Nb v. District of Columbia

District Court, District of Columbia·Decided August 7, 2025·No. Civil Action No. 2010-1511·Published

Opinion

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

ANTONIO MORGAN, et al., )

)

Plaintiffs, )

)

v. ) Civil Case No. 10-1511 (RJL)

)

DISTRICT OF COLUMBIA, )

)

Defendant. )

,lftv

MEMORANDUM OPINION

August 1.J_, 2025 [Dkt. #212]

This case involves a putative class ofD.C. Medicaid recipients ("plaintiffs") suing the District of Columbia (the "District" or "defendant") for allegedly violating their Due Process rights. See generally Third Am. Compl. ("TAC") [Dkt. #226]. Plaintiffs challenge the District's policy and practice "of failing to provide individualized written notice to persons who present a prescription to a Medicaid-participating provider in the District of

Columbia but who are denied Medicaid coverage for the prescription as written." Id. ,r 1. Now before the Court is plaintiffs' motion for class certification. For the reasons set forth

below, I will GRANT plaintiffs' motion and certify the class. I. BACKGROUND A. Statutory and Regulatory Background The structure ofthe District's Medicaid program has been outlined in prior opinions in this case, but I will briefly revisit it here. Medicaid "is a 'cooperative federal-state program that provides federal funding for state medical services to the poor.'" NB. v.

District of Columbia, 794 F.3d 31, 35 (D.C. Cir. 2015) (quoting Frew ex rel. Frew v. Hawkins, 540 U.S. 431, 433 (2004)). The District participates in Medicaid and offers prescription drug coverage under its Medicaid program. See id. The Department of Health Care Finance ("DHCF") is the District's single state agency designated to administer its Medicaid program. See id.; see also 42 U.S.C. § 1396a(a)(5); D.C. Code§ 7-771.07.

D.C. Medicaid beneficiaries are enrolled in one of five plans: the District-run Fee­ for-Service ("FFS") plan or one of four contractor-run Managed Care Plans ("MCPs"). See

29 D.C.M.R. § 5501.1; TAC ,r,r 23-24; Def.'s Opp'n at 1, 3. The District and the MCPs contract with pharmacy benefits managers ("PBMs") "to process prescription drug claims

under Medicaid" for their respective Medicaid plans. See NB., 794 F.3d at 36; TAC ,r 24; Def.'s Opp'n at 3-4. Each PBM's claim management system informs the pharmacist

,r

whether an individual's claim is covered or denied, see TAC 24; Def.'s Opp'n at 3-4, but

DHCF is ultimately responsible "for determining eligibility for all individuals applying for or receiving benefits" under the District's Medicaid program, see 42 C.F.R.§ 431.10(b)(3).

B. Case History Plaintiffs filed suit in 2010, bringing claims under the Due Process clause and D.C.

law. See generally Compl. [Dkt. #3]. All that remains now is their Due Process claim, pursuant to which they allege that the District's Medicaid program has denied coverage of their prescriptions without providing written notice of the reasons for denial. See generally TAC. This, according to plaintiffs, violates Due Process because plaintiffs "have a protected interest in the Medicaid benefits" and the District "has deprived [them] of Medicaid benefits without complying with the due process standards." Id. ,r,r 133-34.

Plaintiffs believe that this is a widespread problem and therefore challenge the District's "policies, procedures, and practices of failing to provide individualized written notice." Id.

,r 1. They seek both declaratory and injunctive relief. Id. at p. 32-33.

During the pendency of this case, the District updated its Medicaid notice

requirements. In 2020 and 2023, it issued two Transmittals requiring pharmacy staff to provide Medicaid beneficiaries with written notice when their claims for prescription drug coverage are denied. See DHCF Transmittal No. 20-01 (Jan. 10, 2020) ("Transmittal No. 20-01") [Dkt. #130-3]; DHCF Transmittal No. 23-23 (May 18, 2023) ("Transmittal No. 23-23") [Dkt. #172-1]. The notice forms state the reason for denial and provide information about challenging the denial. Transmittal No. 20-01; Transmittal No. 23-23.

On September 27, 2024, plaintiffs filed the instant motion to certify a class pursuant to Federal Rule of Civil Procedure 23. Third Renewed Mot. for Class Cert. ("Pls.' Mot.") [Dkt. #212]; Pls.' Mem. of P. & A. in Supp. of Pls.' Mot. ("Pls.' Mem.") [Dkt. #212-1]. The District opposes class certification. Def.'s Opp'n to Pls.' Mot. ("Def.'s Opp'n") [Dkt. #217]. The motion is now ripe for my review. See Pls.' Reply in Supp. of Pls.' Mot. ("Pls.' Reply") [Dkt. #220]; Def.'s Surreply to Pls.' Mot. ("Def.'s Surreply") [Dkt. #223]; Pls.' Sur-surreply Br. in Supp. of Pls.' Mot. ("Pls.' Sur-surreply") [Dkt. #227]. II. LEGAL STANDARD Federal Rule of Civil Procedure 23 sets out the requirements for class certification.

First, the proponent of the class must establish that: "(l ) the class is so numerous that joinder of all members is impracticable; (2) there are questions of law or fact common to the class; (3) the claims or defenses of the representative parties are typical of the claims

or defenses of the class; and (4) the representative parties will fairly and adequately protect the interests of the class." Fed. R. Civ. P. 23(a).

Second, if the requirements of Rule 23(a) are satisfied, the proposed class must also meet one of the three additional requirements set forth in Rule 23(b). See In re White, 64 F.4th 302, 303---04 (D.C. Cir. 2023). As relevant here, Rule 23(b)(2) permits certification if"the party opposing the class has acted or refused to act on grounds that apply generally to the class, so that final injunctive relief or corresponding declaratory relief is appropriate respecting the class as a whole." Fed. R. Civ. P. 23(b)(2). Finally, an order certifying a class must appoint class counsel, after consideration of counsel's ability to fairly and adequately represent the class. Fed. R. Civ. P. 23(g)(l ). III. ANALYSIS Plaintiffs assert that "[t]his case is well-suited" for class certification because "[t]he 'aim' of this lawsuit is 'to rectify the District's systemic failure to comply' with its constitutional duty 'to all class members[.]'" Pls.' Reply at 1 (quoting D.L. v. District of Columbia, 302 F.R.D. 1, 16 (D.D.C. 2013), aff'd, 860 F.3d 713 (D.C. Cir. 2017)). To that end, plaintiffs propose the following class:

All persons who have applied for, received, or are receiving DC Medicaid who present a prescription to a Medicaid-participating provider for a medication that is not completely excluded from coverage under the DC Medicaid program and who do not, or will not, receive timely and adequate individualized written notice when Medicaid coverage is denied for the prescription as written.

Pls.' Mem. at 2.

The District argues that this proposed class does not meet Rule 23's requirements

"because [plaintiffs'] allegations amount to nothing more than scattered, irregular failures

by third- and fourth-party pharmacies in the District of Columbia and Maryland to comply with the District's policy requiring those pharmacies to provide individualized written notice .. . ." Def.'s Opp'n at 13. I find that plaintiffs have met Rule 23's requirements and, as such, I will certify their proposed class.

A. Rule 23(a)'s Requirements 1. Numerosity

A proposed class must be "so numerous that joinder of all members is impracticable." Fed. R. Civ. P. 23(a)(l ). "Impracticability ofjoinder means only that it is difficult or inconvenient to join all class members, not that it is impossible to do so." Coleman ex rel. Bunn v. District of Columbia, 306 F.R.D. 68, 76 (D.D.C. 2015). Considerations include the size of the class, the class members' financial resources and ability to bring individual suits, and the need to join future class members. See D.L., 302 F.R.D. at I 1.

Free access — add to your briefcase to read the full text and ask questions with AI

Nb v. District of Columbia, (D.D.C. 2025).

Nb v. District of Columbia (Nb v. District of Columbia) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

Frew Ex Rel. Frew v. Hawkins
540 U.S. 431 (Supreme Court, 2004)
Wal-Mart Stores, Inc. v. Dukes
131 S. Ct. 2541 (Supreme Court, 2011)
DL v. District of Columbia
713 F.3d 120 (D.C. Circuit, 2013)
Dl v. District of Columbia
302 F.R.D. 1 (District of Columbia, 2013)
Coleman v. District of Columbia
306 F.R.D. 68 (District of Columbia, 2015)
NB Ex Rel. Peacock v. District of Columbia
794 F.3d 31 (D.C. Circuit, 2015)
N.B. v. District of Columbia
244 F. Supp. 3d 176 (District of Columbia, 2017)
DL v. District of Columbia
860 F.3d 713 (D.C. Circuit, 2017)
J.D. v. Alex Azar, II
925 F.3d 1291 (D.C. Circuit, 2019)
Brown v. Dist. of Columbia
928 F.3d 1070 (D.C. Circuit, 2019)
Bynum v. District of Columbia
214 F.R.D. 27 (District of Columbia, 2003)
Lightfoot v. District of Columbia
246 F.R.D. 326 (District of Columbia, 2007)
Vitiello v. Cicconi
103 F.R.D. 130 (D. New Jersey, 1984)
Elsa Maldonado v. DC
61 F.4th 1004 (D.C. Circuit, 2023)
In re: Valerie White
64 F.4th 302 (D.C. Circuit, 2023)