Court of Appeals Rules State Lacks 11th Amendment Immunity From Medicaid Suit

The U.S. Court of Appeals for the Tenth Circuit has ruled that the Eleventh Amendment cannot shield New Mexico from a suit brought by plaintiffs who experienced long delays in receiving services under a Medicaid waiver program. Lewis, et al. v. New Mexico Dept. of Health, et al. (U.S. Ct. App., 10th Cir., No. 00-2154, Aug. 16, 2001).

States participating in Medicaid may request a waiver from the Secretary of Health and Human Services allowing them to pay for home or community-based services as "medical assistance" under their Medicaid plan. 42 U.S.C. Â§ 1396n(c). New Mexico has received two such waivers permitting it to extend home or community-based services to the elderly and to those with developmental disabilities. After applying for waiver services under New Mexico's Medicaid plan, the elderly or disabled plaintiffs in this case were placed on waiting lists for as long as seven years. The plaintiffs argue that the state must provide the waiver services to which they are entitles "with reasonable promptness" as required by 42 U.S.C. Â§ 1396a(a)(8). They seek a declaration that the New Mexico Department of Health's current administration of the waiver services violates federal law and injunctive relief ordering the Department to provide the waiver services with "reasonable promptness."

The United States District Court for the District of New Mexico denied the Department's motion to dismiss based on Eleventh Amendment imunity and Federal Rule of Civil Procedure 12(b)(6). The Department appealed.

The United States Court of Appeals for the Tenth Circuit affirms the district court's denial of the motion to dismiss. The court concludes that the Department is not imune from suit under the Eleventh Amendment because the plaintiffs' claims meet the requirements of the Ex parte Young doctrine, which premits citizens to seek prospective equitable relief for violation sof federal law committed by state officials in their official capacities. Ex parte Young, 209 U.S. 123, 159-60 (1908). One requirement for applying Ex parte Young is that a plaintiffs' claims are not "wholly insubstantial and frivolous." In affirming that the plaintiffs' claims meet this requirement, the court notes that "the statute and implementing regulations at issue here are at least arguably specific enough to creat a binding obligation." The court also rejects the Department's claim that pendent jurisdiction is proper because the 12(b)(6) inquiry is inextricably intertwined with the Ex parte Young inquiry into whether the plaintiffs have alleged a violation of federal law. The court holds that Rule 12(b)(6) and the Ex parte Young doctrine are two distinct inquiries requiring the application of different standards.

However, the court raises the question of whether Â§ 1396a(a)(8) creates a federal right directly benefitting the plaintiffs. "This question," the court writes, "turns on whether the plaintiffs may be included as 'eligible individuals' under Â§ 1396a(a)(8). Whether 'eligible' means eligible for Medicaid or eligible for both Medicaid and waiver services is not entirely clear." The court finds that this inquiry is more appropriately reserved for resolution on the merits of the case.

For the full text of this decision, go to: https://www.casetext.com/case/lewis-et-al-v-new-mexico-dept-of-health

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