Westside Mothers v. Haveman

289 F.3d 852, 2002 WL 987291
CourtCourt of Appeals for the Sixth Circuit
DecidedMay 15, 2002
DocketNo. 01-1494
StatusPublished
Cited by45 cases

This text of 289 F.3d 852 (Westside Mothers v. Haveman) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Westside Mothers v. Haveman, 289 F.3d 852, 2002 WL 987291 (6th Cir. 2002).

Opinion

OPINION

MERRITT, Circuit Judge.

This suit filed under 42 U.S.C. § 1983 alleges that the state of Michigan has failed to provide services required by the Medicaid program. Plaintiffs, Westside Mothers, other advocacy and professional organizations, and eight named individuals allege that defendants James Haveman, director of the Michigan Department of Community Health, and Robert Smedes, deputy director of the Michigan Medical Services Administration, did not provide the early and periodic screening, diagnosis, and treatment services mandated by the Medicaid Act and related laws.

The Medicaid program, created in 1965 when Congress added Title XIX to the Social Security Act, provides a federal subsidy to states that choose to reimburse poor individuals for certain medical care. See 42 U.S.C § 1396 et seq. (1994 & Supp. [856]*8562001) (“Medicaid Act”); Harris v. McRae, 448 U.S. 297, 301, 100 S.Ct. 2671, 65 L.Ed.2d 784 (1980). “Although participation in the program is voluntary, participating states must comply with certain requirements imposed by the Act and regulations promulgated by the Secretary of Health and Human Services.” Wilder v. Virginia Hosp. Assoc., 496 U.S. 498, 502, 110 S.Ct. 2510, 110 L.Ed.2d 455 (1990). Like all other states, Michigan participates in the Medicaid program. Since 1997, operating under a waiver from the Health Care Finance Administration, Michigan has provided eligible residents Medicaid services by requiring them to enroll in Health Maintenance Organizations, which provide medical care in exchange for a flat monthly fee per participant. J.A. at 165-71.

The Medicaid Act and related regulations set out a detailed list of services every state program must provide. See 42 U.S.C. § 1396 et seq.; 41 C.F.R. §§ 430 ei seq. (2000). The Act allows the Secretary of Health and Human Services to limit or end payments to a state whose Medicaid program does not provide these services. See 42 U.S.C. § 1396c.

At issue here is the federal requirement that participating states provide “early and periodic screening, diagnostic, and treatment services ... for individuals who are eligible under the plan and are under the age of 21.” Id. § 1396d(a)(4)(B); see also id. § 1396d(r) (defining such services); 41 C.F.R. §§ 441.55-62 (same). The required services include periodic physical examinations, immunizations, laboratory tests, health education, see 42 U.S.C. § 1396d(r)(l), eye examinations, eyeglasses, see id. § 1396d(r)(2), teeth maintenance, see id. § 1396d(r)(3), diagnosis and treatment of hearing disorders, and hearing aids, see id. § 1396d(r)(4).

In 1999, plaintiffs sued the named defendants under § 1983, which creates a cause of action against any person who under color of state law deprives an individual of “any right, privileges, or immunities secured by the Constitution and laws” of the United States. 42 U.S.C. § 1983. They alleged that the defendants had refused or failed to implement the Medicaid Act, its enabling regulations and its policy requirements, by (1) refusing to provide, and not requiring participating HMOs to provide, the comprehensive examinations required by §§ 1396a(a)(43) and 1396d(r)(l) and 42 C.F.R. § 441.57; (2) not requiring participating HMOs to provide the necessary health care, diagnostic services, and treatment required by § 1396d(r)(5); (3) not effectively informing plaintiffs of the existence of the screening and treatment services, as required by § 1396a(a)(43); (4) failing to provide plaintiffs the transportation and scheduling help needed to take advantage of the screening and treatment services, as required by § 1396a(a)(43)(B) and 42.C.F.R. § 441.62; and (5) developing a Medicaid program which lacks the capacity to deliver to eligible children the care required by §§ 1396(a)(8), 1396a(a)(30)(A), and 1396u-2(b)(5). J.A. 38-M6.

Defendants moved to dismiss the plaintiffs and for dismissal of the suit. In 1999, the district court granted defendants’ motion to dismiss as plaintiffs four organizations.1 It dismissed the Michigan League for Human Services and the Michigan Welfare Rights Organization on the grounds that they lacked constitutional standing, and it dismissed the Michigan chapters of the American Academy of Pe[857]*857diatrics and of the American Academy of Pediatric Dentists on the grounds that they lacked prudential standing. It allowed the remaining organizations and individuals to continue as plaintiffs.

In March 2001 the district court granted defendants’ motion to dismiss all remaining claims. See Westside Mothers v. Haveman, 133 F.Supp.2d 549, 553 (E.D.Mich.2001). In a detailed and far-reaching opinion, the district court held that Medicaid was only a contract between a state and the federal government, that spending-power programs such as Medicaid were not supreme law of the land, that the court lacked jurisdiction over the case because Michigan was the “real defendant and therefore possessed] sovereign immunity against suit,” id., that in this case Ex parte Young was unavailable to circumvent the state’s sovereign immunity, and that even if it were available § 1983 does not create a cause of action available to plaintiffs to enforce the provisions in question.

This appeal followed. We reverse on all issues presented.

Analysis

A. Medicaid Contracts and the Spending Power

Much of the district court’s decision rests on its initial determinations that the Medicaid program is only a contract between the state and federal government and that laws passed by Congress pursuant to its power under the Spending Clause are not “supreme law of the land.” We address these in turn.

1. Whether Medicaid is only a contract. — The district court held that “the Medicaid program is a contract between Michigan and the Federal government.” Westside Mothers, 133 F.Supp.2d at 557. The program, it points out, is not mandatory; states choose whether to participate. See 42 U.S.C. § 1396b (empowering the Secretary to pay funds to states that submit Medicaid plans). If a state does choose to participate, Congress may then “condition receipt of federal moneys upon compliance by the recipient with federal statutory and administrative directives.” Westside Mothers,

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Bluebook (online)
289 F.3d 852, 2002 WL 987291, Counsel Stack Legal Research, https://law.counselstack.com/opinion/westside-mothers-v-haveman-ca6-2002.