D.C. Medicaid prescription drug denials case: NB v. District of Columbia

United States Court of Appeals For the District of Columbia Circuit
Argued April 16, 2012
Decided June 8, 2012 
No. 11-7084 
Appeal from the United States District Court for the District of Columbia (No. 1:10-cv-01511) 
Bruce J. Terris argued the cause for appellants. With him on the briefs were Kathleen L. Millian, Jane M. Liu, and Jane Perkins.
Rochelle Bobroff was on the brief for amicus curiae Legal Aid Society of the District of Columbia, et al., in support of appellants.
Richard S. Love, Senior Assistant Attorney General, Office of the Attorney General for the District of Columbia, argued the cause for appellees. With him on the brief were Irvin B. Nathan, Attorney General, Todd S. Kim, SolicitorGeneral, and Donna M. Murasky, Deputy Solicitor General.
Before: TATEL and KAVANAUGH, Circuit Judges, and GINSBURG, Senior Circuit Judge.
Opinion for the Court filed by Circuit Judge TATEL.
TATEL, Circuit Judge: Five Medicaid recipients filed this class action against the District of Columbia, alleging that the District systematically denies Medicaid coverage of prescription medications without providing the written notice required by federal and D.C. law. The district court dismissed the case on the pleadings, concluding that plaintiffs lacked standing to pursue their claims for injunctive and declaratory relief. Because we believe that the facts alleged in the complaint are sufficient to establish standing, we reverse.
I. Medicaid is a ?cooperative federal-state program that provides federal funding for state medical services to the poor.? Frew v. Hawkins, 540 U.S. 431, 433 (2004). States electing to participate in Medicaid must comply with requirements imposed by federal law. Id. As relevant here, federal regulations mandate procedural protections for Medicaid recipients, including provision of written notice ?[a]t the time of any action affecting [a Medicaid recipient?s] claim.? 42 C.F.R. § 431.206(b), (c)(2). Such notice must contain a statement of what action the state intends to take, the reasons for that action, the specific regulations supporting the action, the individual?s right to a hearing, and an explanation of the circumstances under which coverage will be continued if a hearing is requested. Id. § 431.210. District of Columbia law imposes the same requirements. D.C. Code § 4-205.55.

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