United States District Court, E.D. Michigan, Northern Division
K.B. BY MOTHER, NEXT FRIEND, AND GUARDIAN T.B., ET. AL., Plaintiffs,
MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES, NICK LYON, RICHARD SNYDER, Defendants.
ORDER DENYING DEFENDANTS' MOTION FOR
L. Ludington, United States District Judge.
6, 2018, Plaintiffs filed a complaint against Defendants the
Michigan Department of Health and Human Services, Nick Lyon,
and Richard Snyder. Compl., ECF No. 1. Plaintiffs are
Michigan children and their families who claim that
Defendants are providing them with inadequate mental health
September 7, 2018, Defendants filed a motion to dismiss
Plaintiffs' claims. ECF No. 17. The order was granted in
part and denied in part. ECF No. 29. Defendants then filed a
motion for reconsideration of the Court's order. ECF No.
31. Defendants contend that the Court
“misunderstood” the legal responsibilities of
Prepaid Inpatient Health Plans and local County Medical
Health Service Programs. Id. at 1.
bring their claim as a class action on behalf of “[a]ll
current or future Michigan Medicaid beneficiaries under the
age of 21 with a behavioral, emotional, or psychiatric
disorder who are or may be eligible for, but are not
receiving, home and community-based services.” ECF No.
1 at 12. Plaintiffs contend that Defendants' failure to
provide adequate mental health care services in their homes
and communities have required some Plaintiffs to enter
institutions (such as psychiatric hospitals and juvenile
delinquency facilities) while the other Plaintiffs are at
risk of requiring institutionalization in the future.
Id. at 3.
the Medicaid program is funded through joint contributions by
federal and state governments. Id. at 15. If a state
wishes to participate in the Medicaid program and receive
federal funding, it must comply with certain requirements.
Id. at 16. One of these requirements is that it
provide Early and Periodic Screening, Diagnosis, and
Treatment services (“EPSDT”) for eligible
individuals. Id. The state of Michigan receives
Medicaid funds to assist in its facilitation and provision of
health services. Id. at 15.
the Michigan Department of Health (the
“Department”) is responsible for facilitating the
Medicaid program throughout Michigan. Id. To assist
in this, the Department has contracted with ten Prepaid
Inpatient Health Plans (“PIHPs”) and local County
Medical Health Service Programs (“CMHSP”) to
provide health services. Id. at 17. Plaintiffs
contend that the PIHPs are not fulfilling Medicaid's
requirements and as such, the Department should be held
their complaint, Plaintiffs raise six claims against
Defendants for violating the following: the federal Medicaid
EPSDT Mandate, the federal Medicaid reasonable promptness
requirement, the Americans with Disabilities Act, Section 504
of the Rehabilitation Act, the due process provisions of the
Medicaid Act, and due process rights under the Fourteenth
Amendment. In deciding Defendants' motion to dismiss, the
Court dismissed Count II and a portion of Count I of
Plaintiffs' complaint. ECF No. 32. The balance of
Plaintiffs' allegations remain intact.
their motion for reconsideration, Defendants contend that the
Court should have dismissed Counts V and VI which contain
allegations of Defendants' violations of Plaintiffs'
rights to notice and a hearing. ECF No. 31. Specifically,
Count V provides:
242. The Medicaid Act requires that participating states
provide an opportunity for a fair hearing for any individual
whose requests for Medicaid services have been denied or not
provided with reasonable promptness. 42 U.S.C. §
243. The Defendants have failed to establish and maintain
customs, policies, and practices to provide Plaintiffs and
members of the Plaintiff Class with adequate written notice
of reductions, terminations, and denials of Medicaid funded
intensive home and community-based mental health services and
their rights to a pre-termination or reduction fair hearing,
in violation of 42 U.S.C. § 1396a(a)(3), which is
enforceable by the Plaintiffs pursuant to 42 U.S.C. §
ECF No. 1 at 57.
complaint cites to 42 U.S.C. §1396a(a)(3) which provides
that a “State plan for medical assistance must --
provide for granting an opportunity for a fair hearing before
the State agency to any individual whose claim for medical
assistance under the plan is denied or is not acted upon with
reasonable promptness.” The federal regulation 42
C.F.R. §431.210 requires the State to give the
individual notice of this opportunity for a hearing. The
notice must contain:
(a) A statement of what action the agency, skilled nursing
facility, or nursing facility intends to take and the
effective date of such action;
(b) A clear statement of the specific reasons supporting the
(c) The specific regulations that support, or the change in
Federal or State law that ...