Plaintiff alleged that LDH’s “decisions, policies, and procedures resulted in an illegal termination of her Medicaid benefits” following the [LDH’s] determination that she “was no longer eligible for Medicaid benefits.”
How later courts described this case
- Plaintiff alleged that LDH’s “decisions, policies, and procedures resulted in an illegal termination of her Medicaid benefits” following the [LDH’s] determination that she “was no longer eligible for Medicaid benefits.”
Written by the judges who cited it.
The opinion
UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF LOUISIANA
EARLINE J. PARKER CIVIL ACTION
VERSUS NO: 24-728
LOUISIANA DEPARTMENT
OF HEALTH SECTION: “H”
ORDER AND REASONS
Before the Court is Defendant’s Motion to Dismiss for Failure to State a
Claim (Doc. 22). For the following reasons, Defendant’s Motion is DENIED.
BACKGROUND
Plaintiff Earline J. Parker brings this lawsuit against Defendant Ralph
L. Abraham, M.D., in his official capacity as Secretary of the Louisiana
Department of Health (“LDH”), which is the agency designated by the State of
Louisiana to administer the federal Medicaid program for the State.1 Plaintiff
challenges the LDH’s “illegal termination of Medicaid assistance” under the
Medicaid Act through 42 U.S.C. § 1983.2 Plaintiff seeks reversal of the LDH’s
decision to terminate her Medicaid, a permanent injunction against the LDH
from violating the federal Medicaid statutes and regulations, a declaratory
1 Doc. 21 at 2.
2 42 U.S.C. § 1396 et seq.
1
judgment that the LDH’s Medication Eligibility policy § H-2020 is invalid, and
an award of attorney’s fees and costs.3
Plaintiff alleges the following facts. Plaintiff is a 71-year-old widow who
has sole legal custody of her six-year-old granddaughter, M.H. M.H. resides
with Plaintiff. In August of 2023, shortly before her Medicaid assistance was
terminated, Plaintiff’s monthly income was $2,119.52, which consisted of
$190.52 from a retirement pension, $1,479 in Social Security benefits, and $450
from the Kinship Care Subsidy Program through the Louisiana Department of
Children and Family Services “to help support her six year old [sic]
granddaughter, M.H.”4 At that time, Plaintiff also received Medicaid through
the Medicare Savings Program known as Qualified Individuals, which paid for
her Medicare Part B premium. M.H. receives Medicaid through a different
program.
On September 1, 2023, the LDH determined that Plaintiff’s income
exceeded the threshold for continued assistance as a Qualified Individual. This
determination was based on the LDH’s finding that Plaintiff lived in a one-
person household. The LDH closed Plaintiff’s Medicaid coverage. Plaintiff
appealed the determination, and her Medicaid was continued while her appeal
was pending. Her appeal was denied, and beginning in April of 2024, the LDH
stopped paying Plaintiff’s Medicare Part B premiums.
3 Doc. 21 at 10–11.
4 Doc. 1 at 5; Doc. 21 at 5–6. Plaintiff now receives $1,527 per month in Social Security
benefits. Doc. 21 at 5. In her Amended Complaint, On April 22, 2024, Plaintiff filed a
supplemental declaration, stating that “Medicaid stopped paying for [her] Medicare Part B
premiums of $174.70 per month, so Social Security reduces [her] retirement check to pay
for the premiums.” Doc. 18-1 at 1. Plaintiff now receives a net amount of $1,352 per month
in Social Security benefits. Doc. 18-1 at 2. Additionally, Plaintiff has now lost her Kinship
Care Subsidy due to a “paperwork problem.” Doc. 21 at 6–7.
2
On April 30, 2024, this Court granted Plaintiff’s Motion for Preliminary
Injunction, ordering Defendant to “maintain the status quo in payment of
Plaintiff’s monthly Medicare Part B premiums pending final disposition of this
matter or further order of the Court.”5 Now before the Court is Defendant’s
Motion to Dismiss for Failure to State a Claim. Plaintiff opposes.6
LEGAL STANDARD
To survive a Rule 12(b)(6) motion to dismiss, a plaintiff must plead
enough facts “to state a claim to relief that is plausible on its face.”7 A claim is
“plausible on its face” when the pleaded facts allow the court to “[d]raw the
reasonable inference that the defendant is liable for the misconduct alleged.”8
A court must accept the complaint’s factual allegations as true and must “draw
all reasonable inferences in the plaintiff's favor.”9 The Court need not,
however, accept as true legal conclusions couched as factual allegations.10
To be legally sufficient, a complaint must establish more than a “sheer
possibility” that the plaintiff's claims are true.11 “A pleading that offers ‘labels
and conclusions’ or ‘a formulaic recitation of the elements of a cause of action’”
will not suffice.12 Rather, the complaint must contain enough factual
allegations to raise a reasonable expectation that discovery will reveal evidence
of each element of the plaintiff’s claim.13 “Because of the liberal pleading
5 Doc. 20 at 13.
6 Doc. 25.
7 Ashcroft v. Iqbal, 556 U.S. 662, 667 (2009) (quoting Bell Atlantic Corp. v. Twombly, 550 U.S.
544, 547 (2007)).
8 Id.
9 Lormand v. U.S. Unwired, Inc., 565 F.3d 228, 232 (5th Cir. 2009).
10 Iqbal, 556 U.S. at 667.
11 Id.
12 Id. at 678 (quoting Twombly, 550 U.S. at 555).
13 Lormand, 565 F.3d at 255–57.
3
standard prescribed by F.R.C.P. 8(a), dismissal for failure to state a claim is
viewed with disfavor, and is rarely granted.”14
LAW AND ANALYSIS
Defendant moves this Court to dismiss Plaintiff’s claims because “[t]he
statutory authority that Plaintiff cites in her Complaint does not confer an
individual private right of action that is enforceable under 42 U.S.C. § 1983.”15
Defendant also argues that its “has correctly determined that Plaintiff is a
household of one,” and it “is not in violation of the Medicaid Act and is in
compliance with the Medicaid statutes.”16 Plaintiff responds that she asserts a
right enforceable under § 1983 according to Fifth Circuit precedent, and
Defendant’s decisions, policies, and procedures resulted in illegal termination
of her Medicaid benefits. The Court considers each of Defendant’s arguments
for dismissal in turn.
1. Private Right of Action under § 1983
Section 1983 provides that
Every person who, under color of any statute, ordinance,
regulation, custom, or usage, of any State . . . subjects or causes to
be subjected, any citizen of the United States or other person
within the jurisdiction thereof to the deprivation of any rights,
privileges, or immunities secured by the Constitution and laws,
shall be liable to the party injured in an action at law, suit in
equity, or other proper proceeding for redress.17
14 Sosa v. Coleman, 646 F.2d 991, 993 (5th Cir. 1981).
15 Doc. 22 at 3.
16 Id.; Doc. 22-1 at 1.
17 42 U.S.C. § 1983.
4
The term “laws” as used in § 1983 “is not limited to civil rights or equal
protection laws but rather embraces all federal statutes.”18 “Section 1983 is,
however, unavailable to enforce federal statutes in two settings: (1) where
Congress has foreclosed section 1983 enforcement in the enactment itself and
(2) where the statute does not create enforceable rights, privileges, or
immunities within the meaning of section 1983.”19
In her Amended Complaint, Plaintiff alleges that she “has a private right
of action to challenge illegal termination of Medical assistance under 42 U.S.C.
§ 1983.”20 Specifically, Plaintiff avers that “[i]n applying a standard that is
without basis in federal law, that only the individual and sometimes their
spouse are to be considered in determining eligibility, the Department violates
the requirements of 42 U.S.C. § 1396a(a)(8).”21 Section 1396a(a)(8) requires
that State plans for Medicaid assistance “provide that all individuals wishing
to make application for medical assistance under the plan shall have
opportunity to do so, and that such assistance shall be furnished with
reasonable promptness to all eligible individuals.”22 Thus, the Court must
consider whether § 1396a(a)(8) is a law capable of enforcement under § 1983.
The Supreme Court has set forth a tripart test for determining whether
a federal statute creates a right enforceable under § 1983:
First, Congress must have intended that the provision in question
benefit the plaintiff. Second, the plaintiff must demonstrate that
the right assertedly protected by the statute is not so “vague and
amorphous” that its enforcement would strain judicial competence.
18 Victorian v. Miller, 813 F.2d 718, 720 (5th Cir. 1987) (citing Maine v. Thiboutot, 448 U.S.
1, 4 (1980)).
19 Id. (citing Middlesex Cnty. Sewerage Auth. v. Nat’l Sea Clammers Ass’n, 453 U.S. 1, 20
(1981); Pennhurst State Sch. & Hosp. v. Halderman, 451 U.S. 1, 28 (1981)).
20 Doc. 21 at 3.
21 Id. at 10.
22 42 U.S.C. § 1396a(a)(8).
5
Third, the statute must unambiguously impose a binding
obligation on the States. In other words, the provision giving rise
to the asserted right must be couched in mandatory, rather than
precatory, terms.23
And the Supreme Court later elaborated upon this test in Gonzaga University
v. Doe, holding that nothing “short of an unambiguously conferred right” may
support a cause of action under § 1983.24
Years later, in Romano v. Greenstein, the Fifth Circuit found that §
1396a(a)(8) satisfies the Supreme Court’s three-part test and the standards set
forth in Gonzaga University v. Doe.25 Thus, the Fifth Circuit held that “the
‘reasonable promptness’ provision of § 1396a(a)(8) creates a private cause of
action enforceable under § 1983.”26 Here, Plaintiff asserts a violation of the
reasonable promptness provision of § 1396a(a)(8) and therefore asserts a right
enforceable under § 1983.
Defendant nevertheless argues that “Medicaid’s Equal Access provision
does not confer individual private rights that are enforceable under § 1983”
because it “does not create sufficient ‘rights-granting’ language” demonstrating
congressional intent to create an enforceable right.27 This argument is a
verbatim recitation of the Fifth Circuit’s rationale and holding in Equal Access
for El Paso, Inc. v. Hawkins, wherein the court considered whether the Equal
Access Provision, or 42 U.S.C. § 1396a(a)(30)(A), created a right enforceable
under § 1983.28 The Court notes, however, that § 1396a(a)(8) is the relevant
statute at issue here—not § 1396a(a)(30)(A)—and the facts before this Court
23 Blessing v. Freestone, 520 U.S. 329, 340 (1997).
24 536 U.S. 273, 288 (2002).
25 721 F.3d 373, 378–79 (5th Cir. 2013).
26 Id. at 379.
27 Doc. 22-1 at 11. Defendant does not, however, attempt to argue that Congress has
foreclosed § 1983 enforcement in the enactment itself.
28 509 F.3d 697, 703 (5th Cir. 2007).
6
are wholly distinguishable from those before the Fifth Circuit in Equal Access
for El Paso.29 In fact, Plaintiff does not cite the Equal Access provision
anywhere in her Amended Complaint.30 Without any argument as to why the
Court should adopt the Fifth Circuit’s holding in Equal Access for El Paso,
when Plaintiff asserts violation of an entirely distinct section of the Medicaid
Act—that the Fifth Circuit has held creates an enforceable right—the Court
declines to do so.
Indeed, the Court finds the facts in this case to be analogous to those in
Romano v. Greenstein, as here too, Plaintiff claims that her Medicaid
assistance was illegally terminated in violation of § 1396a(a)(8) as an eligible
individual.31 Accordingly, the Court finds that Plaintiff asserts a right
enforceable under § 1983, and Defendant’s argument fails.
2. Compliance with Medicaid Statutes
Defendant also copies and pastes the same arguments considered by this
Court in granting Plaintiff’s Motion for Preliminary Injunction—namely, that
it has complied with the Medicaid statutes. Now, Defendant seems to argue
29 See id. In Equal Access for El Paso, Inc. v. Hawkins, the Fifth Circuit considered whether
the “Equal Access” requirement
is enforceable in an action pursuant to § 1983 so as to afford declaratory and injunctive
relief because the Medicaid payment rates for the El Paso area are deficiently priced
to enlist enough providers to make medical assistance under the Plan available to the
Medicaid recipients in the El Paso area at least to the extent that such care and
services are available to the general (non-Medicaid) population in that area.”
Id. at 699. In this case, Plaintiff raises no such “Equal Access” challenge.
30 See generally Doc. 21.
31 Compare Doc. 21 (Plaintiff seeks “judicial relief under the Federal Medicaid Act through
42 U.S.C. § 1983, from decisions, procedures, and policies of the Defendant which have
illegally terminated her federal Medicaid assistance” following the LDH’s finding that she
was ineligible for the Qualified Individual program.), with Romano, 721 F.3d at 376
(Plaintiff alleged that LDH’s “decisions, policies, and procedures resulted in an illegal
termination of her Medicaid benefits” following the [LDH’s] determination that she “was
no longer eligible for Medicaid benefits.”). Though the cases involve different benefits under
the Medicaid Act, this fact did not inform the Fifth Circuit’s analysis of whether §
1396a(a)(8) itself created a right enforceable under § 1983.
7
that, because it has complied with the Medicaid statutes, Plaintiff fails to state
a claim upon which relief may be granted.
“To state a claim under § 1983, a plaintiff must allege the violation of a
right secured by the Constitution and laws of the United States, and must show
that the alleged deprivation was committed by a person acting under color of
state law.”32 A suit against a government official in his or her official capacity
is treated as a suit against the entity for whom the official works.33
Plaintiff previously received assistance pursuant to 42 U.S.C. §
1396a(a)(10)(E)(iv). Under this provision, applicants are deemed “Qualified
Individuals” if they would otherwise be qualified Medicare beneficiaries “but
for the fact that their income exceeds the income level established by the State
under section 1396d(p)(2) of this title and is at least 120 percent, but less than
135 percent, of the official poverty line . . . for a family of the size involved.”34
The Medicaid Act does not, however, define the term “family of the size
involved.” States have historically been permitted to “apply their own
reasonable definition of the phrase.”35
In her Amended Complaint, Plaintiff challenges the LDH’s application
of its definition of “family of the size involved” to exclude her minor grandchild
over whom she has sole custody.36 She therefore avers that the LDH has
32 West v. Atkins, 487 U.S. 42, 48 (1988).
33 Greer v. Tran, No. Civ.A. 02–3154, 2003 WL 21467558, at *2 (E.D. La. June 23, 2003)
(Berrigan, J.) (citing Kentucky v. Graham, 473 U.S. 159, 165–66 (1985); Baker v. Putnal,
75 F.3d 190, 195 (5th Cir. 1996)).
34 42 U.S.C. § 1396a(a)(10)(E)(iv).
35 88 Fed. Reg. 35230, 35247 (Sept. 21, 2023).
36 See, e.g., Doc. 21 at 7 (“But for LDH’s policy of considering Ms. Parker as an individual,
Ms. Parker would as of the filing of the Supplemental Complaint be eligible for Qualified
Medicare Beneficiary coverage.”); Doc. 21 at 10 (“By terminating Medicaid based on a
purported lack of eligibility, but without applying the federally mandated standard for
determining that eligibility, the Defendant violates [42 U.S.C. § 1396a(a)(8)].”).
8
violated 42 U.S.C. § 1396a(a)(8) by terminating her Medicaid assistance after
she was improperly found ineligible.?” As discussed supra, Plaintiff asserts a
right enforceable under § 1988 by alleging that the LDH violated § 1396a(a)(8).
Additionally, Plaintiff has pled facts showing that the alleged deprivation was
committed by a person acting under color of state law.*8 Accordingly, the Court
holds that Plaintiff has stated a claim upon which relief may be granted.
CONCLUSION
For the foregoing reasons, Defendant’s Motion to Dismiss for Failure to
State a Claim is DENIED.
New Orleans, Louisiana this 27th day of November, 2024.
ew,
Gg TRICHE MILAZZO
UNITED STATES DISTRICT JUDGE
37 As discussed supra, § 1396a(a)(8) requires that State plans for Medicaid assistance “provide
that all individuals wishing to make application for medical assistance under the plan shall
have opportunity to do so, and that such assistance shall be furnished with reasonable
promptness to all eligible individuals.” 42 U.S.C. § 13896a(a)(8) (emphasis added). An
implementing regulation provides that the agency must “[c]ontinue to furnish Medicaid
regularly to all eligible individuals until they are found to be ineligible.” 42 C.F.R. §
435.930(b). “This provision implies that assistance may not be terminated until an
individual is properly found ineligible.”
38 See Doc. 20 at 1 (This action seeks preliminary and permanent injunctive relief against
Defendant Ralph L. Abraham, M.D., in his official capacity as Secretary of the Louisiana
Department of Health, for Louisiana’s policies of refusing to consider an applicant’s family
size in determining income eligibility for Medicaid’s Medicare premium assistance and
denying that assistance to Plaintiff based on Defendant’s policies.”).