rel. Menking v. Daines, 287 F.R.D. 174, 177–78 (S.D.N.Y. 2012) (where "[p]laintiff had waited 298 days for a determination on her fair hearing request but not received one[,]" the delay in "in rendering a decision after the fair hearing[ ] violate[d] the ninety-day limit mandated by 42 U.S.C. § 1396a(a)(3) [and] 42 C.F.R. § 431.244(f)"); Albert S. v. Dept. of Health and Mental Hygiene , 891 A.2d 402, 411, 416 (Md. Spec. App. 2006) ("final administrative action" did not occur within the ninety (90)-day time limit because the administrative law judge "erred at the fair hearing review by remanding" the proceedings back to the state agency instead of providing a final written decision).
[See Doc. 30 at 9] (emphasis in original).
As is relevant here, Defendants concede that while "there is no binding precedent in the Eleventh Circuit, there is authority from courts in other jurisdictions and elsewhere that supports a finding that ‘final administrative action’ does in fact encompass a written decision." [See Doc. 43-1 at 9]. Despite this admission by Defendants, the Court conducts a substantive analysis of the persuasive authority Plaintiff provides to determine whether "final administrative action" includes not only a fair hearing, but also a written decision. [See Docs. 43-1 at 9; 44-1 at 13–14].
First, the Court turns to Shakhnes, 689 F.3d 244 (2d Cir. 2012). In Shakhnes, the Second Circuit noted that the drafting history of 42 C.F.R. § 431.244(f)(1)(ii) demonstrates that the 90-day time frame applies to the issuance of decisions in the Medicaid fair hearing context. See 689 F.3d at 258. The Second Circuit based this holding on its examination of commentary from an amendment of the Medicaid regulations authored by the Centers for Medicare & Medicaid Services ("CMS"), wherein CMS "referred to the 90-day requirement in [ 42 C.F.R.] § 431.244 as a deadline for the issuance of hearing decisions [.]" See id. at 258.
The issue before the court in Shakhnes arose upon an appeal of a district court order by two (2) New York state agencies: (1) the New York State Department of Health, the state agency responsible for administering Medicaid; (2) and the New York State Office of Temporary and Disability Assistance, the state agency responsible for conducting Medicaid fair hearings. See id. at 248. Like Plaintiff in this case, the plaintiffs in Shakhnes were individuals who either "applied for or received Medicaid-funded home health services, and who requested ... fair hearings to challenge the denial, reduction, or termination of such services." See id.
The district court in Shakhnes granted declaratory judgment and injunctive relief in favor of plaintiffs. See id. at 249. In particular, the district court declared that "final administrative action" occurred upon the completion of four (4) steps: (1) the scheduling of a fair hearing, (2) the completion of the fair hearing, (3) the issuance of a decision after the fair hearing, and (4) the implementation of the relief ordered by the fair hearing decision. See id. Additionally, the district court held that "the fair hearing requirement in 42 U.S.C. § 1396a(a)(3) [the Medicaid Act] is enforceable through a cause of action under § 1983." See id.
Upon appellate review, the Second Circuit began by addressing the district court's ruling that the plaintiffs could properly pursue their claims for violation of their right to fair hearings pursuant to Section 1983. See id. at 250–51. Relying heavily on the Eleventh Circuit case Harris v. James, 127 F.3d 993, 1009 (11th Cir. 1997), the Second Circuit concluded the "[d]istrict [c]ourt correctly held that 42 U.S.C. § 1396a(a)(3) —as construed by the regulation [ 42 C.F.R. § 431.244(f)(1)(ii) ]—creates a right, enforceable under § 1983, to receive a fair hearing and a fair hearing decision ‘[o]rdinarily, within 90 days’ of a fair hearing request." See Shakhnes, 689 F.3d at 254.
Next, the Second Circuit reviewed the district court's holding regarding when "final administrative action" is satisfied and disagreed that it included "the implementation of relief ordered in fair hearing decisions" for the purposes of "the regulation's 90-day time frame." See id. at 257. Thus, the Second Circuit reversed the district court's order in this respect. See id.
However, the Second Circuit upheld the remaining portions of the district court's order, finding that "the right to an opportunity for Medicaid ‘fair hearings’ includes a right to a decision following such hearings." See id. at 256. Specifically, the Second Circuit explained that:
The Medicaid Act does not define the contours of "a fair hearing" for purposes of 42 U.S.C. § 1396a(a)(3). But the applicable federal regulation says that the Medicaid "hearing system must meet the due process standards set forth in Goldberg [ ], 397 U.S. 254 [ ] (1970)." See 42 C.F.R. § 431.205(d).
The due process standards set forth in Goldberg entitle Plaintiffs to decisions following their Medicaid fair hearings. For one, Goldberg says that "the decisionmaker's conclusion ... must rest solely on the legal rules and evidence adduced at the hearing," and that "the decision maker should state the reasons for his determination and indicate the evidence he relied on. "
Goldberg, 397 U.S. at 271 [ ] (emphasis added). In addition, the Goldberg Court emphasized that "an impartial decision maker is essential." Id. We see little reason why this would be so unless the right to a fair hearing includes the right to a decision.
See id. (emphasis in original). Thus, the Second Circuit concluded "that [p]laintiffs have a right to a Medicaid [fair] hearing and decision ordinarily within 90 days of their fair hearing requests, and that such right is enforceable under § 1983." See Shakhnes, 689 F.3d at 247.
The Second Circuit recently confronted this issue once again in Lisnitzer, 983 F.3d 578 (2d Cir. 2020). Specifically, the defendants in Lisnitzer (commissioners of the New York State Department of Health and Office of Temporary and Disability Assistance) challenged a district court's ruling "that the 90-day requirement for ‘final administrative action’ means that the state was required to provide a final determination of [plaintiff's] eligibility for benefits within that time period." See id. at 583. Upon review, the Second Circuit affirmed "the judgment of the district court to the extent [ ] it [held] that the requirement of final administrative action entails a final determination of Medicaid eligibility and must be made within 90 days of a fair hearing request." See id. at 589.
The Eleventh Circuit has not yet addressed this central question of law as the Second Circuit has in the above cases. However, the Court finds the reasoning of the Second Circuit in Shakhnes and Lisnitzer to be persuasive. See id.; see also Shakhnes, 689 F.3d at 256.
In line with this persuasive authority, and absent guidance to the contrary from the Eleventh Circuit, the Court finds that the requirement for a fair hearing and "final administrative action" within ninety (90) days of the request for such fair hearing pursuant to 42 U.S.C. § 1396a(a)(3) and 42 C.F.R. § 431.244(f)(1)(ii) includes the right to a written fair hearing decision. See, e.g., Lisnitzer, 983 F.3d at 589 ; Shakhnes, 689 F.3d at 247 ; Menking, 287 F.R.D. at 177–78 (where "[p]laintiff had waited 298 days for a determination on her fair hearing request but not received one[,]" the delay in "in rendering a decision after the fair hearing[ ] violate[d] the ninety-day limit mandated by 42 U.S.C. § 1396a(a)(3) [and] 42 C.F.R. § 431.244(f)"); Albert S., 891 A.2d at 411, 416 ("final administrative action" did not occur within the ninety (90)-day time limit because the administrative law judge "erred at the fair hearing review by remanding" the proceedings back to the state agency instead of providing a final written decision).
2. Mootness
Having determined that the Medicaid Act gives Plaintiff the right to a fair hearing decision within the ninety (90) day period, the Court proceeds to the second issue contested by the Parties: whether Plaintiff's claims are moot. [See Docs. 43-1 at 11–12; 44-1 at 15–19; 46 at 3–4, 6–7]. According to Defendants, any claim stemming from Plaintiff's 2018 Fair Hearing Request is moot because DBHDD "rescinded its decision to reduce Plaintiff's services" after failing to timely provide him with a fair hearing. [See Doc. 43-1 at 11]. Similarly, Defendants imply Plaintiff cannot bring any claim related to his 2019 Fair Hearing Request because the fair hearing was timely scheduled for the 90th day. [See id. at 12]. However, it is undisputed that Plaintiff did not receive a fair hearing decision within ninety (90) days of either his 2018 or 2019 Fair Hearing Request. See Pl.’s SOMF ¶¶ 25, 37. Thus, Plaintiff contends his case is not moot because his claims are "capable of repetition, yet evading review." [See Doc. 44-1 at 15] (internal quotation and citations omitted).
As the Eleventh Circuit has explained,
Article III of the United States Constitution limits the jurisdiction of the federal courts to actual cases and controversies. To satisfy the case-or-controversy requirement, a plaintiff must have suffered some actual injury that can be remedied or redressed by a favorable judicial decision. A case becomes moot when it no longer presents a live controversy with respect to which the court can give meaningful relief.
.... We have recognized three exceptions to this principle. A case does not become moot (1) where one issue has become moot, but the case as a whole remains alive because other issues have not become moot; (2) when one party unilaterally alters its conduct to terminate the dispute, such as ceasing allegedly illegal conduct; and (3) where a controversy is capable of repetition, yet evades review.
See Yunker v. Allianceone Receivables Mgt., Inc., 701 F.3d 369, 372–73 (11th Cir. 2012) (internal footnote, citations, and punctuation omitted). The United States Supreme Court limits the application of the third exception, capable of repetition yet evading review, to cases where two (2) elements are satisfied: "(1) the challenged action was in its duration too short to be fully litigated prior to its cessation or expiration, and (2) there was a reasonable expectation that the same complaining party would be subjected to the same action again." See Weinstein v. Bradford, 423 U.S. 147, 149, 96 S.Ct. 347, 46 L.Ed.2d 350 (1975).
The Court agrees with Plaintiff that his claims satisfy the first prong of the standard set forth in Weinstein. See id.; [see also Doc. 44-1 at 15–16]. As Plaintiff correctly states, the Eleventh Circuit considers "one year [ ] an insufficient amount of time for a district court, circuit court of appeals, and Supreme Court to adjudicate the typical case." See Bourgeois v. Peters, 387 F.3d 1303, 1309 (11th Cir. 2004). Indeed, the instant litigation has been pending before this Court for over a year and a half. See Compl. (filed November 8, 2019). Thus, any future violation of Plaintiff's rights that results from DBHDD's annual review of his services "is likely to evade review because [it] will occur before the parties have a final ruling on the merits from a court of last resort." See Bourgeois, 387 F.3d at 1309.
Additionally, the Court agrees with Plaintiff that his claims satisfy the second element of Supreme Court's standard set forth in Weinstein because he possesses "a reasonable expectation that" he will "be subjected to the same action again." See 423 U.S. at 149, 96 S.Ct. 347 ; [see also Doc. 44-1 at 17]. "This standard requires more than a ‘mere possibility’ that the conduct at issue will recur, but far less than absolute certainty." See Bourgeois 387 F.3d at 1309 (citing Najjar v. Ashcroft, 273 F.3d 1330, 1340 (11th Cir. 2001) ). Importantly, Defendants "bear[ ] a ‘heavy burden’ in demonstrating that [Plaintiff's] expectation that the [challenged action] will continue is fanciful or unreasonable." See id. (citing United States v. W.T. Grant Co., 345 U.S. 629, 633, 73 S.Ct. 894, 97 L.Ed. 1303 (1953) ). "A case might become moot if subsequent events made it absolutely clear that the allegedly wrongful behavior could not reasonably be expected to recur[.]" See Sec. of Lab., U.S. Dept. of Lab. v. Burger King Corp., 955 F.2d 681, 684 (11th Cir. 1992) (internal citations and quotation marks omitted). Here, Plaintiff contends that he "has a reasonable expectation that Defendants will continue to fail to take timely final administrative action within 90 days of a fair hearing request" because "the state laws governing Medicaid fair hearings fail to impose any deadline for taking final administrative action." [See Doc. 44-1 at 17] (citing O.C.G.A. § 49-4-153(b)(1) (emphasis in original)). Defendants do not dispute this assertion. [See Doc. 46 at 4]. Thus, Defendants fail to carry their "heavy burden" to demonstrate that Plaintiff's right to a timely fair hearing decision will not be violated again during the annual review process of his services. See Bourgeois, 387 F.3d at 1309. Additionally, the Court finds that Plaintiff is correct that the controlling Georgia statute lacks any deadline for the state to take "final administrative action" after receiving a fair hearing request:
Any applicant for medical assistance whose application is denied ... shall be entitled to a hearing upon his or her request for such in writing and in accordance with the applicable rules and regulations of [DCH] and [OSAH]. As a result of the written request for hearing, a written recommendation shall be rendered in writing by the administrative law judge assigned to hear the matter.
See O.C.G.A. § 49-4-153(b)(1). As the Court explains in further detail below, the same Georgia statute provides a fifteen (15) day deadline for the state to transmit a hearing request from a Medicaid services provider to OSAH. See O.C.G.A. § 49-4-153(b)(2)(A). Upon receiving such a request from a provider, OSAH must assign an ALJ to the dispute within fifteen (15) days. See O.C.G.A. § 49-4-153(b)(2)(B). However, the statute fails to provide any similar deadlines for when a Medicaid services recipient (like Plaintiff) requests a fair hearing. See O.C.G.A. § 49-4-153(b)(1). Because state law provides no protection for Plaintiff's right to receive a fair hearing decision within the ninety (90)-day period, and because DBHDD's review of his services takes place on a yearly basis, the Court finds Plaintiff's expectation that he will "be subjected to the same action[s]" of which he herein complains to be "reasonable." See Weinstein, 423 U.S. at 149, 96 S.Ct. 347.
In sum, the Court finds that Plaintiff satisfies both prongs of the two (2)-part test and that Plaintiff's claims are not moot because the controversy is capable of repetition, yet evading review. See id.; see also Yunker, 701 F.3d at 372.
3. Merits of Plaintiff's claims
Having determined Plaintiff has a right to a fair hearing decision within the ninety (90)-day period and that this case is not moot, the Court now proceeds to the merits of Plaintiff's claims upon summary judgment. As noted above, the Parties disagree as to whether Plaintiff sufficiently demonstrates that Defendants violated 42 U.S.C. § 1983 by depriving him of his rights pursuant to the Medicaid Act and the Fourteenth Amendment. [See Docs. 43-1 at 9–16; 44-1 at 12–14]. To that end, the Court notes there are two (2) relevant time periods for the Court to consider in its analysis: (1) the time from when DBHDD received Plaintiff's 2018 Fair Hearing Request until ninety days thereafter (the "2018 Period"); (2) and the time from when DBHDD received Plaintiff's 2019 Fair Hearing Request until Plaintiff received his 2019 Fair Hearing decision from the ALJ on December 20, 2019 (the "2019 Period").
Additionally, because Plaintiff's claims rest upon 42 U.S.C. § 1983, Plaintiff must prove (1) a violation of a constitutional right, (2) by an individual acting under the color of state law. See Lowe v. Aldridge, 958 F.2d 1565, 1572 (11th Cir. 1992) ; see also Laster v. City of Tampa Police Dep't, 575 F. App'x 869, 872 (11th Cir. 2014) (" Section 1983 creates a private cause of action for deprivations of federal rights by persons acting under color of state law.") (citing 42 U.S.C. § 1983 ). In the instant matter, the Parties dot not dispute that Defendants are individuals who acted under the color of state law. See Pl.’s SOMF ¶ 4 ("At all times relevant to this action, Defendants have acted under color of state law."); see also Defs.’ Resp. to Pl.’s SOMF ¶ 4 (admitting Defendants acted under color of state law at all times relevant to this action). Thus, the second prong of the Section 1983 liability analysis is satisfied. See Lowe, 958 F.2d at 1572. Therefore, the Court assesses whether Plaintiff sufficiently demonstrates the first element of the Section 1983 analysis for his claims, to wit, whether he proves Defendants violated his rights. See id.
a. Violation of the Medicaid Act
First, Plaintiff claims that that Defendants deprived him of his rights protected by the Medicaid Act. See Am. Compl. ¶¶ 46–50, 57–60. Specifically, Plaintiff asserts that Defendants deprived him of his "right to receive a fair hearing and final administrative action within 90 days of [ ] receiving his fair hearing request[s.]" See id. ¶ 58.
Defendants do not contest the fact that Plaintiff received no fair hearing following his 2018 Fair Hearing Request. See Defs.’ Resp. to Pl.’s SOMF ¶ 25. Indeed, Defendants admit that as of November 7, 2018, DBHDD staff attorney Ms. Patel had not forwarded Plaintiff's 2018 Fair Hearing Request to OSAH within the ninety (90)-day period and that DBHDD later rescinded its May 2018 decision to reduce Plaintiff's CAG benefits on February 22, 2019, without first holding a hearing. See id. ¶¶ 23, 26; [see also Doc. 48-2]. Accordingly, Plaintiff did not receive a fair hearing decision during the 2018 Period.
As for the 2019 Period, the Parties also do not dispute the underlying facts and evidence. DBHDD informed Plaintiff of its decision to reduce his CAG benefits by its June 2019 Notice. See Pl.’s SOMF ¶ 27; see also Defs.’ SOMF ¶ 17. In response, Plaintiff submitted his 2019 Fair Hearing Request, which DBHDD received on August 15, 2019. See Pl.’s SOMF ¶ 29; see also Defs.’ SOMF ¶ 19. Defendants admit that DBHDD did not forward Plaintiff's 2019 Fair Hearing Request to OSAH until October 1, 2019, forty-seven (47) days after receiving it. See Defs.’ SOMF ¶ 21; Pl.’s Resp. to Defs.’ SOMF ¶ 21; see also Pl.’s SOMF ¶ 30; Defs.’ Resp. to Pl.’s SOMF ¶ 30. Thus, more than half of the ninety (90)-day period prescribed by the Medicaid Act and its implementing regulations had already expired by the time DBHDD even relayed Plaintiff's 2019 Fair Hearing Request to the appropriate court for scheduling. See 42 U.S.C. 42 U.S.C. § 1396a(a)(3) ; 42 C.F.R. § 431.244(f). OSAH originally scheduled Plaintiff's 2019 Fair Hearing for November 13, 2019, the 90th day after DBHDD received Plaintiff's 2019 Fair Hearing Request. See Defs.’ SOMF ¶ 22; see also Pl.’s SOMF ¶ 30.
Plaintiff initiated the present matter on November 8, 2019, and "claimed that DBHDD would be unable to take final administrative action as required by the Medicaid Act" within the ninety (90)-day period since Plaintiff's 2019 Fair Hearing was set to occur on the 90th day. See Defs.’ SOMF ¶ 26; Pl.’s SOMF ¶¶ 32, 34. In light of Plaintiff's TRO motion, the undersigned, the ALJ presiding over the 2019 Fair Hearing, and counsel for both Plaintiff and DBHDD agreed to the continuance of the 2019 Fair Hearing. See Defs.’ SOMF ¶¶ 27–29; Pl.’s SOMF ¶ 35. This Court denied Plaintiff's TRO Motion by an Order dated November 18, 2019. [See Doc. 11]. Thereafter, the ALJ held the 2019 Fair Hearing on December 4, 2019, which was still considered the 90th day. See Defs.’ SOMF ¶ 30; Pl.’s SOMF ¶ 36. Plaintiff ultimately received his 2019 Fair Hearing Decision on December 20, 2019, by which the ALJ reversed DBHDD's reduction of Plaintiff's CAG benefits. See Pl.’s SOMF ¶ 37; [see also Doc. 52-1]. Thus, Plaintiff received his 2019 Fair Hearing Decision outside of the ninety (90)-day period. See Pl.’s SOMF ¶ 37; see also 42 U.S.C. § 1396a(a)(3) ; 42 C.F.R. § 431.244(f)(1)(ii).
Defendants argue they did not violate Plaintiff's right to a timely fair hearing because "Plaintiff's counsel played a significant role in creating the circumstance where Plaintiff's 2019 Fair Hearing was delayed." [See Doc. 43-1 at 15]. However, the Court does not find this assertion to have any bearing on the issue at hand because it is unclear what "delay" Plaintiff's counsel supposedly caused. The Parties agree that the days between when the 2019 Fair Hearing was rescheduled and the date it took place do not count toward the number of days between when DBHDD received Plaintiff's 2019 Fair Hearing Request and the 2019 Fair Hearing. See Defs.’ SOMF ¶¶ 28–30; see also Pl.’s SOMF ¶¶ 35–36. Had the 2019 Fair Hearing occurred on November 8, 2019 (as originally planned), or on December 4, 2019, either date would have been the "90th day" in light of the facts of this case. See Defs.’ SOMF ¶¶ 28–30; see also Pl.’s SOMF ¶¶ 35–36. Accordingly, the 2019 Fair Hearing would have occurred on the 90th day regardless of whether Plaintiff had filed the instant suit or not. [See Doc. 43-1 at 15]. Moreover, the Court finds that any delay in this case was clearly caused by DBHDD because it failed to forward Plaintiff's 2019 Fair Hearing Request to OSAH until forty-seven (47) days after it was received (October 1, 2019). See Defs.’ SOMF ¶ 21; Pl.’s Resp. to Defs.’ SOMF ¶ 21; see also Pl.’s SOMF ¶ 30; Defs.’ Resp. to Pl.’s SOMF ¶ 30.
In sum, the Court finds that Defendants deprived Plaintiff of his right to a timely fair hearing decision in both 2018 and 2019, in violation of the Medicaid Act and Section 1983. Accordingly, the Court grants summary judgment in favor of Plaintiff on this issue.
The Court does not intend to imply that ALJs should reasonably be expected, as a matter of course, to conduct fair hearings and issue written decisions on the same day. The Court appreciates that cases such as the matter at bar are often complex, fact-intensive, and always require careful consideration by the factfinder. To the degree that state agencies such as DBHDD and DCH can avoid placing ALJs in this predicament—where an ALJ must conduct a fair hearing and issue a written decision the same day to prevent a violation of the plaintiff's rights due to the imminent expiration of the ninety (90)-day period—the state agencies should make every diligent effort to do so. Put simply, the burden of complying with the law that entitles a plaintiff to a fair hearing within ninety (90) days, including a written decision from the ALJ, should not rest solely on the ALJ's shoulders. State agencies must also do their part to ensure the fair hearing process occurs in a timely manner, in particular, by promptly forwarding requests for fair hearings to OSAH.
b. Violation of Fourteenth Amendment Due Process
The Court now turns to the Parties’ arguments regarding whether Defendants’ failures to adhere to the ninety (90)-day deadline violated Plaintiff's Fourteenth Amendment right to due process. [See Docs. 43-1 at 12–13; 44-1 at 22–23]. The Fourteenth Amendment of the United States Constitution protects against deprivation by state action of a constitutionally protected interest in "life, liberty, or property" without the due process of law. See Maddox v. Stephens, 727 F.3d 1109, 1118 (11th Cir. 2013). The Due Process clause provides two (2) categories of constitutional protections: (1) procedural protections and (2) substantive protections. See McKinney v. Pate, 20 F.3d 1550, 1555 (11th Cir. 1994). Here, Plaintiff does not specify whether he alleges a violation of procedural due process or substantive due process. See Am. Compl. ¶¶ 51–60. However, Plaintiff contends that Defendants violated his Fourteenth Amendment right to due process by depriving him of his "protectable ‘property interest’ in his statutorily created Medicaid benefits[.]" See id. ¶ 52. Therefore, because Plaintiff's alleged facts are incapable of supporting a substantive due process claim, the Court interprets Plaintiff's Fourteenth Amendment claim as a procedural due process claim.
"The substantive component of the Due Process Clause protects those rights that are fundamental, that is, rights that are implicit in the concept of ordered liberty." McKinney, 20 F.3d at 1556 (internal quotation marks omitted). Fundamental rights are those rights created by the Constitution. Accord Greenbriar Vill., L.L.C. v. Mt. Brook City, 345 F.3d 1258, 1262 (11th Cir. 2003) (citing DeKalb Stone, Inc. v. Cnty. of DeKalb, Ga., 106 F.3d 956, 959 n.6 (11th Cir. 1997) ). "Property interests, of course, are not created by the Constitution. Rather[,] they are created and their dimensions are defined by existing rules or understandings that stem from an independent source such as state law." Board of Regents v. Roth, 408 U.S. 564, 577, 92 S.Ct. 2701, 33 L.Ed.2d 548 (1972) ; accord Vinyard v. Wilson, 311 F.3d 1340, 1356 (11th Cir. 2002) (same). Thus, to the extent that Plaintiff predicates any substantive due process claim directly on the alleged violation of his property interest in his Medicaid benefits, the claim fails as a matter of law. See Am. Compl. ¶ 52; see also McKinney, 20 F.3d at 1560 ; Greenbriar, 345 F.3d at 1262.
"A § 1983 claim alleging a denial of procedural due process requires proof of three elements: (1) a deprivation of a constitutionally-protected liberty or property interest; (2) state action; and (3) constitutionally inadequate process." J.R. v. Hansen, 803 F.3d 1315, 1320 (11th Cir. 2015) (internal citations omitted and alterations adopted). Even where a plaintiff is deprived of a constitutionally protected liberty or property interest, the "procedural due process violation is only cognizable under § 1983 ‘when the state refuses to provide a process sufficient to remedy the procedural deprivation.’ " See Collier v. Conway, 672 F. App'x 950, 952 (11th Cir. 2016) (quoting McKinney, 20 F.3d at 1557 ). As the Eleventh Circuit has further explained:
It is the state's failure to provide adequate procedures to remedy the otherwise procedurally flawed deprivation of a protected interest that gives rise to a federal procedural due process claim. [ ] This rule (that a section 1983 claim is not stated unless inadequate state procedures exist to remedy an alleged procedural deprivation) recognizes that the state must have the opportunity to remedy the procedural failings of its subdivisions and agencies in the appropriate fora—agencies, review boards, and state courts[—]before being subjected to a claim alleging a procedural due process violation.
See Cotton v. Jackson, 216 F.3d 1328, 1331 (11th Cir. 2000). Thus, to sufficiently allege a procedural due process claim, Plaintiff must prove that the state provided a "constitutionally inadequate process" to remedy the alleged deprivation of his protected interest. See id.
As to the first of the three (3) prongs, the Court finds Plaintiff has shown he was deprived of a constitutionally protected interest for two (2) reasons. See Hansen, 803 F.3d at 1320. First, persuasive authority from the Second Circuit—which relied heavily on previous analysis from the Eleventh Circuit—provides that " 42 U.S.C. § 1396a(a)(3) —as construed by the regulation [ 42 C.F.R. § 431.244(f)(1)(ii) ]—creates a right [that is] enforceable under § 1983 [.]" See Shakhnes, 689 F.3d at 254 (citing Harris, 127 F.3d at 1009 ). Second, Plaintiff demonstrates he possesses a property interest in his Medicaid benefits, of which he was deprived from September 2018 through January 2019. See Goldberg, 397 U.S. at 262, 90 S.Ct. 1011 (affirming that welfare benefits are considered a property right for purposes of a due process claim); see also 2d Keir Decl. ¶¶ 5–6; Beumer Aff. ¶ 8; Pl.’s Resp. to Defs.’ SOMF ¶ 16; Pl.’s SOMF ¶ 25.
The second prong Plaintiff must establish to prevail on his procedural due process violation is "state action." See Hansen, 803 F.3d at 1320. In the matter at bar, it is apparent that Defendants are state actors who took state action. See Pl.’s SOMF ¶ 4 ("At all times relevant to this action, Defendants have acted under color of state law."); see also Goldberg, 397 U.S. at 262, 90 S.Ct. 1011 (explaining that the termination of welfare benefits "involves state action"); Lowe, 958 F.2d at 1572 (explaining that a party may be considered a "state actor" where he or she is "a state official") (internal citation omitted).
Finally, Plaintiff must demonstrate the third prong of the procedural due process violation test: that the state provided "constitutionally inadequate process" to remedy the deprivation of his protected interest. See Cotton, 216 F.3d at 1331. On this point, Plaintiff proffers that "the state laws governing Medicaid fair hearings fail to impose any deadline for taking final administrative action." [See Doc. 44-1 at 17] (citing O.C.G.A. § 49-4-153(b)(1) (emphasis in original). Defendants do not directly address this contention by Plaintiff, although they maintain that "Plaintiff has not presented any evidence ... to suggest that Defendants would not be willing and able to comply with the law once this Court settles of the issue of whether ‘final administrative action’ includes the issuance of a written decision[.]" [See Doc. 46 at 6–7].
In support of his argument, Plaintiff contends that the Georgia statute governing "fair hearings of Medicaid applicants and recipients" does not provide "deadlines for either the hearing or the written decision." [See id. at 18]. Upon review, the Court agrees with Plaintiff. Specifically, the Georgia statute instructs, in relevant part:
Any applicant for medical assistance whose application is denied ... shall be entitled to a hearing upon his or her request for such in writing and in accordance with the applicable rules and regulations of [DCH] and [OSAH]. As a result of the written request for hearing, a written recommendation shall be rendered in writing by the administrative law judge assigned to hear the matter.
See O.C.G.A. § 49-4-153(b)(1). The statute does not set any deadline for the issuance of the fair hearing decision when the request comes from a Medicaid recipient or applicant. See id.; [see also Doc. 44-1 at 18]. Similarly lacking is any deadline for DCH (or the agency to which DCH delegates the fair hearing process, DBHDD) to transmit an individual's request for a fair hearing to OSAH. See generally O.C.G.A. § 49-4-153(b)(1). In contrast, the same state statute does provide such deadlines for a hearing request made by a provider of Medicaid services:
The Court finds the lack of statutory deadlines regarding fair hearing requests made by individuals to be particularly relevant where, as here, the responsible state agency (DBHDD) failed to transmit Plaintiff's 2018 Fair Hearing Request to OSAH for at least one hundred thirty-seven (137) days, and subsequently, did not forward Plaintiff's 2019 Fair Hearing Request to OSAH for forty-seven (47) days. See Defs.’ SOMF ¶¶ 13, 21; see also Pl.’s SOMF ¶¶ 23, 30.
[DCH] shall, within 15 business days of receiving the request for hearing from the provider, transmit a copy of the provider's request for hearing to [OSAH]....
...
[OSAH] shall assign an [ALJ] to hear the dispute within 15 days after receiving the request [from the Medicaid provider]. The hearing is required to commence no later than 90 days after the assignment of the case to an [ALJ], and the [ALJ] shall issue a written decision on the matter no later than 30 days after the close of the record except when it is determined that the complexity of the issues and the length of the record require an extension of these periods and an order is issued by an [ALJ] so providing, but no longer than 30 days....
See O.C.G.A. § 49-4-153(b)(2)(A)–(B).
Further, the rules governing OSAH fair hearings do not address this issue. See Ga. Com. R. & Regs. r. 616-1-2-.27. Rather, the applicable OSAH rule provides, in relevant part, that a fair hearing decision:
shall be issued within the time provided by law , or within thirty (30) days of the hearing record closing. Should the Court determine that the complexity of the issues and the length of the record require additional time to issue the Decision, the Court shall enter an order setting forth the earliest practicable date certain for the issuance of the Decision.
See Ga. Com. R. & Regs. r. 616-1-2-.27(2) (emphasis added).
Considering the foregoing, the Court finds that the state has failed "to provide adequate procedures to remedy the otherwise procedurally flawed deprivation of a protected interest that gives rise to a federal procedural due process claim." See Cotton, 216 F.3d at 1331.
This finding is consistent with the United States Supreme Court's guidance regarding the requirements of due process in the context of "pre-termination hearing[s]" for welfare benefits (such as the fair hearings Plaintiff requested in the instant matter). See generally Goldberg, 397 U.S. 254, 90 S.Ct. 1011. In Goldberg, the Supreme Court instructed that such hearings have "one function only: to produce an initial determination of the validity of the welfare department's grounds for discontinuance of payments in order to protect a recipient against an erroneous termination of his benefits." See id. at 267, 90 S.Ct. 1011 (internal citation omitted). Thus, due process requires that these hearings to produce (at least) an "initial determination" or decision, which must "rest solely on the legal rules and evidence adduced at the hearing." See id. at 271, 90 S.Ct. 1011 (internal citation omitted). The Supreme Court explained that "the decision maker should state the reasons for his determination and indicate the evidence he relied on, though his statement need not amount to a full opinion or even formal findings of fact and conclusions of law." See id. (internal citation omitted and emphasis added). The Court finds it reasonable to believe that the "rudimentary due process" requirements set forth by Goldberg are most easily achieved through a written fair hearing decision. See id. at 267, 90 S.Ct. 1011.
Thus, the Court finds that no genuine dispute as to material fact exists and Defendants deprived Plaintiff of his Fourteenth Amendment due process rights in violation of Section 1983. Accordingly, the Court grants summary judgment in favor of Plaintiff on this issue.
In sum, the Court denies Defendants’ motion for summary judgment and grants Plaintiff's motion for summary judgment. [See Docs. 43, 44].
Regarding Plaintiff's claim for reasonable attorneys’ fees (Count IV), the Court observes that Section 1988 provides, in relevant part: "[i]n any action or proceeding to enforce a provision of ... [Section] 1983, ... the court, in its discretion, may allow the prevailing party, other than the United States, a reasonable attorney's fee [award] as part of the costs[.]" See 42 U.S.C. § 1988 ; see also Am. Compl. ¶ 62. Pursuant to Federal Rule of Civil Procedure 54(d)(2)(B)(i), a motion for attorneys’ fees must "be filed no later than 14 days after the entry of judgment[.]"
III. Plaintiff's Motion for Permanent Injunction [Doc. 44]
The Court now turns to Plaintiff's motion for permanent injunction. [Doc. 44]. The Parties vehemently dispute whether Plaintiff is entitled to injunctive relief in this matter. [See Docs. 43-1 at 10–15; 44-1 at 19–20]. Specifically, Plaintiff seeks a permanent injunction to require Defendants "to provide Plaintiff with a timely fair hearing going forward" on the basis that "Defendants have not demonstrated any ability to comply with their fair hearing obligations under the Medicaid Act and continue to openly challenge these obligations in this case." [See Doc. 44-1 at 23].
As the Court sets forth in detail above, Defendants unlawfully violated 42 U.S.C. § 1983 by depriving Plaintiff of his rights pursuant to (1) the Medicaid Act and (2) the Fourteenth Amendment. See 42 U.S.C. § 1396a(a)(3) ; 42 C.F.R. § 231.244(f)(1)(ii); U.S. CONST. amend. XIV ; 42 U.S.C. § 1983. As the Eleventh Circuit has observed, injunctive orders must meet certain standards of specificity:
Every order granting an injunction shall set forth the reasons for its issuance; shall be specific in terms; [and] shall describe in reasonable detail, and not by reference to the complaint or other document, the act or acts sought to be restrained.
See Hughey v. JMS Dev. Corp., 78 F.3d 1523, 1531 (11th Cir. 1996) (citing FED. R. CIV. P. 65(d) ) (alteration in original). A district court must frame the "precise bounds" of any order for injunctive relief so that "informed and intelligent appellate review" is possible. See id. (quoting Schmidt v. Lessard, 414 U.S. 473, 476, 94 S.Ct. 713, 38 L.Ed.2d 661 (1974) ) (internal quotation marks omitted).
In the matter at hand, although it is possible that Plaintiff could meet the standards for injunctive relief, the Court finds that it cannot fashion specific relief beyond that already provided by its above rulings. The Court determined above that Plaintiff has a right to a written fair hearing decision within the ninety (90)-day period, and that Defendants violated Plaintiff's rights. Thus, any injunction requiring Defendants "to provide Plaintiff with a timely fair hearing going forward" and to "comply with their fair hearing obligations under the Medicaid Act"—as Plaintiff requests—would amount to no more than a mere "obey-the-law injunction." [See Doc. 44-1 at 23].
As the term suggests, "an obey-the-law injunction does little more than order the defendant to obey the law[,]" and the Eleventh Circuit has "repeatedly questioned the enforceability of [such] injunctions[.]" See SEC v. Goble, 682 F.3d 934, 949 (11th Cir. 2012) ; see also Burton v. City of Belle Glade, 178 F.3d 1175, 1201 (11th Cir. 1999) ("As this injunction would do no more than instruct the [defendant] to ‘obey the law,’ we believe that it would not satisfy the specificity requirements of Rule 65(d) and that it would be incapable of enforcement."); Hughey, 78 F.3d at 1531 ("appellate courts will not countenance injunctions that merely require someone to ‘obey the law’ "). In line with Eleventh Circuit precedent, the Court finds that it would be improper to grant Plaintiff injunctive relief considering the Court's other rulings contained herein. Therefore, the Court denies Plaintiff's motion for permanent injunction. [Doc. 44].
Because the Court finds that any potential injunctive relief to Plaintiff in this matter would only amount to an unenforceable "obey-the-law" injunction, the Court declines to reach the Parties’ arguments on the merits of Plaintiff's motion for permanent injunction. [See generally Docs. 43-1, 44-1, 46, 48, 50, 52].
IV. Conclusion
Accordingly, the Court DENIES Defendants’ "Motion for Summary Judgment." [Doc. 43]. The Court GRANTS IN PART AND DENIES IN PART Plaintiff's "Motion for Summary Judgment, Declaratory Judgment, and Permanent Injunction." [Doc. 44]. Specifically, the Court GRANTS Plaintiff's motion to the extent it grants summary judgment in favor of Plaintiff in this declaratory judgment action. For this reason, the Court DIRECTS the Clerk to ENTER JUDGMENT in favor of Plaintiff. However, the Court DENIES Plaintiff's motion for injunctive relief. Finally, the Court DIRECTS the Clerk to close this case.
SO ORDERED , this 27th day of August, 2021.