Nb v. District of Columbia

CourtDistrict Court, District of Columbia
DecidedAugust 7, 2025
DocketCivil Action No. 2010-1511
StatusPublished

This text of Nb v. District of Columbia (Nb v. District of Columbia) is published on Counsel Stack Legal Research, covering District Court, District of Columbia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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

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. 2 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

3 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.

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