Rodriguez ex rel. Corella v. Chen

985 F. Supp. 1189, 1996 U.S. Dist. LEXIS 21754, 1996 WL 932336
CourtDistrict Court, D. Arizona
DecidedFebruary 6, 1996
DocketNo. CIV. 95-130 TUC RMB
StatusPublished
Cited by6 cases

This text of 985 F. Supp. 1189 (Rodriguez ex rel. Corella v. Chen) is published on Counsel Stack Legal Research, covering District Court, D. Arizona primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Rodriguez ex rel. Corella v. Chen, 985 F. Supp. 1189, 1996 U.S. Dist. LEXIS 21754, 1996 WL 932336 (D. Ariz. 1996).

Opinion

ORDER

BILBY, Senior District Judge.

I.

INTRODUCTION

This case arises under the United States Constitution, the federal Medicaid statute, Title XIX of the Social Security Act, 42 U.S.C. § 1396 and the Arizona AHCCCS statute, AR.S. § 36-2903.01. Plaintiffs Carlos Rodriguez, Howard Cahill and Adeline Cahill bring this suit as a prospective class action against Mabel Chen in her capacity as Director of the Arizona Health Care Cost Containment System (“AHCCCS”).

Plaintiffs seek to compel the AHCCCS Program to stop its practice of giving low income persons inadequate notices regarding the denial or termination of their eligibility. The relief sought is a declaratory judgment holding that Defendant’s failure to include certain information in AHCCCS termination and denial notices violates the United States Constitution, and the federal Medicaid statute and regulations and Arizona’s AHCCCS statute and regulations. Plaintiffs also seeks a permanent injunction mandating that the State of Arizona include this information in all notices to AHCCCS applicants who are denied or terminated from the program.

In the parties’ August 7, 1995 Joint Proposed Case Management Plan, they agreed that Plaintiffs’ claims raise questions of law with no material questions of fact at issue. Accordingly, before the Court are cross-motions for summary judgment and Plaintiffs’ motion for class certification.

After a review of the pleadings submitted, relevant law and entertaining oral argument, the Court concludes that the AHCCCS written notice system is constitutionally deficient. The Notice does not provide sufficient information so that an applicant may evaluate the accuracy of the action or adequately contest an unfavorable decision. Additionally, the Court finds class certification unwarranted in this case.

II.

THE AHCCCS PROGRAM

Congress established the Medicaid program under Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq. This Act authorizes a state’s participation in a cooperative federal-state Medicaid program to provide medical assistance to low-income persons. To be eligible for federal financial assistance, states such as Arizona must administer their programs in accordance with [1191]*1191federal guidelines. 42 U.S.C. § 1396a. Arizona adopted its plan through the waiver program known as AHCCCS, AR.S. § 36-2901 et seq. The due process clause of the fourteenth amendment prohibits the AHCCCS program from denying a beneficiary his property right in AHCCCS health care services without adequate notice and the right to a fair hearing. Medicaid regulations mandate that the notice contain:

(a) a statement of what action the State, skilled nursing facility, or nursing facility intends to take;
(b) The reasons for the intended action;
(c) The specific regulations that support, or the change in Federal or State law that requires the action.

42 C.F.R. 431.210.

Additionally, Arizona AHCCCS statutes require notice and grievance procedures for adverse decisions. A.R.S. § 36-2903.01. These procedures are detailed by AHCCCS regulation:

B. The notice shall include all of the following information that applies to the action being taken for each applicant.
1. The approval and classification as either indigent, medically needy, or eligible low-income child or the denial of eligibility.
2. The denial or discontinuance, the reason as action has been taken, and the law or regulation that requires the action.
3. The advanced notice proposing discontinuance, the reason the discontinuance is being proposed, the law or rule that requires the action and the applicant’s right to provide proof of eligibility to avoid discontinuance pri- or to the date of discontinuance.
4. The right to request a hearing and the time limits within which a hearing must be requested.
5. The procedure for requesting a hearing.
6. The expiration date of the certification period.
7. The effective date of the action.
8.The signature of the eligibility worker.

R9-22-316, Arizona Administrative Code, Title 9, Chapter 22 (1993).

III.

FACTUAL BACKGROUND

A. Carlos Rodriguez

Carlos Rodriguez is a 14 year-old boy who resides with his family in Tucson, Arizona. Until August 1, 1995, Carlos was eligible for medical assistance benefits under the AHCCCS program based on his family’s financial situation.

On July 26,1994 AHCCCS mailed a notice to Carlos’ mother, Norma R. Corella, stating that Carlos was no longer eligible for AHCCCS benefits effective August 1, 1994. That notice which set out the basis for termination from AHCCCS stated:

MEDICAL ASSISTANCE HAS BEEN TERMINATED FOR THE PERSON(S) LISTED BELOW BECAUSE CARLOS RODRIGUEZ IS NOW IN A NEW CATEGORY FOR HIS AGE AND NO LONGER IS ELIGIBLE DUE TO HOUSEHOLD EXCESS INCOME.
* * *
THIS ACTION IS BASED ON MANUAL SECTION DES 3-27-500
And at the bottom of the page:
MEDICAL ASSISTANCE TERMINATION NOTICE
FROM LARA, JULIO
TO CONTACT ME, CALL 620-6616. CALL 623-9461 FOR FREE LEGAL ADVICE SI TIENE PREGUNTAS ACERCA DE ESTE AVISO, LLAME AT 542-9935 EN PHOENIX, O GRATIS AL 1-800-352-8401.

At deposition, Norma Corella testified that her notice did not include the following standard language typically included on all such notices:

[1192]*1192YOU MAY REQUEST A FAIR HEARING ON THE REVERSE OF THIS NOTICE.
PLEASE NOTE: REGARDLESS OF THE ACTION TAKEN' ABOVE. THE FIRST TIME A PERSON IS ENROLLED IN A HEALTH PLAN, MEDICAL COVERAGE IS GUARANTEED FOR UP TO SIX MONTHS. IF YOU HAVE BEEN ENROLLED LESS THAN SIX MONTHS, CONTACT THE AHCCCS ADMINISTRATION IN PHOENIX AT 264-0422, OR TOLL FREE 1-800-962-6690 FOR THE EXACT DATE YOUR COVERAGE WILL STOP. YOU MAY BE ELIGIBLE FOR MEDICAL ASSISTANCE UNDER COUNTY REQUIREMENTS. TO APPLY, CONTACT THE COUNTY ELIGIBILITY OFFICE IN YOUR AREA. ONCE MEDICAL ASSISTANCE IS TERMINATED, THE DIVISION OF CHILD SUPPORT ENFORCEMENT (DCSE) WILL CONTINUE TO PROVIDE CHILD/MEDICAL SUPPORT SERVICES. IF YOU DO NOT WANT THESE SERVICES TO CONTINUE OR IF YOU HAVE NEW INFORMATION REGARDING YOUR CHILD/MEDICAL SUPPORT CASE, PLEASE NOTIFY DCSE IN WRITING AT P.O. BOX 40458, PHOENIX, ARIZONA 85067.

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Bluebook (online)
985 F. Supp. 1189, 1996 U.S. Dist. LEXIS 21754, 1996 WL 932336, Counsel Stack Legal Research, https://law.counselstack.com/opinion/rodriguez-ex-rel-corella-v-chen-azd-1996.