Cohon Ex Rel. Bass v. New Mexico Department of Health

788 F. Supp. 2d 1245, 2009 U.S. Dist. LEXIS 131065, 2009 WL 8150060
CourtDistrict Court, D. New Mexico
DecidedDecember 2, 2009
DocketCIV-08-1115 LAM/RHS
StatusPublished

This text of 788 F. Supp. 2d 1245 (Cohon Ex Rel. Bass v. New Mexico Department of Health) is published on Counsel Stack Legal Research, covering District Court, D. New Mexico primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cohon Ex Rel. Bass v. New Mexico Department of Health, 788 F. Supp. 2d 1245, 2009 U.S. Dist. LEXIS 131065, 2009 WL 8150060 (D.N.M. 2009).

Opinion

ORDER GRANTING STATE DEFENDANTS’ MOTION TO DISMISS PLAINTIFF’S CLAIMS FOR DECLARATORY/INJUNCTIVE RELIEF

LOURDES A. MARTÍNEZ, United States Magistrate Judge.

THIS MATTER is before the Court on Defendants’ Motion to Dismiss Plaintiff’s Claim for Declaratory!Injunctive Relief and Memorandum in Support (Doc. 33) (hereinafter “Motion to Dismiss ”), filed on July 10, 2009 by the New Mexico Human Services Department, Carolyn Ingram, Pamela Hyde, 1 Alfredo Vigil, and Cindy Padilla (hereinafter “State Defendants”). On July 27, 2009, Plaintiff filed Plaintiff’s Response to Defendants’ Motion to Dismiss Plaintiffs Claim for Declaratoryllnjunctive Relief (Doc. 3k) (hereinafter “Response ”), and on August 7, 2009, State Defendants filed Defendants’ Reply in Support of Motion to Dismiss Plaintiffs Claims for Declaratory/Injunctive Relief (Doc. 37) (hereinafter “Reply”). The undersigned United States Magistrate Judge, acting upon consent and designation pursuant to 28 U.S.C. § 636(c) and Fed.R.Civ.P. 73(b), and having considered the parties’ submissions, the relevant law, and otherwise being fully advised in the premises, FINDS, for the reasons set forth below, that State Defendants’ Motion to Dismiss should be GRANTED.

I. BACKGROUND

The following facts are either undisputed or are viewed in a light most favorable *1249 to Plaintiff. See Anderson v. Suiters, 499 F.3d 1228, 1232 (10th Cir.2007). Plaintiff has a medical history of cerebral palsy and autism and is legally blind. Notice of Appeal From Administrative Hearing and Complaint for Injunctive and Declaratory Relief (Doc. 1-2) at 2 (attached to Joint Notice of Removal (Doc. 1)) (hereinafter “Plaintiff’s Notice of Appeal and Complaint”). Plaintiff applied for “Mi Via Waiver” services under New Mexico’s Home and Community Based Services Waiver provisions. 2 Id. Under the Mi Via Waiver program, participants over the age of 21 are given an annual budget of $34,553 (excluding residential support services) or $59,449 3 (including residential support services) to purchase goods and services. Record, Exhibit 2 at 160; see also Motion to Dismiss (Doc. 33) at 2, Plaintiff’s Notice of Appeal and Complaint at 6. Pursuant to NMAC § 8.314.6.17(B)(2) (2006), the annual budget for participants with no prior waiver cost experience is “calculated based on algorithms developed by the state for recipients of the same waiver population ... with similar characteristics as the [M]i [V]ia participant.” See also Mi Via Waiver Program Service Standards, Record, Exhibit 3 at 162-63. A participant’s budget allotment can be increased if the participant shows that she or he has one or more of the following: (1) a chronic physical condition; (2) a change in physical health status; (3) chronic or intermittent behavioral conditions or cognitive difficulties; or (4) a change in natural supports. Mi Via Waiver Service Standards, Record, Exhibit 3 at 163-67.

Plaintiff was given an annual budget of $59,449 under the Mi Via Waiver program. Motion to Dismiss (Doc. 33) at 2. Plaintiff met the criteria for an increased budget allotment for chronic behavioral conditions and cognitive difficulties. Plaintiff’s Notice of Appeal and Complaint (Doc. 1-2) at 6. After meeting with a consultant hired by the New Mexico Department of Health, Plaintiff submitted a proposed request for additional funding to make her total budget amount $116,080. Id. at 7. After an additional meeting which included Plaintiff, Mi Via Waiver program employees and the state consultant, Plaintiff submitted a revised budget request of $106,667. Id. Finally, without input from Plaintiff, Defendant New Mexico Department of Health, the consultant, and Lovelace staff made a further deduction of $9,660.44 from Plaintiffs proposed budget, resulting in an approved budget of $97,007.24. Id. at 7-8. In making the final deduction of $9,660.44, Plaintiff was denied funding for: chiropractic and orthotic services, nutritional supplements, fleet enemas, ski lessons, swim punch card, funds to attend non-local conferences and meetings (including regis *1250 tration, hotel, and per diem), four DVDs, overnight care, care buddy merit increases, driver merit increases, community job advisor raises, and money in a reserve fund. Id. at 2; Motion to Dismiss (Doc. 33) at 3. Lovelace stated that the rejected requests were denied pursuant to NMAC § 8.314.6.17(C) (2006), which provides that requested services can be approved if they: (1) “increase the participant’s functioning related to the disability;” (2) “increase the participant’s safety in the home environment;” or (3) “decrease [the participant’s] dependence on other medicaid-funded services.”). See Record, Exhibit 26 at 339-40.

Plaintiff requested and was provided an administrative evidentiary hearing concerning the items denied in her budget request. Appellant Jessica Cohon[’s] Statement of Appellant Issues (Doc. 10) at 4. The administrative law judge made a determination that Plaintiffs additional budget requests met the criteria for Mi Via Waiver services, that the requests for chiropractic and orthotic services and nutritional supplements and fleet enemas should have been approved, but Defendant New Mexico Human Services Department had the discretion to disapprove the other services. Record at x-xi. Defendant Ingram, Medical Assistance Division Director, reversed the administrative law judge’s determination that any of the additional budget requests should be approved, and stated that, because the additional budget requests exceeded the Mi Via budgetary allotment, they must meet the requirement that they be necessary to “keep the participant safe.” Id. at i-ii.

On October 30, 2008, Plaintiff filed her appeal of the administrative decision in the First Judicial District Court of New Mexico. Plaintiff’s Notice of Appeal and Complaint (Doc. 1-2) at 1. Plaintiff appeals the denial of her budget request (id. at 2), and claims “that the denial of the requested services is a violation of her civil rights as guaranteed under the federal and state constitutions, 42 U.S.C. § 1983, the Americans with Disabilities Act and Section 504 of the Rehabilitation Act” (id. at 3).

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Bluebook (online)
788 F. Supp. 2d 1245, 2009 U.S. Dist. LEXIS 131065, 2009 WL 8150060, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cohon-ex-rel-bass-v-new-mexico-department-of-health-nmd-2009.