Bontrager v. Indiana Family & Social Services Administration , 697 F.3d 604 ( 2012 )


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  •                              In the
    United States Court of Appeals
    For the Seventh Circuit
    No. 11-3710
    S ANDRA M. B ONTRAGER, on her own behalf and
    on behalf of a class of those similarly situated,
    Plaintiff-Appellee,
    v.
    INDIANA F AMILY AND S OCIAL S ERVICES A DMINISTRATION,
    M ICHAEL A. G ARGANO , and P ATRICIA C ASANOVA,
    Defendants-Appellants.
    Appeal from the United States District Court
    for the Northern District of Indiana, South Bend Division.
    No. 3:11-cv-216—Philip P. Simon, Chief Judge.
    A RGUED JUNE 4, 2012—D ECIDED S EPTEMBER 26, 2012
    Before K ANNE, W OOD , and T INDER, Circuit Judges.
    K ANNE, Circuit Judge. On May 5, 2011, Sandra M.
    Bontrager filed a putative class action complaint chal-
    lenging Indiana’s $1,000 annual limit for dental services
    covered by Medicaid. The district court granted
    Bontrager’s request for a preliminary injunction, holding
    2                                                No. 11-3710
    that Indiana is required to cover all medically necessary
    dental services, irrespective of the monetary cap.
    We affirm.
    I. B ACKGROUND
    The Medicaid program, 
    42 U.S.C. § 1396
     et seq., allows
    states to provide federally subsidized medical assistance
    to low-income individuals and families. Collins v.
    Hamilton, 
    349 F.3d 371
    , 374 (7th Cir. 2003). “Although
    participation in Medicaid is optional, once a state has
    chosen to take part . . . it must comply with all federal
    statutory and regulatory requirements.” Miller ex rel.
    Miller v. Whitburn, 
    10 F.3d 1315
    , 1316 (7th Cir. 1993).
    Indiana participates in the Medicaid program and is
    therefore bound by its rules and regulations. See 
    Ind. Code § 12-15-1-1
     et seq.
    Under federal Medicaid law, “[a] State plan for
    medical assistance must . . . provide . . . for making
    medical assistance available . . . to all [eligible] individu-
    als.” 42 U.S.C. § 1396a(a)(10). “Medical assistance”
    includes “dental services,” but coverage for these services
    is not required. 42 U.S.C. §§ 1396a(a)(10)(A), 1396d(a)(10).
    Under its Medicaid plan, Indiana elects to cover certain
    dental services, see 
    405 Ind. Admin. Code 5
    -14-1 et seq.,
    that are “medically reasonable and necessary” and not
    listed as “noncovered” or otherwise excluded, 
    id.
     at 5-2-
    17(1)-(2). Whether a service is “medically reasonable
    and necessary” is determined by utilizing “generally
    accepted standards of medical or professional practice.”
    No. 11-3710                                                3
    
    Id.
     at 5-2-17(1). Even if medically necessary, “covered
    services routinely provided in a dental office will be
    limited to one thousand dollars ($1,000) per recipient,
    per twelve (12) month period.” 
    Id.
     at 5-14-1(b). This
    $1,000 limit, a cost-cutting measure for Indiana, went
    into effect on January 1, 2011.
    Bontrager is an Indiana Medicaid recipient in need of
    significant dental services, including two endosteal
    implants and two implant abutments for her lower
    jaw. Bontrager sought payment of these services through
    Medicaid, but her claim, although covered and medically
    necessary, was denied to the extent her requested treat-
    ment exceeded the $1,000 annual limit. Bontrager’s medi-
    cally necessary procedures, considered separately or in
    combination, exceed this cap and she is unable to
    pay for the services on her own.
    Bontrager’s lawsuit alleges that the Indiana Family
    and Social Services Administration, which administers
    Indiana’s Medicaid program, and its individually
    named administrators (collectively, the “State”), violated
    state and federal Medicaid laws by instituting the
    $1,000 annual cap on dental services, even when such
    services are covered and medically necessary. Bontrager’s
    federal claim seeks injunctive and declaratory relief
    under 
    42 U.S.C. § 1983
     for the State’s violation of 42 U.S.C.
    § 1396a(a)(10). On November 4, 2011, the district court
    granted a preliminary injunction, preventing the State
    from enforcing its $1,000 cap on dental services. This
    matter is now before us on interlocutory appeal. See 
    28 U.S.C. § 1292
    (a)(1).
    4                                               No. 11-3710
    II. A NALYSIS
    The State presents two issues for our consideration:
    (1) whether Bontrager has a private right of action under
    
    42 U.S.C. § 1983
     for a violation of 42 U.S.C. § 1396a(a)(10),
    and (2) whether the district court erred in granting
    the preliminary injunction. We consider each of these
    questions in turn.
    A. Private Right of Action
    First we must consider, as the district court did, whether
    Bontrager has a private right of action to challenge Indi-
    ana’s $1,000 annual limit on dental services covered by
    Medicaid under 
    42 U.S.C. § 1983
    . “In order to seek redress
    through § 1983, . . . a plaintiff must assert the violation
    of a federal right, not merely a violation of federal law.”
    Blessing v. Freestone, 
    520 U.S. 329
    , 340 (1997). “Once a
    plaintiff demonstrates that a statute confers an indi-
    vidual right, the right is presumptively enforceable by
    § 1983.” Gonzaga Univ. v. Doe, 
    536 U.S. 273
    , 284 (2002).
    Generally, we consider three factors to determine if
    a statute creates an enforceable right: (1) whether
    Congress intended the provision to benefit the plaintiff,
    as evidenced by “rights-creating” language, see id.;
    (2) whether the right is not so “vague and amorphous”
    that its enforcement would strain judicial competence;
    and (3) whether the statute unambiguously imposes
    a binding obligation on the States, such that the provi-
    sion is “couched in mandatory, rather than precatory,
    terms.” Blessing, 
    520 U.S. at 340-41
    .
    No. 11-3710                                                  5
    Bontrager’s § 1983 claim is based upon an implied right
    of action conferred by the federal Medicaid statute,
    42 U.S.C. § 1396a(a)(10)(A). In Miller, we considered
    whether this same provision creates an enforceable
    federal right under § 1983. 
    10 F.3d at 1319
    . We
    answered that question in the affirmative, and held that
    § 1396a(a)(10)(A) satisfies the standard set forth in
    Wilder v. Virginia Hospital Association, 
    496 U.S. 498
    ,
    509 (1990), and permitted the plaintiff to challenge Wis-
    consin’s classification of a liver-bowel transplant as “ex-
    perimental.” 
    10 F.3d at 1319-20
    . In Wilder, the Supreme
    Court determined that a portion of the Medicaid Act
    governing reimbursement of health care providers
    was enforceable pursuant to § 1983. 
    496 U.S. at 509-10
    . In
    doing so, the Court found that the provision at issue
    was intended to benefit the putative plaintiff, the
    statute created a binding obligation on the govern-
    mental unit, and the plaintiff’s interests were not too
    vague and amorphous for courts to enforce. 
    Id. at 509
    .
    The State argues that Miller no longer governs
    because the post-Wilder cases of Blessing and Gonzaga
    changed the standard for determining whether a
    private right of action exists. Although we have acknowl-
    edged that Gonzaga “may have taken a new analytical
    approach,” Bertrand ex rel. Bertrand v. Maram, 
    495 F.3d 452
    , 456 (7th Cir. 2007), Wilder has not been overruled,
    id.; cf. State Oil Co. v. Khan, 
    522 U.S. 3
    , 20 (1997) (“[I]t is
    [the Supreme Court’s] prerogative alone to overrule one
    of its precedents.”). Further, post-Blessing and Gonzaga,
    several circuit courts have held that the Medicaid
    provision at issue creates an enforceable federal right.
    6                                                  No. 11-3710
    See, e.g., Watson v. Weeks, 
    436 F.3d 1152
    , 1159-61 (9th Cir.
    2006); Sabree ex rel. Sabree v. Richman, 
    367 F.3d 180
    ,189-
    92 (3d Cir. 2004); S.D. ex rel. Dickson v. Hood, 
    391 F.3d 581
    , 604-06 (5th Cir. 2004). We find the reasoning of
    these courts persuasive and reaffirm Miller’s holding.
    Accordingly, Bontrager has an enforceable federal right
    capable of redress through § 1983, and her claim may
    proceed.
    B. Preliminary Injunction
    We next consider whether the district court properly
    granted Bontrager’s motion for a preliminary injunction.
    On appeal, we review the district court’s grant of a pre-
    liminary injunction by considering its legal rulings
    de novo, its factual determinations for clear error, and its
    balancing of the factors for an abuse of discretion.
    Pro’s Sports Bar & Grill, Inc. v. City of Country Club Hills,
    
    589 F.3d 865
    , 870 (7th Cir. 2009). To justify a
    preliminary injunction, Bontrager must show that she is
    “likely to succeed on the merits, . . . likely to suffer irrepa-
    rable harm without the injunction, that the harm [she]
    would suffer is greater than the harm that the
    preliminary injunction would inflict on the defendants,
    and that the injunction is in the public interest.” Judge v.
    Quinn, 
    612 F.3d 537
    , 546 (7th Cir. 2010).
    To determine Bontrager’s likelihood of success, we
    must take a closer look at the applicable state and
    federal Medicaid statutes and regulations. As noted
    previously, Indiana voluntarily participates in the Medi-
    No. 11-3710                                                 7
    caid program and provides Medicaid coverage for
    dental services. 
    Ind. Code § 12-15-5-1
    . This coverage
    includes only those dental services listed in Indiana’s
    Administrative Code. 
    405 Ind. Admin. Code 5
    -14-1(a), 5-14-
    2. The dental service must be a “medically reasonable
    and necessary service,” which is defined as “a covered
    service . . . that is required for the care or well being of
    the patient and is provided in accordance with
    generally accepted standards of medical or professional
    practice.” 
    Id.
     at 5-2-17. 1 To be reimbursable, a service
    must be “medically reasonable and necessary,” a deter-
    mination made by utilizing “generally accepted
    standards of medical or professional practice,” 
    id.
     at 5-2-
    17(1), and not listed as a noncovered service or other-
    wise excluded from coverage, 
    id.
     at 5-2-17(2).
    Neither party disputes that the State is required to
    provide Medicaid coverage for medically necessary
    treatments in those service areas that the State opts to
    provide such coverage (such as dental services). The
    district court thoroughly discussed this issue, Bontrager
    v. Ind. Family & Soc. Servs. Admin., 
    829 F. Supp. 2d 688
    , 696-
    98 (N.D. Ind. 2011), and its opinion is well-supported
    by state and federal case law. See, e.g., Beal v. Doe, 
    432 U.S. 438
    , 444 (1977) (“[S]erious statutory questions
    1
    A “covered service” is defined as “a service provided by a
    Medicaid provider for a Medicaid recipient for which
    payment is available under the Indiana Medicaid program
    subject to the limitations of [
    405 Ind. Admin. Code 5
    ].” 
    405 Ind. Admin. Code 5
    -2-6.
    8                                              No. 11-3710
    might be presented if a state Medicaid plan excluded
    necessary medical treatment from its coverage . . . .”);
    Lankford v. Sherman, 
    451 F.3d 496
    , 511 (8th Cir. 2006)
    (“While a state has discretion to determine the
    optional services in its Medicaid plan, a state’s failure
    to provide Medicaid coverage for non-experimental,
    medically-necessary services within a covered Medicaid
    category is both per se unreasonable and inconsistent
    with the stated goals of Medicaid.”); Thie v. Davis,
    
    688 N.E.2d 182
    , 186 (Ind. Ct. App. 1997) (Indiana
    Medicaid statute’s “language is unequivocal” such that
    “medically necessary treatment must be covered.”).
    But even though a state is required to cover all
    medically necessary treatments in those service areas
    in which the state opts to provide coverage, federal reg-
    ulations grant a state considerable leeway in carrying
    out its plan. Under those regulations, a state’s Medicaid
    plan must “specify the amount, duration, and scope of
    each service that it provides,” 
    42 C.F.R. § 440.230
    (a), and
    “[e]ach service must be sufficient in amount, duration,
    and scope to reasonably achieve its purpose,” 
    id.
    § 440.230(b). Accord 
    Ind. Code § 12-15-21-3
    (3) (permitting
    the State to establish limitations “consistent with
    medical necessity concerning the amount, scope, and
    duration of the services and supplies to be provided”).
    Yet the State “may place appropriate limits on a
    service based on such criteria as medical necessity or
    on utilization control procedures.” 
    42 C.F.R. § 440.230
    (d).
    The regulations do not define “utilization control pro-
    cedures.”
    No. 11-3710                                               9
    The State’s primary argument is that Medicaid re-
    cipients in need of medically reasonable and necessary
    dental services over $1,000 are not categorically ex-
    cluded from receiving such treatments; instead, their
    treatments are merely subject to an appropriate, lawful
    limitation put in place by the State. Thus, the State
    asserts it is providing the necessary coverage required
    under Medicaid. In this way, the State believes the
    present case differs from other Indiana Medicaid cases
    involving the categorical exclusion of medically necessary
    treatments. In Thie, for instance, the Indiana Court of
    Appeals examined the State’s exclusion of dentures from
    dental service coverage, and held that the exclusion was
    inconsistent with the State’s definition of medical neces-
    sity. 
    688 N.E.2d at 188
    . Because “federal law requires that
    medically necessary dental treatments be covered,” 
    id. at 186
    , and the State’s dentures regulation excluded
    medically necessary treatment, the court determined
    that the regulation was invalid, 
    id. at 188
    . Accord Coleman
    v. Ind. Family & Soc. Servs. Admin., 
    687 N.E.2d 366
    , 369
    (Ind. Ct. App. 1997) (regulation excluding partial
    dentures was invalid where treatment was deemed
    medically necessary). Similarly, in Davis v. Schrader, the
    court held that the exclusion of orthopedic shoes was
    inconsistent with the State’s definition of medical neces-
    sity, which required the item to be “necessary for the
    treatment of an illness or injury or to improve the func-
    tioning of a body member.” 
    687 N.E.2d 370
    , 373-74 (Ind.
    Ct. App. 1997) (quoting 
    405 Ind. Admin. Code 1
    -6-
    12(h)(1)(A) (repealed)).
    In contrast to Thie, Coleman, and Davis, the State asserts
    that the $1,000 cap does not prevent coverage of any
    10                                             No. 11-3710
    medically necessary dental procedures, but operates as
    an appropriate limitation authorized by 
    42 C.F.R. § 440.230
    and 
    Ind. Code § 12-15-21-3
    (3). The district court found
    problems with this reasoning, noting that the cap
    conflicts with our traditional understanding of insurance
    coverage. Bontrager, 829 F. Supp. 2d at 699 (“This is a
    bizarro-world notion of insurance coverage: once the
    insurance provider (the State) meets the initial deductible
    ($1,000), the insured is left covering all the remaining
    costs. Under any commonsense notion, this is not insur-
    ance ‘coverage.’ ”). We agree with the district court that
    the cap prevents the State from providing coverage for
    all medically necessary services, and partial payment
    for such services does not constitute “some coverage,”
    as the State would have us believe. To illustrate, a medi-
    cally necessary procedure that costs $1,200 is not “cov-
    ered” since the State’s cap prevents full reimbursement
    to the provider. Although the State agrees to pay $1,000,
    an indigent individual will likely be unable to pay the
    remaining $200 and will have to go without the proce-
    dure. The State’s monetary contribution has no
    effect (i.e., the State ends up paying nothing) and the
    Medicaid recipient is left without recourse. And if the
    indigent individual has already used a portion of her
    $1,000 allotment toward other dental services, she
    would be required to come up with even more money
    to pay for the procedure.
    According to the State’s own documentation, the effec-
    tive rates for at least three dental procedures exceed
    the $1,000 cap and are therefore—like the treatments in
    Thie, Coleman, and Davis—categorically excluded from
    No. 11-3710                                               11
    coverage. See Ind. Health Coverage Programs, IHCP
    bulletin, BT201012 (April 15, 2010), available at
    http://www.indianamedicaid.com/ihcp/Bulletins/BT2010
    12.pdf. For instance, a “Mandible—closed reduction”
    procedure costs $1,247.59, a “Mandible—open reduction”
    procedure costs $2,396.14, and a “Facial bones—compli-
    cated reduction” procedure costs $1,114.35. Id. Because
    of the $1,000 cap, the State’s Medicaid program will
    not cover these procedures, despite their medical neces-
    sity. Accord Montoya v. Johnston, 
    654 F. Supp. 511
    , 514 (W.D.
    Tex. 1987) (“[T]he $50,000 Medicaid cap is arbitrary and
    unreasonable in that it functionally excludes the Plain-
    tiffs’ [$200,000] liver transplants from medicaid cover-
    age.”). As noted previously, even if the State offers to pay
    $1,000 toward these treatments, a Medicaid recipient is
    effectively precluded from receiving such treatments
    because the leftover balance remains unpaid.
    In finding that the $1,000 cap does not provide
    coverage for all medically necessary procedures, it is
    important to distinguish this case from other cases
    which have upheld similar numerical constraints. For
    instance, in Charleston Memorial Hospital v. Conrad, the
    Fourth Circuit upheld South Carolina’s reductions in
    inpatient and outpatient hospital coverage. 
    693 F.2d 324
    , 330 (4th Cir. 1982). Medicaid recipients were
    limited to twelve inpatient visits and eighteen out-
    patient visits per year. 
    Id.
     The Fourth Circuit held that
    the limitations would still meet the needs of most
    eligible recipients, and therefore, were sufficient to
    satisfy federal law. 
    Id.
     Similarly, in Curtis v. Taylor, the
    Fifth Circuit upheld Florida’s limitation on reimburse-
    12                                              No. 11-3710
    ment for up to three physician visits per month (except
    in emergency medical situations). 
    625 F.2d 645
    , 652 (5th
    Cir. 1980). The court held that Florida could limit
    services “based upon a judgment of degree of medical
    necessity so long as it does not discriminate on the basis
    of the kind of medical condition that occasions the
    need.” 
    Id.
     Finally, in Grier v. Goetz, Tennessee’s five-
    prescription-per-month limitation was upheld because
    “the evidence presented does not demonstrate that
    most [Medicaid] enrollees will not receive medically
    necessary treatment or that their access to such treat-
    ment will be severely curtailed as a result of the [lim-
    itation].” 
    402 F. Supp. 2d 876
    , 913 (M.D. Tenn. 2005).
    In contrast to Charleston Memorial, Curtis, and Grier, the
    $1,000 cap in this case denies coverage for medically
    necessary services outright by functionally excluding
    certain procedures. The cap is not in any way based on
    degree or consideration of medical necessity. Moreover,
    in those cases, the limitations were “soft,” i.e., excep-
    tions could be granted. Charleston Memorial, 
    693 F.2d at
    327 n.5 (exceptions for “certain vital health care
    needs”); Curtis, 
    625 F.2d at 652
     (exceptions for emer-
    gency services); Grier, 
    402 F. Supp. 2d at 914
     (exceptions
    on case-by-case basis and shortlist of exempt drugs).
    Here, the $1,000 cap applies without exception to all
    medically necessary, routine dental services. See 
    405 Ind. Admin. Code 5
    -14-1(b). Thus, even though the State
    asserts that the $1,000 cap still serves over 99% of the
    State’s Medicaid recipients, the dental services provided
    are not “sufficient in amount, duration, and scope to
    reasonably achieve [their] purpose.” 
    42 C.F.R. § 440.230
    (b).
    No. 11-3710                                             13
    The purpose of Medicaid dental services is to provide
    reimbursement for routine dental treatments to
    medically needy, indigent individuals. But, in light of
    the $1,000 cap, these services are, in some cases, com-
    pletely excluded from coverage. As the district court
    noted, “when a service goes completely unprovided, it
    has obviously not been provided in an amount sufficient
    to achieve its purpose.” Bontrager, 829 F. Supp.2d at 703.
    We also disagree with the State’s classification of the
    $1,000 cap as a “utilization control procedure.” As noted
    previously, this term is undefined in the state and
    federal regulations. But cases from other jurisdictions
    have offered various interpretations of the term. First,
    Grier held that a five-prescription-per-month limitation
    was a proper utilization control procedure, 
    402 F. Supp. 2d at 911
    , but we have already distinguished Grier’s limita-
    tion from the $1,000 cap. Other courts hold that a
    prior authorization system is an acceptable utilization
    control procedure. See, e.g., Ladd v. Thomas, 
    962 F. Supp. 284
    , 294 (D. Conn. 1997) (citing Jeneski v. Myers, 
    209 Cal. Rptr. 178
    , 187 (Cal. Ct. App. 1984)). One state court
    has held that a points system used to determine the
    medical necessity of orthodontic treatment is a rea-
    sonable utilization control procedure. Semerzakis v.
    Comm’r of Soc. Servs., 
    873 A.2d 911
    , 929 (Conn. 2005).
    The Southern District of New York notes that a state
    is permitted to use reasonable utilization control proce-
    dures “to limit unnecessary utilization of Medicaid ser-
    vices,” but an arbitrary cap on personal home-care
    services, applicable only to new Medicaid recipients,
    was not an appropriate utilization control procedure.
    14                                            No. 11-3710
    DeLuca v. Hammons, 
    927 F. Supp. 132
    , 136 (S.D.N.Y. 1996).
    Finally, the Eastern District of Michigan has held that
    “[p]rocedures to promote utilization control cannot
    justify precluding funding of medically necessary proce-
    dures.” Allen v. Mansour, 
    681 F. Supp. 1232
    , 1239 (E.D.
    Mich. 1986).
    None of these cases indicate that a state’s monetary
    cap on medically necessary services constitutes a rea-
    sonable utilization control procedure. The State’s $1,000
    cap is certainly not a prior authorization process,
    or similarly designed to control access, prevent fraud, or
    streamline efficiency. Nor is it used as a resource to
    determine the medical necessity of a procedure, as
    in Semerzakis. We have already determined that the
    cap excludes medically necessary treatment, so the cap
    cannot be designed to limit only medically unnecessary
    coverage. Whatever the interpretation of “utilization
    control procedure,” we do not believe implementation
    of such a procedure allows a state to shirk its primary
    obligation to cover medically necessary treatments.
    Accordingly, the State’s monetary cap, which serves to
    exclude medically necessary treatment, is not a utiliza-
    tion control procedure.
    Having determined that Bontrager has some likeli-
    hood of success on the merits, we turn to the remaining
    preliminary-injunction considerations. “These consider-
    ations are interdependent: the greater the likelihood of
    success on the merits, the less net harm the injunction
    must prevent in order for preliminary relief to be war-
    ranted.” Judge, 
    612 F.3d at 546
    . We agree with the
    district court that Bontrager and similarly situated indi-
    No. 11-3710                                               15
    viduals will likely suffer irreparable harm if the
    injunction is not granted, as they would be denied medi-
    cally necessary care. Bontrager, 829 F. Supp. 2d at 705
    (citing cases); accord Camacho v. Tex. Workforce Comm’n,
    
    326 F. Supp. 2d 794
    , 802 (W.D. Tex. 2004); Olson v. Wing,
    
    281 F. Supp. 2d 476
    , 486 (E.D.N.Y.) (“The award of retro-
    active benefits cannot ameliorate the harm suffered if
    such a recipient should be forced by circumstances to
    [forgo] treatment or medication.”), aff’d, 66 F. App’x
    275 (2d Cir. 2003).
    In light of the irreparable harm facing Bontrager and
    her likelihood of success on the merits, the balance of
    the equities likely also favors Bontrager. In making this
    determination, we consider whether “the harm to the
    defendant would substantially outweigh the benefit to
    the plaintiff.” Michigan v. U.S. Army Corps of Eng’rs,
    
    667 F.3d 765
    , 789 (7th Cir. 2011). The State’s potential
    budgetary concerns are entitled to our consideration,
    but do not outweigh the potential harm to Bontrager
    and other indigent individuals, especially when the
    State’s position is likely in violation of state and federal
    law. See Tallahassee Mem’l Reg’l Med. Ctr. v. Cook, 
    109 F.3d 693
    , 704 (11th Cir. 1997) (budgetary constraints do not
    permit a state to evade Medicaid legal requirements); Ark.
    Med. Soc’y, Inc. v. Reynolds, 
    6 F.3d 519
    , 531 (8th Cir. 1993)
    (“[T]he state may not ignore the Medicaid Act’s require-
    ments in order to suit budgetary needs.”).
    The same reasoning applies to our consideration of
    the public interest. The Medicaid statute was designed
    to pay for the healthcare costs of “the most needy in the
    country.” Schweiker v. Hogan, 
    457 U.S. 569
    , 590 (1982).
    16                                               No. 11-3710
    Although we are mindful of potential budgetary con-
    cerns, these interests do not outweigh Medicaid recipi-
    ents’ interests in access to medically necessary health care.
    See, e.g., Dominguez v. Schwarzenegger, 
    596 F.3d 1087
    , 1098
    (9th Cir. 2010) (“[W]e have repeatedly recognized
    that individuals’ interests in sufficient access to health
    care trump the State’s interest in balancing its budget.”),
    vacated on other grounds, Douglas v. Indep. Living Ctr. of
    S. Cal., Inc., 
    132 S. Ct. 1204
     (2012). The State cautions that
    it may end coverage of all dental services under its
    Medicaid plan if the $1,000 cap is no longer in place.
    Thus, this lawsuit may result only in a pyrrhic victory
    for the plaintiff. But the State’s likely violation of state
    and federal law cannot be ignored in order to preserve
    the status quo. Moreover, there are other avenues by
    which the State can limit its exposure to significant
    Medicaid costs. See, e.g., Moore ex rel. Moore v. Reese, 
    637 F.3d 1220
    , 1255 (11th Cir. 2011) (“A state may also
    limit required Medicaid services based upon its judg-
    ment of degree of medical necessity so long as such
    limitations do not discriminate on the basis of the kind
    of medical condition.”); Coleman, 687 N.E.2d at 368 (the
    State may limit coverage “by narrowing the definition
    of medical necessity”).
    III. C ONCLUSION
    Because the balance of the factors weighs in favor of
    granting a preliminary injunction, we A FFIRM the judg-
    ment of the district court.
    9-26-12
    

Document Info

Docket Number: 11-3710

Citation Numbers: 697 F.3d 604, 2012 WL 4372524, 2012 U.S. App. LEXIS 20157

Judges: Kanne, Eanne, Wood, Tinder

Filed Date: 9/26/2012

Precedential Status: Precedential

Modified Date: 11/5/2024

Authorities (29)

Schweiker v. Hogan , 102 S. Ct. 2597 ( 1982 )

susan-lavon-lankford-rachel-ely-joseph-everett-by-next-friend-jan-everett , 451 F.3d 496 ( 2006 )

Camacho v. Texas Workforce Commission , 326 F. Supp. 2d 794 ( 2004 )

Blessing v. Freestone , 117 S. Ct. 1353 ( 1997 )

State Oil Co. v. Khan , 118 S. Ct. 275 ( 1997 )

Ladd v. Thomas , 962 F. Supp. 284 ( 1997 )

margarette-curtis-v-alvin-j-taylor-individually-and-as-secretary-of-the , 625 F.2d 645 ( 1980 )

Moore Ex Rel. Moore v. Reese , 637 F.3d 1220 ( 2011 )

Tallahassee Memorial Regional Medical Center v. Cook , 109 F.3d 693 ( 1997 )

42-socsecrepser-362-medicaremedicaid-guide-p-41659-arkansas-medical , 6 F.3d 519 ( 1993 )

Wilder v. Virginia Hospital Assn. , 110 S. Ct. 2510 ( 1990 )

Gonzaga University v. Doe , 122 S. Ct. 2268 ( 2002 )

Montoya v. Johnston , 654 F. Supp. 511 ( 1987 )

Grier v. Goetz , 402 F. Supp. 2d 876 ( 2005 )

S.D. Ex Rel. Dickson v. Hood , 391 F.3d 581 ( 2004 )

Brandon Collins v. John Hamilton , 349 F.3d 371 ( 2003 )

Bertrand Ex Rel. Bertrand v. Maram , 495 F.3d 452 ( 2007 )

Dominguez v. Schwarzenegger , 596 F.3d 1087 ( 2010 )

charleston-memorial-hospital-south-carolina-hospital-association , 693 F.2d 324 ( 1982 )

Allen v. Mansour , 681 F. Supp. 1232 ( 1986 )

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