Stewart v. Azar

308 F. Supp. 3d 239
CourtCourt of Appeals for the D.C. Circuit
DecidedApril 10, 2018
DocketCivil Action No. 18–152 (JEB)
StatusPublished
Cited by11 cases

This text of 308 F. Supp. 3d 239 (Stewart v. Azar) is published on Counsel Stack Legal Research, covering Court of Appeals for the D.C. Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Stewart v. Azar, 308 F. Supp. 3d 239 (D.C. Cir. 2018).

Opinion

JAMES E. BOASBERG, United States District Judge

Plaintiffs are sixteen Kentucky Medicaid enrollees who brought this action under the Administrative Procedure Act, 5 U.S.C. §§ 701 - 706, challenging the federal government's approval of a new Kentucky Medicaid program, Kentucky HEALTH. Defendants-the Department of Health and Human Services, the Centers for Medicare and Medicaid Services, and four officials-now move to transfer the case to the Eastern District of Kentucky pursuant to 28 U.S.C. § 1404(a). Because the Court finds that convenience and the interests of justice warrant keeping the matter in the District of Columbia, it will deny the Motion.

I. Background

A. Medicaid Program

Since 1965 the federal government and the states have worked together to provide medical care to certain vulnerable populations under Title XIX of the Social Security Act, colloquially known as Medicaid. See 42 U.S.C. § 1396-1. The Centers for Medicare and Medicaid Services (CMS), a federal agency within the Department of Health and Human Services (HHS), has primary responsibility for overseeing Medicaid programs. Under the cooperative federal-state arrangement, participating states submit their "plans for medical assistance" and receive federal funding to offset some of the costs if the plan is "approved by the Secretary [of HHS]." Id. Currently, all states have chosen to participate in the program.

The Medicaid Act sets out certain parameters for states to follow, but each state is free to administer its Medicaid program as it wishes within those strictures. See 42 U.S.C. § 1396a. One such provision requires state plans to "mak[e] medical assistance available" to certain low-income individuals, including pregnant women, children, and their families; former foster children under the age of 26; the elderly; and people with certain disabilities. Id. § 1396a(a)(10)(A) ; see ECF No. 1 (Complaint), ¶ 44. In 2010, Congress enacted *243the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), "to increase the number of Americans covered by health insurance." Id., ¶ 45 (quoting Nat'l Fed'n of Indep. Bus. v. Sebelius, 567 U.S. 519, 538, 132 S.Ct. 2566, 183 L.Ed.2d 450 (2012) ). Under the ACA, states can choose to expand their Medicaid coverage to include low-income adults under 65 who would not otherwise qualify. See 42 U.S.C. § 1396a(a)(10)(A)(i)(VIII). While generally a state must cover all qualified individuals to receive any Medicaid funding, id. § 1396a(a)(10)(B), it may choose not to cover this "expansion population." Compl., ¶ 46; see NFIB, 567 U.S. at 587, 132 S.Ct. 2566. If the state decides to cover the expansion group, however, those individuals become part of the state's mandatory population.

Both before and after the ACA, a state that wishes to deviate from the Medicaid Act's requirements must obtain a Section 1115 waiver from the Secretary of HHS. See 42 U.S.C. § 1315. These waivers allow the Secretary to approve "experimental, pilot, or demonstration project[s]" in state medical plans outside of the statutory parameters of the Medicaid Act, "which, in the judgment of the Secretary, [are] likely to assist in promoting the [Act's] objectives." Id. § 1315(a). The ultimate decision whether to grant a waiver rests with the Secretary, but his discretion is not boundless. Before HHS can act on a waiver application, the state "must provide at least a 30-day public notice and comment period regarding" the proposed program and hold at least two hearings at least 20 days before submitting the application. See 42 C.F.R. §§ 431.408(a)(1), (3). Once a state completes those prerequisites, it then sends an application to CMS. Id. § 431.412 (listing application requirements). After the agency notifies the state that it has received the waiver application, a federal 30-day public-notice period commences, and the agency must wait at least 45 days before rendering a final decision. Id. §§ 431.416(b), (e)(1). Under very limited circumstances-e.g. , "natural disaster" or "public health emergency"-CMS or the Secretary may waive the federal or state public-comment period. Id. § 431.416(g).

On January 11, 2018, Brian Neale, Director of CMS, issued a letter to state Medicaid Directors "announcing a new policy designed to assist states in their efforts to improve Medicaid enrollee health and well-being through incentivizing work and community engagement among" certain adult mandatory Medicaid groups. See Compl., Exh. D at 1. The nine-page letter noted that work-requirement-based eligibility for Medicaid "is a shift from prior agency policy,"

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Bluebook (online)
308 F. Supp. 3d 239, Counsel Stack Legal Research, https://law.counselstack.com/opinion/stewart-v-azar-cadc-2018.