Julia M. v. Scott

243 F.R.D. 365, 68 Fed. R. Serv. 3d 570, 2007 U.S. Dist. LEXIS 45849, 2007 WL 1847152
CourtDistrict Court, W.D. Missouri
DecidedJune 25, 2007
DocketNo. 07-4036-CV-C-NKL
StatusPublished

This text of 243 F.R.D. 365 (Julia M. v. Scott) is published on Counsel Stack Legal Research, covering District Court, W.D. Missouri primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Julia M. v. Scott, 243 F.R.D. 365, 68 Fed. R. Serv. 3d 570, 2007 U.S. Dist. LEXIS 45849, 2007 WL 1847152 (W.D. Mo. 2007).

Opinion

ORDER

LAUGHREY, District Judge.

Plaintiff Julia M. brings this action on behalf of her daughter, J.W.M., and a proposed class of MC+ recipients,1 to enjoin Defendants (a) to notify all MC+ recipients who are disenrolled from MC + health coverage for failure to meet premium requirements of their right to appeal prior to disen-rollment; (b) to provide the opportunity for continued enrollment and aid pending a hearing; and (c) to first determine whether such MC+ recipients are otherwise eligible for medical assistance. Pending before the Court are Plaintiffs’ Motions for Class Certification [Doe. # 5] and Preliminary Injunction [Doc. # 11]. For the reasons set forth below, class certification is granted and oral argument is ordered on the Preliminary Injunction Motion.

I. Background

Missouri’s State Children’s Health Insurance Program (SCHIP) is a jointly funded state and federal program that provides health assistance to uninsured, low income children whose family income is above the State’s Medicaid income limits, but who cannot afford private health insurance. 42 U.S.C. § 1397aa-jj. Missouri’s SCHIP program, called Medicaid MC + , provides that

Parents and guardians of uninsured children with incomes between one hundred fifty-one and three hundred percent of the federal poverty level who do not have access to affordable employer-sponsored health care insurance or other affordable health care coverage may obtain coverage pursuant to this section____ The parents and guardians of eligible uninsured children pursuant to this section are responsible for a monthly premium equal to the average premium required for the Missouri consolidated health care plan____

Mo.Rev.Stat. § 208.640. However, if a participating parent fails to make a payment, “the child shall not be eligible for coverage under [Mo.Rev.Stat.] sections 208.631 to 208.660 for six months after the department provides notice of such failure to the parent or guardian.” Mo.Rev.Stat. § 208.646.

By accepting matching funds from the federal government, the MC+ program is bound by the requirements of the SCHIP Act and regulations promulgated by the Department of Health and Human Services (HHS). Although there are many regulations applicable to this case, at a minimum, the SCHIP Act requires that

(a) The State must give enrollees reasonable notice of and an opportunity to pay past due premiums, copayments, coinsurance, deductibles or similar fees prior to disenrollment.
(c) The State must provide the enrollee with an opportunity for an impartial review to address disenrollment from the program in accordance with § 457.1130(a)(3).

42 C.F.R. § 457.570(a), (c). Such reviews include “disenrollment for failure to pay cost sharing,” id. § 457.1130(a)(3), and the “State must ensure the opportunity for continuation of enrollment pending the completion of review of a suspension or termination of enrollment, including a decision to disenroll for failure to pay cost sharing.” Id. § 457.1170. Finally, the State must determine a recipi[367]*367ent’s continuing eligibility for Medicaid under any alternative bases before terminating SCHIP benefits for ineligibility under the original basis. 42 U.S.C. § 1396(a)(8); 42 C.F.R. § 435.930(b).

Through a series of bank errors, JW.M.’s monthly MC+ premium was not automatically deducted from her mother’s account in a timely fashion and J.W.M.’s benefits were terminated. Julia M. received a notice of termination after benefits had already been terminated. Although the notice referenced a right to appeal, it did not indicate that J.W.M. had a right to continued benefits pending the outcome of that appeal. Nor did the notice indicate that the State had conducted any evaluation to determine whether J.W.M. was eligible for benefits under any other category before her benefits were terminated. Only after Julia M. initiated this lawsuit did the Defendants consent to reinstating JW.M.’s MC + benefits.

Plaintiffs allege that the Defendants routinely terminate benefits for nonpayment as they did in JW.M.’s case without notifying recipients of their right to appeal and their right to continued benefits pending the outcome of that appeal. Plaintiffs seek to certify a class of plaintiffs which includes “[a]ll children residing in Missouri and who are receiving or who will receive MC+ health coverage and are required to pay a premium under Mo.Rev.Stat. § 208.640.” They further seek a preliminary injunction requiring Defendants to provide notice and continued benefits required by the regulation to all class members.

II. Mootness

Defendants contend that the Court should consider neither Plaintiffs’ request for injunctive relief nor for class certification since J.W.M.’s case has been mooted by the restoration of her benefits. Generally, “where [a] named plaintiffs personal claim becomes moot prior to district court’s ruling on certification of a class action, the court loses jurisdiction over the action because the case or controversy requirement of Article III is violated.” Shipman v. Missouri Dep’t of Family Servs., 877 F.2d 678, 682 (8th Cir.1989). However, in Sosna v. Iowa the Supreme Court noted in dicta that

There may be cases in which the controversy involving the named plaintiffs is such that it becomes moot as to them before the district court can reasonably be expected to rule on a certification motion. In such instances, whether the certification can be said to “relate back” to the filing of the complaint may depend upon the circumstances of the particular case and especially the reality of the claim that otherwise the issue would evade review.

419 U.S. 393, 402 n. 11, 95 S.Ct. 553, 42 L.Ed.2d 532 (1975). In a subsequent case involving pretrial detainees, the Supreme Court cited its Sosna dictum to hold that the detainee ease “belongs to that narrow class of cases in which the termination of a class representative’s claim does not moot the claims of the unnamed members of the class.” Gerstein v. Pugh, 420 U.S. 103, 111 n. 11, 95 S.Ct. 854, 43 L.Ed.2d 54 (1975). The Supreme Court went on to explain that “[i]t is by no means certain that any given individual, named as plaintiff, would be in pretrial custody long enough for a district judge to certify the class. Moreover, in this case the constant existence of a class of persons suffering the deprivation is certain.” Id. at n. 11. The claim, in short, is one that is distinctly “ ‘capable of repetition, yet evading review.’ ” Id. at n. 11.

In the wake of Sosna and Gerstein, the Eighth Circuit has held that “where a claim is ‘capable of repetition but evading review’ a court may rule on class certification even if the named plaintiffs individual claim bee[o]me[s] moot before the court ha[s] considered class certification.” Shipman, 877 F.2d at 682 (quoting Gerstein, 420 U.S.

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Related

Sosna v. Iowa
419 U.S. 393 (Supreme Court, 1975)
Gerstein v. Pugh
420 U.S. 103 (Supreme Court, 1975)
General Telephone Co. of Southwest v. Falcon
457 U.S. 147 (Supreme Court, 1982)
Amchem Products, Inc. v. Windsor
521 U.S. 591 (Supreme Court, 1997)

Cite This Page — Counsel Stack

Bluebook (online)
243 F.R.D. 365, 68 Fed. R. Serv. 3d 570, 2007 U.S. Dist. LEXIS 45849, 2007 WL 1847152, Counsel Stack Legal Research, https://law.counselstack.com/opinion/julia-m-v-scott-mowd-2007.