TPM Wins Leave to File a Second Amended Complaint in Medicaid Due Process Notice Case

On April 4, 2019, the United States District Court for the District of Columbia granted plaintiffs, represented by Terris, Pravlik & Millian, LLP and the National Health Law Program, leave to file a Second Amended Complaint over the opposition of the defendant the District of Columbia in Maldonado v. District of Columbia, D.D.C., Civ. No. 10-1511.   

The case was brought in 2010 by plaintiffs, a class of Medicaid beneficiaries seeking due process notice when their requests for coverage for prescription medications are denied.  Plaintiffs first amended their complaint in 2013, after their standing to bring suit had been recognized by the Court of Appeals for the District of Columbia Circuit. 

There have been significant rulings by the district court and the Court of Appeals since 2013.  In 2015, the Court of Appeals held that plaintiffs had a protected property interest under the Fifth Amendment of the Constitution in any prescribed medication “not completely excluded from coverage” by Medicaid.  In March 2017, the district court found that plaintiffs stated a claim that the District’s current Medicaid prescription medication claims processing system violates the Fifth Amendment’s Due Process Clause by not providing individualized written notice at the point-of-sale to persons denied Medicaid coverage for their prescriptions as written.  In plaintiffs’ Second Amended Complaint, plaintiffs add a class representative, supplement the descriptions of recent prescription denial experiences by the class representatives, refine the definition of the plaintiff class, and ensure consistency with the rulings of the district court and the Court of Appeals since 2013.   

On May 31, 2019, the District of Columbia filed a partial motion to dismiss plaintiffs’ Second Amended Complaint – its fourth motion to dismiss in the case.  On June 28, 2019, plaintiffs opposed the motion to dismiss and filed a cross-motion for partial summary judgment. The parties are currently completing the briefing on the motions.