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Levin v. South Carolina Department of Health and Human Services

United States District Court, District of South Carolina, Columbia Division

April 20, 2015

Robert Levin, and Mary Self, Mother of Robert Levin, Plaintiffs,
v.
South Carolina Department of Health and Human Services, Defendant.

ORDER

Joseph F. Anderson, Jr. United States District Judge

I. Introduction

This case arises out of the reduction in benefits provided to a Medicaid-eligible individual and seeks to challenge the policies and procedures in the operation of the Head and Spinal Cord Injury (“HASCI”) Medicaid waiver program. In the Second Amended Complaint, Robert Levin (“Levin”), and Mary Self (“Self”), Mother of Robert Levin (collectively “Plaintiffs”) allege numerous causes of action; however, as a result of dispositive motions and a bench trial, [1] Plaintiffs’ only remaining cause of action is for violation of 42 U.S.C. § 1983 against the South Carolina Department of Health and Human Services (“SDHHS”).[2] (ECF No. 72). The Order issued at the conclusion of the bench trial specifically requested briefing by the parties on the § 1983 claim. (ECF No. 184). In light of those briefs and the Court’s previous rulings in this case, the Court makes the following ruling as to Plaintiffs’ § 1983 claims.

II.42 U.S.C. § 1983 Claims

Plaintiffs have listed seven specific provisions of the Medicaid Act which they allege have been violated by SCDHHS in its administration of services to Levin under the HASCI waiver program.

A. 42 U.S.C. § 1396a(a)(3) – Fair Hearing

The Fair Hearing provision of the Medicaid Act requires all States provide an opportunity for a fair hearing before the State Agency to any individual whose request for services is denied or is not acted upon with reasonable promptness. Plaintiffs assert SCDHHS has violated this hearing requirement “by failing to establish a hearing system meeting the requirements of Goldberg v. Kelly and the due process requirements of the United States Constitution. The hearing system operated by the State is arbitrary and capricious and it is designed to exhaust all resources of appellants through endless delays and remands and retaliation against persons who challenge DDSN and DHHS. This system fails to provide a final administrative determination within 90 days . . .” (ECF No. 187).

As already noted by the Court in the Order on the parties cross motions for summary judgment, Levin never alleged in the Complaint that he was denied a fair hearing, and there is no evidence in the record to substantiate a claim that he ever requested review or reconsideration from SCDHHS after the HASCI waiver caps were implemented. (ECF No. 131). The substance of Levin’s claim for violations of statutory and constitutional due process merely allege that any appeal, had it been taken, would have been futile. As already explained by the Court in its previous Order, these speculative allegations do not give rise to a due process violation. Accordingly, the Court also finds that there has been no violation by SCDHHS of the Fair Hearing provision of the Medicaid Act as to Levin.

B. 42 U.S.C. § 1396a(a)(8) – Reasonable Promptness

The Reasonable Promptness provision of the Medicaid Act provides, “all individuals who wish to make an application of medical assistance under the plan shall have an opportunity to do so, and that such assistance shall be furnished with reasonable promptness to all eligible individuals.” 42 U.S.C. § 1396a(a)(8). Plaintiffs have alleged that SCDHHS has failed to actually provide the services requested with reasonable promptness because the services were not given within ninety (90) days of the request.

Similarly to the Fair Hearing requirement, the Court has already determined that Levin has not articulated a Reasonable Promptness claim. Specifically, this Court stated, “[t]he complaint also alleges SCDHHS did not act with reasonable promptness in rendering a final state agency determination by failing to adhere to the requirement that such decisions be made within ninety (90) days. However, this allegation is only applicable to Stogsdill because Levin never requested state agency review.” (ECF No. 131, fn 13). As such, Levin has not alleged a Reasonable Promptness violation.

Moreover, to the extent Levin intends to raise the 2014 request for nursing services as grounds for his Reasonable Promptness claim, the Court has already determined that this claim is not ripe, as more fully articulated in the Court’s Order ruling on the bench trial. (ECF No. 184). Therefore, the Court finds there has been no violation by SCDHHS of the Reasonable Promptness provision of the Medicaid Act as to Levin.

C. 42 U.S.C. § 1396a(a)(10) – Amount, Duration, and Scope

The sufficiency provision of the Medicaid Act requires that the State provide medical assistance to an individual in the same amount, duration, and scope as the medical assistance provided to other participants. The Medicaid Act also requires comparability of services for all recipients. However, a limitation on these requirements exists, which provides, “if CMS has approved a waiver of Medicaid requirements under § 431.55, services may be limited as provided by the waiver.” 42 C.F.R. ...


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