Hamilton v. Ohio Dept. of Health

2015 Ohio 4041
CourtOhio Court of Appeals
DecidedSeptember 30, 2015
Docket14AP-1035
StatusPublished
Cited by8 cases

This text of 2015 Ohio 4041 (Hamilton v. Ohio Dept. of Health) is published on Counsel Stack Legal Research, covering Ohio Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hamilton v. Ohio Dept. of Health, 2015 Ohio 4041 (Ohio Ct. App. 2015).

Opinion

[Cite as Hamilton v. Ohio Dept. of Health, 2015-Ohio-4041.]

IN THE COURT OF APPEALS OF OHIO

TENTH APPELLATE DISTRICT

Edward Hamilton, :

Plaintiff-Appellant, : No. 14AP-1035 v. : (C.P.C. No. 11CVH-13646)

Ohio Department of Health et al., : (ACCELERATED CALENDAR)

Defendants-Appellees. :

D E C I S I O N

Rendered on September 30, 2015

Edward Hamilton, pro se.

Michael DeWine, Attorney General, and Melissa L. Wilburn, for appellees.

APPEAL from the Franklin County Court of Common Pleas SADLER, J. {¶ 1} Plaintiff-appellant, Edward Hamilton, appeals the November 21, 2014 decision and entry of the Franklin County Court of Common Pleas granting the motion to dismiss filed by defendants-appellees, Ohio Department of Health and its director ("ODH"), and denying appellant's motion for leave to file a second amended complaint. For the following reasons, we affirm the judgment of the trial court. I. FACTS AND PROCEDURAL HISTORY {¶ 2} This case concerns the standing of appellant to challenge in a civil action for declaratory and injunctive relief a rule promulgated by ODH that alters certain eligibility protocols, if Ohio's "Ryan White Part B" program suffers a future funding shortfall. {¶ 3} Ohio's Ryan White Part B program, which includes the Ohio HIV Drug Assistance Program ("OHDAP"), arose under the federal Ryan White Act "Part B - Care No. 14AP-1035 2

Grant Program." 42 U.S.C. 300ff-21. Part B permits the federal government, "subject to the availability of appropriations," to provide grants to enable applicant states "to improve the quality, availability and organization of health care and support services for individuals and families with HIV/AIDS." Applicant states must provide an assurance that the state will, "to the maximum extent practicable, ensure that HIV-related health care and support services delivered pursuant to a program established with assistance * * * provided without regard to the ability of the individual to pay for such services and without regard to the current or past health condition of the individual with HIV/AIDS." 42 U.S.C. 300ff-27(b)(7)(B)(i). A state may use the grants to support core medical services, including drug assistance programs, as well as certain support services and administrative expenses. {¶ 4} The Ohio legislature charged ODH with administering the Ohio Ryan White Part B program, and in R.C. 3701.241(D) allows its director discretion to adopt rules and issue orders as necessary for administration of the funds. In September 2011, appellees began the administrative rule-making process to revise the code section pertaining to eligibility for benefits under the Ohio Ryan White Part B program, now numbered Ohio Adm.Code 37o1-44-03. {¶ 5} The two appendices which support Ohio Adm.Code 37o1-44-03 are central to this appeal. Appendix A establishes medical guidelines to determine the priority in which an applicant would receive OHDAP services, including access to medications, if a waiting list forms due to insufficient funds.1 Appendix B provides the director of ODH

1 Ohio Adm. Code 37o1-44-03, Appendix A: Medical Guidelines, reads:

These additional medical guidelines only apply to applications to the Ohio HIV Drug Assistance Program (OHDAP). When OHDAP has a waiting list for program enrollment and subject to sufficient funding, applicants to the Ryan White Part B programs must meet one of the following medical guidelines to be eligible for expedited enrollment: 1. Pregnant women who meet all OHDAP eligibility criteria and who are not eligible for other programs which provide antiretroviral (ARV) medications. 2. Post partum women (women who [have] given birth within 180 days prior to applying to OHDAP) who meet all OHDAP eligibility criteria and who are not eligible for other programs which provide antiretroviral (ARV) medications. No. 14AP-1035 3

with discretion to reduce the maximum gross family income threshold from 300 percent of the federal poverty level ("FPL") to no less than 100 percent of the FPL, if there is insufficient funding to sustain current services of the program.2

If the OHDAP is able to enroll some but not all individuals from the waiting list (based on insufficient funds), applications from individuals who meet all OHDAP eligibility criteria and who are not eligible for other programs which provide ARV medications will be prioritized as follows: Priority 1: Individuals with HIV and other extreme medical conditions such as, but not limited to, HIV-associated nephropathy or HIV related dementia. The applicant’s HIV-treating physician or nurse practitioner shall complete a medical waiver request consistent with section 3701-44- 04 of the Ohio Administrative Code. Priority 2: Individuals with a history of AIDS-defining illness [see paragraph (C) of Appendix A to section 3701-3-12 of the Ohio Administrative Code for indicator diseases diagnosed definitively] and/or a nadir CD4 count of less than or equal to 200 cells/mm3 (or less than 14%). Documentation shall be provided by the HIV-treating physician or nurse practitioner evidencing how the individual meets this priority. Priority 3: Individuals with HIV and a nadir CD4 count between 201-350 cells/mm3. Documentation shall be provided by the HIV-treating physician or nurse practitioner evidencing how the individual meets this priority. Priority 4: Individuals with HIV and a nadir CD4 count between 351-500 cells/mm3. Documentation shall be provided by the HIV-treating physician or nurse practitioner evidencing how the individual meets this priority. Priority 5: Individuals with HIV and a nadir CD4 count above 500 cells/mm3. Documentation shall be provided by the HIV-treating physician or nurse practitioner evidencing how the individual meets this priority. Individuals on the waiting list should notify OHDAP if there is deterioration in their health. Individuals who submit documentation by the HIV-treating physician or nurse practitioner evidencing how the individual meets one of the above listed priorities will move to the appropriate priority while retaining their original waiting list date.

2 Ohio Adm.Code 37o1-44-03, Appendix B: Financial Eligibility Guidelines for OHDAP/HIPP/ Spenddown, reads:

Applicants to the Ryan White Part B programs must meet the following financial guidelines to be eligible: 1. The individual or individual's family gross income must be equal to or less than three hundred percent (300%) of the Federal Poverty Level (FPL) as published in the Federal Register on or before the first of April of each calendar year. 2. The calculation shall exclude taxes and any mandatory retirement deduction. Eligibility in Ryan White Part B programs is subject to sufficient funding. Pursuant to division (D) of section 3701.241 of the Revised Code and paragraph (C) of this rule, if there is insufficient funding to sustain current services, the director may, at any time and as necessary for the No. 14AP-1035 4

{¶ 6} On November 2, 2011, appellant filed a complaint asking the court to declare Ohio Adm.Code 3701-44-03 unenforceable as proposed and asking the court for temporary, preliminary, and permanent injunctive relief to enjoin ODH from enforcing the rule. Appellant contended that Appendices A and B amounted to a material modification of the new rule that necessitated another public hearing under the rule- making process in Chapter 119 of the Revised Code. The trial court issued an order temporarily restraining ODH from enforcing or implementing the proposed rule until the court resolved whether to grant declaratory or injunctive relief.

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Bluebook (online)
2015 Ohio 4041, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hamilton-v-ohio-dept-of-health-ohioctapp-2015.