# May v. Azar

> District Court, M.D. Alabama · November 4, 2019

URL: https://www.frixlaw.com/law-library/cases/9986925

## Case

- **Court:** District Court, M.D. Alabama
- **Decided:** November 4, 2019
- **Opinion:** 100trialcourt
- **Cited by:** 0 later opinions in the Frix Law Library

## Citator (automated)

- No negative treatment found by the automated citator. That is not the same as a confirmation that the case is good law; read the citing cases.
- Full citator and citing cases: https://www.frixlaw.com/law-library/cases/9986925

## How later opinions describe it (automated extraction)

- holding a federal court may abstain from a case if (1) there is a parallel lawsuit in state court, and (2) judicial administration reasons demand abstentions

## Opinion text

IN THE UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF ALABAMA
NORTHERN DIVISION

JEAN C. MAY, by and through :
Isaac W. May, her next friend and :
attorney-in-fact, et al. :
:
Plaintiff, :
:
vs. : CIVIL ACT. NO. 2:18-cv-885-TFM-SMD
:
STEPHANIE AZAR, in her official capacity:
as Commissioner of the Alabama Medicaid :
Agency, :
:
Defendant. :

MEMORANDUM OPINION AND ORDER
Pending before the Court is Defendant Stephanie Azar’s Motion to Dismiss or, in the
Alternative Motion to Stay or, in the Alternative Motion for a More Definite Statement. Doc. 6,
filed November 6, 2018. Pursuant to Fed. R. Civ. P. 12(b)(1) and (b)(6), Defendant Azar requests
the Court dismiss Plaintiff Jean C. May’s Complaint for injunctive and declaratory relief; or in the
alternative, requests the Court stay this matter pursuant to the Colorado River abstention doctrine
while related proceedings that are on appeal before the Alabama Court of Civil Appeals conclude;
or in the alternative, requests the Court order a more definite statement pursuant to Fed. R. Civ. P.
12(e). Id. at 1. Having considered the motion and relevant law, the Court finds the motion to
dismiss is due to be GRANTED in part and DENIED in part.
I. PARTIES
Herein, the Court will refer to the parties to this action as follows: Plaintiff Jean C. May
will be referred to as “Jean May,” Plaintiff Isaac W. May will be referred to as “Isaac May,” and
they will be collectively referred to as “Plaintiffs” or the “Mays.” Defendant Stephanie Azar will
be referred to as either “Defendant” or the “Commissioner,” and the Alabama Medicaid Agency
will be referred to as the “AMA.”
II. JURISDICTION AND VENUE
The district court has subject matter jurisdiction over the claims in this action pursuant to

28 U.S.C. § 1331 (federal question) as Plaintiffs bring claims pursuant to 42 U.S.C. § 1983 for
violations of the Medicaid Act and violation of 42 U.S.C. § 1396a(a)(8).
The district court has personal jurisdiction over the claims in this action because Jean May
and Isaac May, Jean’s husband, next friend, and attorney-in-fact, are alleged to be citizens of
Montgomery County, Alabama, and Stephanie Azar is the Commissioner of the Alabama
Medicaid Agency, and are within the Court’s district. Daimler AG v. Bauman, 571 U.S. 117, 137,
134 S. Ct. 746, 760, 187 L. Ed. 2d 624 (2014) (“‘For an individual, the paradigm forum for the
exercise of general jurisdiction is the individual’s domicile; for a corporation, it is an equivalent
place, one in which the corporation is fairly regarded as at home.’ [Goodyear Dunlop Tires
Operations, S.A. v. Brown,] 564 U.S. [915,] 924, 131 S. Ct. 2846, 2854, 180 L. Ed. 2d 796, 806

(citing [Lea] Brilmayer et al., A General Look at General Jurisdiction, 66 TEX. L. REV. 721, 728
(1988)). With respect to a corporation, the place of incorporation and principal place of business
are ‘paradig[m] . . . bases for general jurisdiction.’ Id. at 735; see also [Mary] Twitchell, The Myth
of General Jurisdiction, 101 HARV. L. REV. [610,] 633.”).
Venue is proper in this Court pursuant to 28 U.S.C. § 1391(b)(1) because the events that
are described in the Complaint occurred in this district.
The parties do not contest either personal jurisdiction or venue. Defendant contests subject
matter jurisdiction because she brings her instant motion pursuant to Fed. R. Civ. P. 12(b)(1), but
as the Court has already discussed, the Court has subject matter jurisdiction over this matter and
Defendant does not distinguish in her motion between Fed. R. Civ. P. 12(b)(1) and (b)(6).
III. FACTUAL AND PROCEDURAL BACKGROUND
At all relevant times, Jean May was married to Isaac May. Doc. 1 ¶ 12. On January 13,
2016, Jean May was admitted to a nursing home, John Knox Manor. Id. ¶ 11. The Mays paid out

of pocket for Jean May to be admitted to the nursing home. Id. ¶ 13. After the Mays “spent-down”
their resources to what they understood to be the required limit for Medicaid, a Medicaid
application was filed for Jean May on February 28, 2017. Id. ¶ 14. Issac May, along with his son
and daughter-in-law, assisted Jean May with the Medicaid benefits process. Id. ¶ 15. On March
2, 2017, Medicaid supplied Isaac May with a pre-filled “Agreement to Sell” form in regard to a
junkyard that is jointly owned by the Mays. Id. ¶ 32. The “Agreement to Sell” form states, “If
this agreement is made by and with respect to an individual who is not filing for or receiving
benefits but whose resources effect the eligibility of another individual for benefits, this agreement
is required by regulations (20 C.F.R. §§ 416.1240, 416.1202, 416.1203).” Id. After Isaac May
received the “Agreement to Sell” form, he completed it and returned it signed on March 20, 2017.

Id. ¶ 35. On June 9, 2017, Medicaid denied Jean May’s application for “failure to provide
information.” Id. ¶ 17.
Jean May’s attorney requested an informal conference with Medicaid after Jean May’s
Medicaid application was denied. Id. ¶ 18. The conference was held on June 29, 2017, after which
Medicaid continued to process Jean May’s Medicaid application. Id. However, as of June 29,
2017, Medicaid had not issued a “spousal assessment” for the Mays. Id. ¶ 19. For Medicaid
eligibility purposes, a spousal assessment determines the total combined resources of an applicant
and her community spouse and states Medicaid’s calculation of how much of those joint assets
may be preserved for the community spouse, pursuant to the applicable spousal improverishment
rules. Id. ¶ 20. The spousal assessmenet is required under 42 U.S.C. § 1396r-5(c)(1)(B). Id. ¶ 21.
On June 30, 2017, Jean May’s attorney emailed Medicaid to inquire about the status of the
spousal assessment and submitted a “re-application” to preserve the maximum benefits for Jean
May in the event the first denial stood. Id. ¶ 22. On July 5, 2017, Medicaid issued the first spousal

assessment. Id. ¶ 23. On the same date, Medicaid notified Jean May’s attorney a second denial
of Jean May’s Medicaid application because of “excess resources” would issue. Id. ¶ 24.
Jean May’s attorney again requested an informal conference with Medicaid to discuss the
spousal assessment. Id. ¶ 25. The conference was held on July 7, 2017, with the Medicaid District
Office Manager and the case worker who was assigned the relevant file. Id. As a result of the
conference, the Montgomery District Office Manager requested an “interpretation request” from
the Medicaid central office. Id. ¶ 26. On August 4, 2017, Medicaid issued a second denial letter,
in which Jean May was denied Medicaid benefits for excess resources. Id. ¶ 30. Medicaid’s
position in the second denial letter was Jean May was ineligible due to excess resources because
her husband, Isaac May, owned an undivided one-half interest in a junkyard, which was listed for

sale since March 2, 2016. Id. ¶ 31. It is Medicaid’s position that the “bona fide effort to sell”
exclusion1 is not available to a married applicant and that was the reason Jean May’s Medicaid
application was denied.

1 Real property may be excluded as long as a bona fide effort is being made to sell
the property. A bona fide effort to sell is defined as an attempt to sell through listing
with a real estate agent or by attempt to sell by the owner. A period in excess of 7
days during which no attempt is made to sell voids this exclusion. To qualify for
this exclusion, the property must have been listed for sale as of the first moment of
the month that eligibility is being sought. Applicant must agree to reimburse the
Agency for expenses incurred during the effort to sell and make prompt repayment
after sale. Bona fide effort to sell will be review periodically to verify a continuing
effort.
ALA. ADMIN. CODE r. 560-X-25-.06(2)(e)5.
Jean May appealed the second denial of her Medicaid application and an administrative
fair hearing was conducted on October 13, 2017, before an Administrative Law Judge (the “ALJ”)
as the designee of the Commissioner of the AMA. Id. ¶ 40. On December 14, 2017, the ALJ
issued her Recommendation to the Commissioner of the AMA, in which she recommended both

of the decisions to deny Jean May’s Medicaid application be reversed. Id. ¶ 41. On January 12,
2018, the Commissioner accepted the ALJ’s recommendation as to the denial of Jean May’s
Medicaid application for “failure to provide information.” Id. ¶ 42. However, the Commissioner
declined to accept the ALJ’s recommendation as to the second denial of Jean May’s Medicaid
application. Id. ¶ 43.
On January 29, 2018, pursuant to the Alabama Administrative Procedures Act, a petition
for judicial review of the Commissioner’s decision was filed with the Circuit Court of Montgomery
County, Alabama. Id. ¶ 44. On August 30, 2018, the circuit court issued an order in which it
reversed the ALJ’s decision. Id. ¶ 45. The circuit court’s order was appealed to the Alabama
Court of Civil Appeals on September 27, 2018. Id.

On October 15, 2018, Jean May, by and through Isaac May, her next friend and attorney-
in-fact, and Isaac May, individually, filed this instant action against the AMA Commissioner, in
her official capacity. Id. The Mays bring against the Commissioner two claims: (1) a claim for
violation of 42 U.S.C. § 1983 because the Mays allege they were deprived of rights that are secured
to them by the Medicaid Act, 42 U.S.C. §§ 1396-1396w; 42 C.F.R. § Part 435; the Social Security
Act, 42 U.S.C. §§ 1381-1385; and 20 C.F.R. Part 416 and (2) a claim for violation of 42 U.S.C. §
1396a(a)(8) because the Mays claim the Commissioner failed to furnish Medicaid assistance to
Jean May with “reasonable promptness.” Id. ¶¶ 90-101.
On November 6, 2018, Defendant filed her Motion to Dismiss or, in the Alternative Motion
to Stay or, in the Alternative Motion for a More Definite Statement. Doc. 6. Plaintiffs timely
responded in opposition, to which Defendant replied. Docs. 13-14. The Court finds oral argument
unnecessary for resolution at this time. Therefore, the motion is fully briefed and ripe for
adjudication.

On July 31, 2019, the Court entered an Order for the parties to file a joint status report to
inform the Court about the status of the related matter that was before the Alabama Court of Civil
Appeals. Doc. 17. According to the parties’ joint status report, the appeals court issued its opinion
on Jean May’s appeal on August 2, 2019, in which it upheld the circuit court’s decision to deny
Jean May’s application for Medicaid benefits. Doc. 18-1.
IV. STANDARD OF REVIEW
A. Fed. R. Civ. P. 12(b)(1)
A Fed. R. Civ. P. 12(b)(1) motion directly challenges the district court’s subject matter
jurisdiction. McElmurray v. Consol. Gov’t of Augusta-Richmond Cty., 501 F.3d 1244, 1251 (11th
Cir. 2007); Gilmore v. Day, 125 F. Supp. 2d 468, 470 (M.D. Ala. 2000). The burden of proof for

a Fed. R. Civ. P. 12(b)(1) motion is on the party averring jurisdiction. Gilmore, 125 F. Supp. 2d
at 471 (citing Thomson v. Gaskill, 315 U.S. 442, 446, 62 S. Ct. 673, 86 L. Ed. 951 (1942)). A
motion to dismiss for lack of subject matter jurisdiction may occur either facially or factually.
Makro v. Capital of Am., Inc. v. UBS AG, 543 F.3d 1254, 1258 (11th Cir. 2008) (citing Morrison
v. Amway Corp., 323 F.3d 920, 925 n.5 (11th Cir. 2003)); Stalley v. Orlando Reg’l Healthcare
Sys., Inc., 524 F.3d 1229, 1232 (11th Cir. 2008) (citing McElmurray, 501 F.3d at 1251).
A “facial attack” is based solely on the pleadings and requires the court to assess whether
the plaintiff has alleged a sufficient basis for subject matter jurisdiction. Stalley, 524 F.3d at 1232-
33; Morrison, 323 F.3d at 925 n.5; Lawrence v. Dunbar, 919 F.2d 1525, 1529 (11th Cir. 1990).
“On a facial attack, a plaintiff is afforded safeguards similar to those provided in opposing a [Fed.
R. Civ. P.] 12(b)(6) motion -- the court must consider the allegations of the complaint to be true.”
Lawrence, 919 F.2d at 1529 (citing Williamson v. Tucker, 645 F.2d 404, 412 (5th Cir. 1981)); see
also Houston v. Marod Supermarkets, 733 F.3d 1323, 1335 (11th Cir. 2013) (evaluating whether

the plaintiff “has sufficiently alleged a basis of subject matter jurisdiction” in the complaint and
employing standards similar to those that govern a Fed. R. Civ. P. 12(b)(6) review). The Court is
“not required to accept mere conclusory allegations as true, nor are we required to accept as true
allegations in the complaint that are contrary to factual details presented in the exhibits.” Griffin
Indus., Inc. v. Irvin, 496 F.3d 1189, 1205-06 (11th Cir. 2007). “[W]hen the exhibits contradict the
general and conclusory allegations of the pleading, the exhibits govern.” Id. at 1206. When
discussing exhibits on a facial attack, the Court may consider exhibits that are attached to the
complaint as well as those attached to a motion to dismiss. Lawrence v. United States, 597 F.
App’x 599, 602 (11th Cir. 2015). Exhibits attached to the complaint are considered part of the
complaint for all purposes. Id. Further, exhibits attached to a motion to dismiss may be considered

for a facial attack if the documents are central to the plaintiff’s claim and their authenticity is not
disputed. Id.
On the other hand, a “factual attack” challenges “subject matter jurisdiction in fact,
irrespective of the pleadings.” Morrison, 323 F.3d at 925. On a Fed. R. Civ. P. 12(b)(1) factual
attack, the court “may proceed as it never could under 12(b)(6) or Fed. R. Civ. P. 56. Lawrence,
919 F.2d at 1529. Further, in resolving a factual attack, the court “may consider extrinsic evidence
such as testimony and affidavits.” Makro, 543 F.3d at 1258 (quoting Morrison, 323 F.3d at 925
n.5); accord Stalley, 524 F.3d at 1233; Miccosukee Tribe of Indians of Fla. v. U.S., E.P.A., 105
F.3d 599, 603 (11th Cir. 1997) [hereinafter Miccosukee Tribe]. “[A] trial court is free to weigh
the evidence and satisfy itself as to the existence of its power to hear the case without presuming
the truthfulness of the plaintiff’s allegations.” Makro, 543 F.3d at 1528 (citation and internal
quotation marks omitted); see also Willett v. United States, 24 F. Supp. 3d 1167, 1173 (M.D. Ala.
2014) (stating same). In other words, “the district court should apply a summary judgment

standard when ruling on the motion to dismiss as a factual attack on subject matter jurisdiction.”
Miccosukee Tribe, 105 F.3d at 603 (citing Lawrence, 919 F.2d at 1530).
However, the Court is not at liberty to weigh the evidence when the factual attack “also
implicates an element of the cause of action.” Lawrence, 919 F.2d at 1529. The Eleventh Circuit
has specifically cautioned district courts “should only rely on [Fed. R. Civ. P.] 12(b)(1) if the facts
necessary to sustain jurisdiction do not implicate the merits of plaintiff’s cause of action.”
Morrison, 323 F.3d at 925 (emphasis in original) (internal quotation marks omitted) (quoting
Garcia v. Copenhaver, Bell & Assocs., 104 F.3d 1256, 1261 (11th Cir. 1997).
B. Fed. R. Civ. P. 12(b)(6)
Pursuant to Fed. R. Civ. P. 12(b)(6), a defendant may move to dismiss a complaint on the

basis that the plaintiff has failed to state a claim upon which relief may be granted. See FED. R.
CIV. P. 12(b)(6). To survive a motion to dismiss, a plaintiff must plead “only enough facts to state
a claim to relief that is plausible on its face.” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570, 127
S. Ct. 1955, 1974, 167 L. Ed. 2d 929 (2007); see also Ashcroft v. Iqbal, 556 U.S. 662, 678, 129 S.
Ct. 1937, 1949, 173 L. Ed. 2d 868 (2009) (“To survive a motion to dismiss, a complaint must
contain sufficient factual matter, accepted as true, to ‘state a claim to relief that is plausible on its
face.’ [Twombly, 550 U.S.] at 570, 127 S. Ct. [at] 1955. A claim has facial plausibility when the
plaintiff pleads factual content that allows the court to draw the reasonable inference that the
defendant is liable for the misconduct alleged. Id. at 556, 127 S. Ct. [at] 1955.”). Since a Fed. R.
Civ. P. 12(b)(6) motion questions the legal sufficiency of a complaint, in assessing the merits of
the motion, the court must assume that all the factual allegations set forth in the complaint are true.
See, e.g., United States v. Gaubert, 499 U.S. 315, 327, 111 S. Ct. 1267, 1276, 113 L. Ed. 2d 335
(1991); Powell v. Lennon, 914 F.2d 1459, 1463 (11th Cir. 1990); but see also Iqbal, 556 U.S. at

678, 129 S. Ct. at 1949 (citing Twombly, 550 U.S. at 555, 127 S. Ct. at 1955) (“[T]he tenet that a
court must accept as true all of the allegations contained in a complaint is inapplicable to legal
conclusions. Threadbare recitals of the elements of a cause of action, supported by mere
conclusory statements, do not suffice.”). Moreover, all factual allegations shall be construed in
the light most favorable to the plaintiff. See, e.g., Brower v. County of Inyo, 489 U.S. 593, 598,
109 S. Ct. 1378, 1382, 103 L. Ed. 2d 628 (1989). Obviously, therefore, a district court may not
resolve factual disputes when adjudicating a motion to dismiss. Page v. Postmaster Gen. and
Chief Exec. Officer of the U.S. Postal Serv., 493 F. App’x 994, 995 (11th Cir. 2012) (citing, among
other cases, Lawrence v. Dunbar, 919 F.2d at 1529, for the proposition that, under Fed. R. Civ. P.
12(b)(6), the existence of disputed material facts precludes a district court from granting a motion

to dismiss). “‘When considering a motion to dismiss . . . the court limits its consideration to the
pleadings and all exhibits attached thereto.’” Thaeter v. Palm Beach Cty. Sheriff’s Office, 449
F.3d 1342, 1352 (11th Cir. 2006) (quoting Grossman v. Nationsbank, N.A., 225 F.3d 1228, 1231
(11th Cir. 2000) (per curiam)); see also Reese v. Ellis, Painter, Ratterree & Adams, LLP, 678 F.3d
1211, 1215-16 (11th Cir. 2012) (“Because the Ellis law firm’s dunning letter and enclosed
documents were attached to the Reeses’ complaint as an exhibit, we treat them as part of the
complaint for [Fed. R. Civ. P.] 12(b)(6) purposes.”).
V. DISCUSSION AND ANALYSIS
Defendant puts forth numerous arguments in support of her motion: Jean May is not
eligible for the requested Medicaid nursing home benefits based on applicable federal and state
Medicaid laws and regulations; Jean May failed to exhaust her remedies pursuant to Ala. Code
§41-22-20; the Rooker-Feldman doctrine applies; the Colorado River abstention doctrine applies;
Isaac May, in his individual capacity, lacks standing; damages in the form of Medicaid benefits

are barred by Eleventh Amendment immunity; and the AMA was unable to act with reasonable
promptness because Jean May continued to submit documents to the AMA for it to determine her
Medicaid eligibility. In the alternative, Defendant argues, should the Court deny her motion to
dismiss and alternative request for a stay under the Colorado River abstention doctrine, the Court
order a more definite statement, pursuant to Fed. R. Civ. P. 12(e). Defendant does not state under
which standard she brings each of her arguments, Fed. R. Civ. P. 12(b)(1) or (b)(6). The Court
will address each of Defendant’s arguments in turn.
A. Jean May is not Eligible for the Requested Medicaid Nursing Home Benefits Based
on Applicable Federal and State Medicaid Laws and Regulations

Defendant argues federal and state Medicaid laws and regulations do not allow excluded
from a Spousal Assessment the equity interest of non-residential real property subject to a “bona
fide effort to sell.” Doc. 6 ¶ 11. Plaintiffs argue, if their factual assertions are taken as true,
Defendant’s argument that she acted in accordance with applicable laws is insufficient to
demonstrate Plaintiffs have failed to state a claim upon which relief can be granted. Doc. 13. ¶ 24.
Plaintiffs also argue Defendant’s interpretation of federal and state Medicaid laws and regulations
is incorrect. Id. ¶ 25.
As to Plaintiffs’ first argument that, if their factual assertions are taken as true, they have
properly stated a claim, the Court notes it must accept as true all of the factual allegations in
Plaintiffs’ Complaint, but such is inapplicable to legal conclusions. Iqbal, 556 U.S. at 678. Count
1 of Plaintiffs’ Complaint states Defendant wrongly denied Jean May Medicaid benefits based on
Defendant’s interpretation of the applicable statutes. Whether Defendant wrongly interpreted
those statutes would not be contingent on Plaintiffs’ factual assertions and strictly would be a
matter of law for the Court to decide. However, Count 2 of Plaintiffs’ Complaint states Defendant
failed to determine whether Jean May was eligible for Medicaid benefits within the statutorily

mandated timeframe. Whether Defendant determined Jean May was eligible for Medicaid benefits
within the statutorily mandated timeframe would be a matter of fact. In any case, Defendant only
argues Count 1 should be dismissed because Defendant correctly denied Jean May benefits based
on the applicable statutes and regulations.
However, the same issue of whether Defendant properly denied Jean May Medicaid
benefits based on Defendant’s interpretation of the applicable statutes was litigated in the Alabama
courts, which may implicate the legal principles of res judicata, collateral estoppel, and/or
improper claim splitting.
Accordingly, the Court will deny without prejudice to reassert the motion to dismiss as to
whether Defendant properly denied Jean May Medicaid benefits and grant leave to Defendant to

reassert her argument in a new fully-briefed motion based on the current posture of the case.
B. Exhaustion of Remedies Pursuant to Ala. Code §41-22-20
Defendant argues Plaintiffs have not fully exhausted their remedies pursuant Ala. Code. §
41-22-20. Doc. 6 ¶ 14. Plaintiffs argue this Court, the Eleventh Circuit, and the Supreme Court
have concluded, under the Medicaid Act, plaintiffs are not required to exhaust their administrative
remedies under state law before they filed a § 1983 action in federal court. Doc. 13 ¶ 73; see also
Alacare, Inc.-N.v. Baggiano, 785 F.2d 963, 965-67 (11th Cir. 1986) (“The evidence of a
congressional preference for imposing an exhaustion requirement in Medicaid cases is simply
inevident . . . .”) (applying Patsy v. Fla. Bd. of Regents, 457 U.S. 496, 102 S. Ct. 2557, 73 L. Ed.
2d 172 (1982)); Planned Parenthood Se., Inc. v. Bentley, 141 F. Supp. 3d 1207, 125 (M.D. Ala.
2015) (citations omitted) (“[T]he Eleventh Circuit, like every other circuits to consider the issue,
has concluded that exhaustion is not required for claims under the Medicaid Act.”). Defendant
concedes the appeal in state court does not prevent Plaintiffs’ instant § 1983 action; however, to

the extent Plaintiffs raise violations of undisclosed state law in their claims, Defendant argues
Plaintiffs should be precluded from raising such claims. Doc. 14 at 6-7.
A review of Plaintiffs’ Complaint shows they have not raised violations of state law. See
Doc. 1.
Accordingly, Defendant’s motion to dismiss based on Plaintiffs’ failure to exhaust their
administrative remedies is denied.
C. Rooker-Feldman Doctrine
Defendant argues, based on the pending state court action, the Court should dismiss this
matter pursuant to the Rooker-Feldman doctrine. Doc. 6 ¶¶ 15-17; Rooker v. Fid. Trust Co., 263
U.S. 413, 44 S. Ct. 149, 68 L. Ed. 362 (1923); D.C. Court of Appeals v. Feldman, 460 U.S. 462,

103 S. Ct. 1303, 75 L. Ed. 2d 206 (1983). Plaintiffs argue the Rooker-Feldman doctrine is
inapplicable to this matter. Doc. 13 ¶ 76.
Rooker and Feldman exhibit the limited circumstances in which [the Supreme]
Court’s appellate jurisdiction over state-court judgments, 28 U.S.C. § 1257,
precludes a United States district court from exercising subject-matter jurisdiction
in an action it would otherwise be empowered to adjudicate under a congressional
grant of authority, e.g., § 1330 (suits against foreign states), § 1331 (federal
question), and § 1332 (diversity). In both cases, the losing party in state court filed
suit in federal court after the state proceedings ended, complaining of an injury
caused by the state-court judgment and seeking review and rejection of that
judgment.

. . .

When there is parallel state and federal litigation, Rooker-Feldman is not triggered
simply by the entry of judgment in state court.
. . .

Disposition of the federal action, once the state-court adjudication is complete,
would be governed by preclusion law.

Exxon Mobil Corp. v. Saudi Basic Indus. Corp., 544 U.S. 280, 291-93, 125 S. Ct. 1517, 1526-27,
161 L. Ed. 2d 454 (2005).
This action was commenced while the state court action was pending, which makes the
Rooker-Feldman doctrine inapplicable. See Nicholson v. Shafe, 558 F.3d 1266, 1279 (11th Cir.
2009) (“In conclusion, we agree with our sister circuits (the First, Eighth and Tenth Circuits) and
hold that state proceedings have not ended for purposes of Rooker-Feldman when an appeal from
the state court judgment remains pending at the time the plaintiff commences the federal court
action that complains of injuries caused by the state court judgment and invites review and
rejection of that judgment.”).
Accordingly, Defendant’s motion to dismiss based on the Rooker-Feldman doctrine is
denied.2
D. Colorado River Abstention Doctrine
Defendant argues the Court should stay this matter under the Colorado River abstention
doctrine while the state court action is appealed. Doc. 6 ¶¶ 18-20; Colo. R. Water Conservation
Dist. v. United States, 424 U.S. 800, 96 S. Ct. 1236, 47 L. Ed. 2d 483 (1976) (holding a federal
court may abstain from a case if (1) there is a parallel lawsuit in state court, and (2) judicial
administration reasons demand abstentions). Plaintiffs argue the Colorado River abstention

2 The Court does not have current information on the status of the state appeal after August 2,
2019. Doc. 18.
doctrine applies in only exceptional circumstances, which are not found in this case. Doc. 13 ¶¶
84-94.
“‘[A]s a threshold matter,’ a federal court may abstain under the Colorado River doctrine
only if there is a parallel state action, which is one involving ‘substantially the same parties and

substantially the same issues.’” Jackson-Platts v. GE Capital Corp., 727 F.3d 1127 1140 (11th
Cir. 2013) (quoting Ambrosia Coal and Constr. Co. v. Morales, 368 F.3d 1320, 1330 (11th Cir.
2004)).
The state court action was brought by Jean May against the AMA pursuant to the Alabama
Administrative Procedures Act, ALA. CODE § 41-22-1 through -27, and ALA. ADMIN. CODE r. 560-
x-3-.01 through .07, in which she sought judicial review of the AMA’s decision to deny her nursing
home benefits. May v. Ala. Medicaid Agency, No. 03-CV-2018-900178, Doc. 2 (15th Jud. Cir. of
Ala. Jan. 29, 2018). Specifically, Jean May argued the agency’s decision in regard to the bona-
fide effort to sell real property exemption should be reversed. Id. Here, Plaintiffs bring a claim
for violation of 42 U.S.C. § 1983 because Jean May was deprived of her rights that are secured by

the Medicaid Act, and violation of 42 U.S.C. § 1396a(a)(8) because Defendant failed to furnish
Medicaid assistance to Jean May with “reasonable promptness.” Doc. 1 ¶¶ 90-101. Plaintiffs’ §
1983 claim specifically challenges the AMA’s decision to not apply to her claim for benefits the
bona-fide effort to sell real property exemption. See Doc. 13 ¶¶ 1-5. While the issue of whether
the bona-fide effort to sell real property exemption should have been applied to Jean May’s claim
for Medicaid benefits is a common issue that is presented here and in the state court action, this
action also presents the issue of whether Defendant provided Jean May Medicaid assistance with
“reasonable promptness.” Therefore, the state court action and this action do not present
substantially the same issues. There is an entirely new claim that was not presented in the state
court action.
Accordingly, Defendant’s motion to dismiss based on the Colorado River abstention
doctrine is denied.

E. Isaac May, in His Individual Capacity, Lacks Standing
Defendant argues Isaac May, in his individual capacity, should be dismissed because he
does not have standing to bring claims based on the fact that his wife was denied Medicaid benefits.
Doc. 6 ¶¶ 21. Defendant argues Isaac May is not a real party in interest because he is neither a
Medicaid recipient nor an applicant for Medicaid benefits, and he was not a party to either the
administrative proceedings or the state court action. Id. Defendant also argues Isaac May would
not be allowed to seek a state fair hearing pursuant to the applicable regulations and statutes. Id.
Plaintiffs argue Isaac May may seek a state fair hearing pursuant to the applicable regulations and
statutes and satisfies the elements of standing. Doc. 13 ¶¶ 96-103.
The Court notes Defendant confuses “the principle of jurisdictional standing under Article

III of the United States Constitution, which would impact the court’s subject matter jurisdiction,
with the principle of real party in interest, which does not impact the court’s subject matter
jurisdiction.” Dunn v. Advanced Med. Specialties, Inc., 556 F. App’x 785, 789-90 (11th Cir. 2014)
(citing Barger v. City of Cartersville, 348 F.3d 1289, 1292 (11th Cir. 2003)).3 While, Defendant
quotes language for standing, her argument is Isaac May is not a real party in interest pursuant to
Fed. R. Civ. P. 17(a)(1).

3 In this Circuit, “[u]npublished opinions are not considered binding precedent, but they may be
cited as persuasive authority.” 11th Cir. R. 36-2 (effective Dec. 1, 2014); see also Henry v. Comm'r
of Soc. Sec., 802 F.3d 1264, 1267 n.1 (11th Cir. 2015) (per curiam) (“Cases printed in the Federal
Appendix are cited as persuasive authority.”).
“An action must be prosecuted in the name of the real party in interest.” FED. R. CIV. P.
17(a)(1). “A real party in interest is ‘the party who, by the substantive law, has the right sought to
be enforced.’” Symonette v. V.A. Leasing Corp., 648 F. App’x 787, 790 (11th Cir. 2016) (quoting
Lubbock Feed Lots, Inc. v. Iowa Beef Processors, Inc., 630 F.2d 250, 257 (5th Cir. 1980)).4

Here, Plaintiffs claim Defendant applied overly restrictive methodologies to determine
Jean May’s eligibility for Medicaid benefits. While Isaac May’s preserved community-spouse
resources are affected by Defendant’s conduct, said conduct does not affect his eligibility for
Medicaid benefits. As for Plaintiffs’ claim Defendant failed to provide them an opportunity for a
fair hearing because Defendant failed to provide Jean May with Medicaid benefits with reasonable
promptness, again, it is Plaintiffs’ claim Defendant failed to provide Jean May, not Isaac May,
with Medicaid benefits that is the impetus of the claim, which makes Jean May the real party in
interest. While Plaintiffs cite language from Ala. Admin. Code r. 560-X-3-.01(1)5 to argue Isaac
May may request a state fair hearing, Plaintiffs would seem to invite the Court to read the
regulation to allow any individual to be entitled to such a hearing rather than a claimant for medical

benefits, an invitation that the Court declines.

4 The Eleventh Circuit has adopted the decisions of the Fifth Circuit that were decided prior to
September 30, 1981, as binding precedent. Bonner v. City of Prichard, 661 F.2d 1206, 1207 (11th
Cir. 1981) (en banc).

5 An opportunity for a fair hearing shall be granted to any individual or provider of services
requesting a hearing because a claim for medical assistance or payment for services
provided a recipient is denied or is not acted upon with reasonable promptness, or because
the party is aggrieved by any other agency action regarding receipt of medical assistance
or payment for services, or by an agency policy as it affects the situation . . . .

ALA. ADMIN. CODE r. 560-X-3-.01(1).
Accordingly, Defendant’s motion to dismiss is granted as to Isaac May’s individual claims.
Isaac May’s claims that are brought on behalf of Jean May remain.
F. Eleventh Amendment Immunity
Defendant argues, to the extent Plaintiffs seek to recover damages from the AMA in the

form of Medicaid benefits for Jean May, such claims are barred by Eleventh Amendment
immunity. Doc. 6 ¶ 22. In response, Plaintiffs argue they seek only prospective relief. Doc. 13 ¶
107.
“[T]he rule has evolved that a suit by private parties seeking to impose a liability which
must be paid from public funds in the state treasury is barred by the Eleventh Amendment.”
Edelman v. Jordan, 415 U.S. 651, 663, 94 S. Ct. 1347, 1356, 39 L. Ed. 2d 662 (11th Cir. 1974)
(citations and internal quotation marks omitted). However, “the Eleventh Amendment does not
generally prohibit suits against state officials in federal court seeking only prospective injunctive
or declaratory relief, but bars suits seeking retrospective relief such as restitution or damages.” Fla
Ass’n of Rehab. Facilities v. Fla. Dep’t of Health & Rehav. Servs., 225 F.3d 1208, 1220 (11th Cir.

2000) (citations omitted).
A review of Plaintiffs’ Complaint shows the relief they seek is confined to prospective
relief as well as costs and fees pursuant to 42 U.S.C. § 1988. See Doc. 1.
Accordingly, Defendant’s motion to dismiss based on Eleventh Amendment immunity is
denied.
G. Count 2 Should be Dismissed
Defendant argues Plaintiff’s Count 2 of their Complaint should be dismissed because the
AMA was unable to act with reasonable promptness since Jean May continued to submit
documents to the AMA for it to determine her Medicaid eligibility. Doc. 6 ¶ 23. Plaintiffs argue
Defendant’s argument is improper in a motion to dismiss. Doc. 13 ¶¶ 110-12.
The Court agrees with Plaintiffs the reason for the AMA’s delay is a factual dispute that is
improper for the Court to decide by a motion to dismiss.

Accordingly, Defendant’s motion to dismiss because the AMA was unable to act with
reasonable promptness since Jean May continued to submit documents to the AMA for it to
determine her Medicaid eligibility is denied.
H. In the Alternative, Motion for More Definite Statement
Finally, Defendant requests, should the Court deny Defendant’s motion to dismiss and
alternative request for a stay under the Colorado River abstention doctrine, the Court order a more
definite statement, pursuant to Fed. R. Civ. P. 12(e).
Defendant’s alternative request for a more definite statement is denied at this time.
VI. CONCLUSION
Based on the foregoing discussion and analysis, Defendant’s Motion to Dismiss or, in the

Alternative Motion to Stay or, in the Alternative Motion for a More Definite Statement (Doc. 6)
is GRANTED in part and DENIED in part. Defendant’s motion is GRANTED as to
Defendant’s motion to dismiss Isaac May’s individual claims; otherwise, Defendant’s motion is
DENIED as discussed above.
DONE and ORDERED this the 4th day of November 2019.
/s/ Terry F. Moorer
TERRY F. MOORER
UNITED STATES DISTRICT JUDGE

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/9986925. Public record. Not legal advice.