Salazar v. District of Columbia, D.C. District Court, D.C. Circuit

Executive Summary

This class action was originally brought in 1996 on behalf of children and adults who had applied for Medicaid, with claims including that the Medicaid agency failed to: issue decisions and provide coverage within 45 days of a submitted application, provide advance notice of termination of benefits; provide or arrange for EPSDT services; and notify individuals of the availability of EPSDT services. After reaching a settlement, plaintiffs moved to conduct limited discovery regarding compliance with the settlement agreement in regards to the provision of home health care, private duty nursing, and personal care services. Defendants and two non-parties, HSCSN and McKesson, refused to provide the Interqual Clinical Decision Support Criteria in response to a discovery request, claiming the treatment guidelines were copyrighted by McKesson, were protected as a trade secret, and could only be provided under a comprehensive confidential agreement. This agreement would curtail distribution only to plaintiffs and their physicians if those services had been denied, limited, or terminated, and attorneys for the plaintiff class.

In 2009, The District Court found that the federal Medicaid statute and regulations requiring that procedures for obtaining benefits be provided in sufficient detail such that beneficiaries understand the benefits to which they are entitled were not curtailed by trade secret or similar protections. The Court ordered that the Interqual Criteria be made available to members of the Class who might be eligible for particular benefits, to counsel advising such class members, and to health care advocates advising class members about such benefits. After reconsideration in 2010, the Court found that a limited protective order was appropriate, but did not grant the breadth of protections requested and still ensured access to the Interqual Criteria for the Medicaid beneficiaries and those assisting them.