Wilson v. Long

CourtDistrict Court, M.D. Tennessee
DecidedJanuary 28, 2020
Docket3:14-cv-01492
StatusUnknown

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

Bluebook
Wilson v. Long, (M.D. Tenn. 2020).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF TENNESSEE NASHVILLE DIVISION

MELISSA WILSON, et al., ) individually and on behalf of all ) others similarly situated, ) ) Plaintiffs, ) NO. 3:14-cv-01492 ) v. ) JUDGE CAMPBELL ) MAGISTRATE JUDGE WENDY LONG, et al., ) NEWBERN ) Defendants. )

MEMORANDUM Pending before the Court is Plaintiffs’ Motion for Attorneys’ Fees and Costs. (Doc. No. 272). Through the Motion, Plaintiffs request $372,725 in attorneys’ fees and costs on the grounds that they are the prevailing party on the motion for preliminary injunction. Defendant filed a response in opposition to the Motion (Doc. No. 276) and a Notice of Supplemental Authority (Doc. No. 283). Plaintiffs replied. (Doc. Nos. 282, 284). For the reasons stated below, Plaintiffs’ Motion for Attorneys’ Fees and Costs is GRANTED in part. I. BACKGROUND On July 23, 2014, Plaintiffs filed the instant suit for themselves and on behalf of unnamed Tennesseans who applied for Medicaid coverage in Tennessee (“TennCare”) and did not receive timely eligibility determinations. Plaintiffs alleged Defendants (the “State”) was failing to provide timely determinations of TennCare eligibility, in violation of 12 U.S.C. § 1396a(a)(8) (Count I); and failing to provide any sort of fair hearing on the delayed adjudications in violation of 42 U.S.C. § 1396(a)(a)(3) and the Due Process Clause (Counts II and III). At the time the Complaint was filed, the named Plaintiffs had applications for TennCare benefits that had been pending for five to nine months without an eligibility determination. When they asked about a hearing, Plaintiffs were told “they do not do those hearings” and “there was no way [to] appeal without a determination of [their] eligibility.” (See Doc. No. 91 at 2). The Court

held a hearing on Plaintiffs’ motion to certify class and for a preliminary injunction on August 29, 2014. Before the hearing occurred, the named Plaintiffs were enrolled in TennCare. On September 2, 2014, The Court certified the following class as requested by Plaintiffs1: All individuals who have applied for Medicaid (TennCare) on or after October 1, 2013, who have not received a final eligibility determination in 45 days (on in the case of disability applicants, 90 days), and who have not been given the opportunity for a “fair hearing” by the State Defendants after these time periods have run.

(Doc. No. 90). The Court also entered a preliminary injunction ordering Defendants to provide hearing to those individuals whose applications were delayed (Doc. No 91). The Court found “it is clear that irreparable harm has occurred and will continue to occur without the issuance of injunctive relief.” The preliminary injunction ordered: The Defendants are enjoined from continuing to refuse to provide “fair hearings” on delayed adjudications, as required by 42 U.S.C. § 1396a(a)(3) and 42 C.F.R. § 435.912(c)(3). More specifically, based on these provisions, and the Fourteenth Amendment Due Process Clause, the Defendants are ordered to provide the Plaintiff Class with an opportunity for a fair hearing on any delayed adjudication. Any fair hearing shall be held within 45 days after the Class Member requests a hearing and provides the Defendants with proof that an application for medical assistance was filed (or the hearing shall be held within 90 days after that date, if the application was based on disability).

1 The Court’s certification was a more concise wording of Plaintiffs’ request. Plaintiffs had requested certification of the following class: “[A]ll individuals who have applied for TennCare on or after October 1, 2013, who have not received a final eligibility determination in a timely manner, and who have contacted the Tennessee Health Connection or its successor entity for assistance with that application.” (See Doc. No. 90). (Doc. No. 91). The preliminary injunction did not, however, grant Plaintiffs’ requested relief as to all claims. In the Motion for Preliminary Injunction (Doc. No. 4), Plaintiffs also requested injunctive relief as to Count I – requiring the State to adjudicate the Medicaid applications with “reasonable promptness,” pursuant to 42 U.S.C. § 1396(a)(8).

Shortly after the Court issued the preliminary injunction, the State enacted legislation codifying an appeals system that met the requirements of the preliminary injunction. See TENN. COMP. R. & REGS. 1200-13-19 et seq. (emergency rule filed Nov. 7, 2014). On August 10, 2016, the Court of Appeals for the Sixth Circuit affirmed the preliminary injunction ruling. (Doc. No. 159); see Wilson v. Gordon, 822 F.3d 934 (6th Cir. 2016) (affirming the district court ruling on the preliminary injunction). At trial on October 9 and 10, 2018, the parties stipulated that the State has complied with the preliminary injunction since August 2015. (Doc. No. 244 at 6). Plaintiffs stipulated the delay appeal process, codified in TennCare Rules at 1200-13-19 et seq., was available to class members upon request when their applications for Medicaid were not acted upon with reasonable

promptness. (Findings of Fact and Conclusions of Law, Doc. No. 269 at 9). The evidence presented at trial showed that, since August 2015, every delayed application processing appeal for which there was proof of a delayed application had been closed for one of the following reasons: 1) the appellant failed to provide the requested information necessary to process his/her application; 2) an eligibility determination was made and a hearing was no longer necessary; or 3) a fair hearing on the reason for the delay was provided within 45 days. (Id.). Although delays were once widespread, during 2017, the last year for which data was available at the time of the trial, fewer than 1% of applicants filed a delayed application appeal. (Id. at 10). Of those for which a delayed application appeal was filed, 100% were resolved either through a determination of eligibility or a hearing within the 45 or 90-day appeal period. (Id. at 17 n.3). At the conclusion of the trial, the Court denied Plaintiffs’ request for a permanent injunction. The problems with the TennCare application process that existed at the

commencement of the lawsuit had been corrected so that, at the time of the trial, Defendants were in substantial compliance with the law and Plaintiffs were unable to show a continuing violation of the law or any “existing or imminent invasion” of their rights. This ruling was based on the changed landscape of the Medicare application process. The Court stated: Throughout the course of this lawsuit, Plaintiffs have consistently requested (1) a declaration that Defendants are violating Section 1396a(a)(3), and (2) an injunction that requires Defendants to provide TennCare applicants with an opportunity for a fair hearing to contest delays in determining their eligibility for TennCare. The stipulated facts and evidence at trial establish Plaintiffs have received what they requested. Specifically, the parties stipulated that a delayed application appeals process is both codified in the TennCare regulations, TENN. COMP. R. & REGS. 1200-13-19 et seq., and available to all class members.

Defendants demonstrated at trial that they have no intention of abandoning this process in the absence of judicial supervision.

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Bluebook (online)
Wilson v. Long, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wilson-v-long-tnmd-2020.