Fishman ex rel. Fishman v. Daines

247 F. Supp. 3d 238, 2017 WL 1169671, 2017 U.S. Dist. LEXIS 46764
CourtDistrict Court, E.D. New York
DecidedMarch 29, 2017
DocketNo. 09-cv-5248 (JFB) (ARL)
StatusPublished
Cited by2 cases

This text of 247 F. Supp. 3d 238 (Fishman ex rel. Fishman v. Daines) is published on Counsel Stack Legal Research, covering District Court, E.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Fishman ex rel. Fishman v. Daines, 247 F. Supp. 3d 238, 2017 WL 1169671, 2017 U.S. Dist. LEXIS 46764 (E.D.N.Y. 2017).

Opinion

MEMORANDUM AND ORDER

Joseph F. Bianco, District Judge:

Plaintiffs Neil Fishman, through his legal guardian (“Fishman”), and Suruj Sirik-eshun (“Sirikeshun”) (collectively, “plaintiffs”) bring this class action pursuant to 42 U.S.C. §§ 1983 and 1396a(a)(3) against the Commissioner of the New York State Department of Health (“DOH”)1 and the [241]*241Commissioner of the Office of Temporary and Disability Assistance of the New York State Department of Family Assistance (“OTDA”)2 (collectively, “defendants”).

By Memorandum and Order dated September 16, 2014, the Court denied plaintiffs’ motion for a preliminary injunction requiring defendants to mail a “default notice” to members of the plaintiff class before their Medicaid appeals are deemed abandoned because they missed a scheduled hearing. The Court found that plaintiffs failed to make a clear showing that they were likely to succeed on the merits of their due process or statutory claims. Plaintiffs appealed this decision, and by Summary Order dated October 15, 2015, the Second Circuit reversed this Court’s denial of the preliminary injunction and remanded the case for further proceedings. The Court subsequently granted plaintiffs’ motion for a preliminary injunction by Memorandum and Order dated March 4, 2016, as amended on March 10, 2016.

Thereafter, on April 20, 2016, plaintiffs moved for partial summary judgment, seeking to make the preliminary injunction permanent. Defendants oppose the motion on the sole ground that plaintiffs lack standing to bring this action. For the reasons discussed below, the Court finds defendants’ position to be without merit, grants plaintiffs’ motion for partial summary judgment in its entirety, and hereby orders that defendants are permanently enjoined from dismissing administrative appeals of defaulting Medicaid appellants ho are not given at least ten (10) days to respond to a written notice from defendants inquiring as to whether they would like their hearings rescheduled.

I. Background

A. Facts and Legal Framework

Because defendants’ opposition is restricted to standing, the Court limits its analysis to those facts set forth in the parties’ Rule 56.1 statements, as well as the parties’ affidavits and exhibits, pertaining to that issue.3 Upon consideration of the motion for partial summary judgment, the Court will construe the facts in the light most favorable to defendants as the nonmoving party, and it will resolve all factual ambiguities in their favor. See Capobianco v. New York, 422 F.3d 47, 50 n.1 (2d Cir. 2005).

The background facts of this case, including an overview of the Medicaid system and appeals process, are set forth in this Court’s opinions (1) denying, in large part, defendants’ motion to dismiss, see Fishman v. Daines, 743 F.Supp.2d 127 (E.D.N.Y. 2010) (“Fishman I”); (2) denying the preliminary injunction, see Fishman ex rel. Fishman v. Daines, No. 09-CV-5248 JFB ARL, 2014 WL 4638962 (E.D.N.Y. Sept. 16, 2014) (“Fishman II”), vacated and remanded sub nom. Fishman v. Paolucci, 628 Fed.Appx. 797 (2d Cir. 2015); and (3) granting the preliminary injunction following remand, see Fishman v. Daines, 164 F.Supp.3d 409 (E.D.N.Y. 2016) (“Fishman III”). In addition, the Second Circuit summarized the contours of the Medicaid program in its order remanding this action. See Fishman, 628 Fed.Appx. at 797. Because defendants do not contest either this Court’s or the Second [242]*242Circuit’s analysis of the relevant legal scheme (see Defs.’ Opp’n Br., ECF No. 159, at 12 n.6), the Court will briefly outline the law and regulations at issue.

In short, this'case involves the procedures by which defendants determine that a Medicaid appeal is abandoned. After defendants conclude that a claimant is no longer entitled to Medicaid benefits, they inform the claimant by letter and advise him that he may request a fair hearing. See Fishman II, 2014 WL 4638962, at *1-2. If the request is timely made, the claimant may continue to receive “aid-continuing” Medicaid coverage pending the outcome of the hearing, and defendants send two additional letters: first, an acknowl-edgement that a fair hearing has been requested; and second, a notice that the fair hearing has been scheduled, which includes instructions for requesting adjournments. Id.

If a claimant does not attend his fair hearing, whether because he did not receive a notice or for any other reason, he is considered to have defaulted his hearing, and risks having his appeal deemed abandoned. See 18 N.Y.C.R.R. § 358-5.5(a). It is possible to restore a defaulted hearing to the calendar, but the timing of the request to do so affects the continuing provision of Medicaid coverage. See id. § 358-5.5(c). Plaintiffs contend that many class members lost aid-continuing coverage, at least temporarily, because they did not realize that they missed their fair hearing. Fishman II, 2014 WL 4638962, at *2; The default notice requested by plaintiffs, and temporarily put in place by the Court when it granted the preliminary injunction, would inquire as to whether the defaulting Medicaid appellant wanted his or her hearing rescheduled and would give the appellant at least ten (10) days to respond to the notice before dismissal of the administrative appeal. Id.; see also Fishman III, 164 F.Supp.3d at 418.

B. Procedural Background

. After the Court issued its opinion on the motion to, dismiss in 2010, see Fishman I, 743 F.Supp.2d at 127, the parties reached a comprehensive stipulation, .which the Coqrt ordered effective on April 6, 2011 (ECF No. 61). Among other things, the stipulation certified this case as a class action, on behalf of “[a]ll past, present, and future applicants and recipients of Medical Assistance ... in New York State who: (a) requested or will request an administrative fair hearing ... (b) failed or will fail to appear in-person ,., and (c). suffered or will suffer dismissal of their administrative appeal without defendants’ prior written inquiry,”4 (Id. ¶ 1.) The stipulation also required defendants to begin issuing letters-to prospective class members who defaulted their fair hearings, (Id. ¶ 3(b).) The letters asked class members if then- hearing, request was abandoned, and advised them- that if they intended to reschedule their hearing, they must provide good cause for having defaulted. (Id.) The letter also required the class members to respond within ten (10) days of the letter’s mailing date, or else their hearing request would be deemed abandoned. (Id.) The letters were issued for approximately two years, between the,date, the Court so-ordered the stipulation on April 6, 2011, and the date it was vacated on September 16, 2013.

The stipulation also included a provision exempting prospective class members from the' requirements of 18 N.Y.C.R.R. § 358-[243]*2435.5. (Id.

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Cite This Page — Counsel Stack

Bluebook (online)
247 F. Supp. 3d 238, 2017 WL 1169671, 2017 U.S. Dist. LEXIS 46764, Counsel Stack Legal Research, https://law.counselstack.com/opinion/fishman-ex-rel-fishman-v-daines-nyed-2017.