Opinion ID: 747250
Heading Depth: 2
Heading Rank: 2

Heading: Do Medicaid Recipients Have a Federal Right to Transportation?

Text: 61 In the instant case, the plaintiffs seek to enforce a transportation requirement that appears explicitly not in the Medicaid Act, but in a federal regulation. The plaintiffs argue that the transportation regulation is a valid interpretation of at least one of several statutory provisions found at 42 U.S.C. § 1396a(a). Those provisions are as follows: 62 (a) A State plan for medical assistance must-- 63 (1) provide that it shall be in effect in all political subdivisions of the State, and, if administered by them, be mandatory upon them; 64 . . . . . 65 (4) provide (A) such methods of administration ... as are found by the Secretary to be necessary for the proper and efficient operation of the plan ...; 66 . . . . . 67 (8) provide that all individuals wishing to make application for medical assistance under the plan shall have opportunity to do so, and that such assistance shall be furnished with reasonable promptness to all eligible individuals; 68 . . . . . 69 (10) (B) that the medical assistance made available to any individual described in subparagraph (A) [describing the so-called categorically needy] 70 (i) shall not be less in amount, duration, or scope than the medical assistance made available to any other such individual, and 71 (ii) shall not be less in amount, duration, or scope than the medical assistance made available to individuals not described in subparagraph (A) ...; 72 . . . . . 73 (19) provide such safeguards as may be necessary to assure that eligibility for care and services under the plan will be determined, and such care and services will be provided, in a manner consistent with simplicity of administration and the best interests of the recipients; 74 . . . . . 75 (23) provide that (A) any individual eligible for medical assistance ... may obtain such assistance from any institution, agency, community pharmacy, or person, qualified to perform the service or services required ... who undertakes to provide him such services.... 76 According to the plaintiffs, the regulatory and statutory provisions create a federal right to transportation to and from providers. 16 77 We turn initially to questions regarding the appropriate analytical approach for cases such as the instant one which involve federal regulations. As a previous panel of this court has pointed out, There is no precedent in our circuit and those that exist are split and far from clear. Colvin v. Housing Auth. of Sarasota, Fla., 71 F.3d 864, 865 n. 1 (11th Cir.1996) (concluding that the issue had been waived in the case before it). The plaintiffs point out that the Sixth Circuit has asserted that because federal regulations have the force of law, they may create enforceable rights under § 1983. Loschiavo v. City of Dearborn, 33 F.3d 548, 551 (6th Cir.1994), cert. denied, 513 U.S. 1150, 115 S.Ct. 1099, 130 L.Ed.2d 1067 (1995). Accordingly, the Loschiavo panel simply applied the three prongs of the federal right test directly to the regulation at issue--i.e., the panel asked whether the regulation was intended to benefit the plaintiff, whether the regulation imposed a mandatory obligation, and whether the regulation was capable of judicial enforcement. Id. at 552-53. See also Levin v. Childers, 101 F.3d 44, 47 (6th Cir.1996) (describing Loschiavo as holding that 'plaintiffs may use Section 1983 to enforce not only constitutional rights, but also those rights defined by federal statutes [and federal regulations]' ) (brackets in original). 17 Similarly, we note that three Justices of the Supreme Court have expressed the view that a valid regulation can create a federal right enforceable under § 1983. In Guardians Ass'n v. Civil Serv. Comm'n of New York, 463 U.S. 582, 638, 103 S.Ct. 3221, 3251, 77 L.Ed.2d 866 (1983), Justice Stevens, joined by Justices Brennan and Blackmun, wrote: [I]t is clear that the § 1983 remedy is intended to redress the deprivation of rights secured by all valid federal laws, including statutes and regulations having the force of law. According to these Justices, the rationale of Maine v. Thiboutot, whose holding applied expressly only to federal statutes, applies equally to administrative regulations having the force of law. Id. at 638 n. 6, 103 S.Ct. at 3251 n. 6. 78 On the other hand, we note that four Justices have suggested that federal rights enforceable under § 1983 cannot derive either from valid regulations alone or from any and all valid administrative interpretations of statutes creating federal rights. In Wright v. Roanoke Redevelopment and Housing Authority, 479 U.S. 418, 107 S.Ct. 766, 93 L.Ed.2d 781 (1987), Justice O'Connor, joined by Chief Justice Rehnquist, Justice Powell, and Justice Scalia, wrote in dissent: 79 In the absence of any indication in the language, legislative history, or administrative interpretation of the Brooke Amendment that Congress intended to create an enforceable right to utilities, it is necessary to ask whether administrative regulations alone could create such a right. This is a troubling issue not briefed by the parties, and I do not attempt to resolve it here. The Court's questionable reasoning that, because for four years HUD gave somewhat less discretion to the PHA's in setting reasonable utilities allowances, HUD understood Congress to have required enforceable utility standards, apparently allows it to sidestep the question. I am concerned, however, that lurking behind the Court's analysis may be the view that, once it has been found that a statute creates some enforceable right, any regulation adopted within the purview of the statute creates rights enforceable in federal courts, regardless of whether Congress or the promulgating agency ever contemplated such a result. Thus, HUD's frequently changing views on how best to administer the provision of utilities to public housing tenants becomes the focal point for the creation and extinguishment of federal rights. Such a result, where determination of § 1983 rights has been unleashed from any connection to congressional intent, is troubling indeed. 80 Id. at 437-38, 107 S.Ct. at 777-78. The Fourth Circuit, citing the position of the dissent in Wright, has written that [a]n administrative regulation ... cannot create an enforceable § 1983 interest not already implicit in the enforcing statute. Smith v. Kirk, 821 F.2d 980, 984 (4th Cir.1987). See also Former Special Project Employees Ass'n v. City of Norfolk, 909 F.2d 89 (4th Cir.1990) (following Smith v. Kirk ). 18 81 Given the fact that the view set out above represented the position of the dissenting Justices in Wright, we think our first obligation is to ascertain whether the majority opinion in Wright, which remains binding upon us, rejected the dissent's position regarding cases involving federal regulations. Ultimately, we are persuaded that the majority did not reject that position and thus that the majority's opinion does not foreclose arguments that turn on the concerns expressed by the dissent. Because careful attention to the language of the majority's opinion is required, we set out the relevant discussion again: 82 The Brooke Amendment could not be clearer: as further amended in 1981, tenants could be charged as rent no more and no less than 30 percent of their income. This was a mandatory limitation focusing on the individual family and its income. The intent to benefit tenants is undeniable. Nor is there any question that HUD interim regulations, in effect when this suit began, expressly required that a reasonable amount for utilities be included in rent that a PHA was allowed to charge, an interpretation to which HUD has adhered both before and after the adoption of the Brooke Amendment. HUD's view is entitled to deference as a valid interpretation of the statute, and Congress in the course of amending that provision has not disagreed with it. 83 Respondent nevertheless asserts that the provision for a reasonable allowance for utilities is too vague and amorphous to confer on tenants an enforceable right within the meaning of § 1983 and that the whole matter of utility allowances must be left to the discretion of the PHA, subject to supervision by HUD. The regulations, however, defining the statutory concept of rent as including utilities, have the force of law ..., they specifically set out guidelines that the PHAs were to follow in establishing utility allowances, and they require notice to tenants and an opportunity to comment on proposed allowances. In our view, the benefits Congress intended to confer on tenants are sufficiently specific and definite to qualify as enforceable rights under Pennhurst [Pennhurst State School & Hosp. v. Halderman, 451 U.S. 1, 101 S.Ct. 1531, 67 L.Ed.2d 694 (1981) ] and § 1983, rights that are not, as respondent suggests, beyond the competence of the judiciary to enforce. 84 Wright, 479 U.S. at 430-32, 107 S.Ct. at 773-75. We do not think the passage is fairly read to hold that federal rights are created either by regulations of their own force or by any valid administrative interpretation of a statute that creates some enforceable right. We begin by noting that the majority nowhere takes issue with the dissent's suggestion that the majority did not hold so much. As for what the majority did say, we note the persistent focus on tying the right to a reasonable utility allowance to Congressional intent to create federal rights. We find significant in this regard the fact that the majority first focused directly on the statutory provision creating the rent ceiling, describing the provision as a mandatory limitation focusing on the individual family and its income. In other words, the Court seemed to locate the right in the statutory provision, turning to the regulation only to answer the respondent's argument that HUD's definition of the statutory concept of rent was not authorized by the statute. See id. at 430 n. 11, 107 S.Ct. at 774 n. 11 (We thus reject respondent's argument that the Brooke Amendment's rent ceiling applies only to the charge for shelter and that the HUD definition of rent as including a reasonable charge for utilities is not authorized by the statute.). Although the Court in that discussion spoke of the deference owed to valid administrative interpretations of statutes, it did so in the particular context of a regulation that merely defined the content of a specific right that, in the majority's opinion, Congress had conferred upon the plaintiffs by statute. See id. at 431, 107 S.Ct. at 774 (referring to the regulations as defining the statutory concept of 'rent' ). In conclusion, the Court reiterated that it believed that the benefits Congress intended to confer on tenants are sufficiently specific and definite to qualify as enforceable rights under Pennhurst and § 1983, rights that are not, as respondent suggests, beyond the competence of the judiciary to enforce. Id. at 432, 107 S.Ct. at 774-75 (emphasis added). 19 We conclude that the Wright majority did not hold that federal rights are created either by regulations alone or by any valid administrative interpretation of a statute creating some enforceable right. 85 In our view, the driving force behind the Supreme Court's case law in this area is a requirement that courts find a Congressional intent to create a particular federal right. We find a clear expression of this in Suter, where the Court posed as the dispositive question: Did Congress, in enacting the Adoption Act, unambiguously confer upon the child beneficiaries of the Act a right to enforce the requirement that the State make 'reasonable efforts' to prevent a child from being removed from his home, and once removed to reunify the child with his family? 503 U.S. at 357, 112 S.Ct. at 1367. In light of this focus, we reject the Sixth Circuit's approach--i.e., finding a federal right in any regulation that in its own right meets the three-prong federal rights test. For the same reason, we also reject the approach labeled troubling by the dissent in Wright--i.e., finding enforceable rights in any valid administrative interpretation of a statute that creates some enforceable right. 86 We need not in this case define the precise role which a valid regulation may play in the federal rights analysis. 20 Wright would seem to indicate that so long as the statute itself confers a specific right upon the plaintiff, and a valid regulation merely further defines or fleshes out the content of that right, then the statute--in conjunction with the regulation--may create a federal right as further defined by the regulation. 21 In Wright, the statute itself conferred a specific right on the plaintiffs: tenants could be charged as rent no more and no less than 30% of their income. The regulation concerning the utility allowance merely defined the statutory concept of rent. Thus, Wright has been described as holding that [a] statute providing that tenants in low-income housing could only be charged 30% of their income in rent, in conjunction with regulations providing that 'reasonable utilities' costs were included in the rental figure, created [a] right under § 1983 to not be charged more than a 'reasonable' amount for utilities. Suter, 503 U.S. at 361 n. 13, 112 S.Ct. at 1369 n. 13. 87 On the other hand, if the regulation defines the content of a statutory provision that creates no federal right under the three-prong test, or if the regulation goes beyond explicating the specific content of the statutory provision and imposes distinct obligations in order to further the broad objectives underlying the statutory provision, we think the regulation is too far removed from Congressional intent to constitute a federal right enforceable under § 1983. 22 To hold otherwise would be inconsistent with the driving force of the Supreme Court precedent requiring a Congressional intent to create federal rights and with the Supreme Court's directive that courts must find that Congress has unambiguously conferred federal rights on the plaintiff. See Suter, 503 U.S. at 357, 112 S.Ct. at 1367; see also Pennhurst, 451 U.S. at 18, 24-25, 101 S.Ct. at 1540, 1543-44. 88 Applying these principles to the case at hand, we conclude that the transportation regulation does not define the content of any specific right conferred upon the plaintiffs by Congress. In our view, the nexus between the regulation and Congressional intent to create federal rights is simply too tenuous to create an enforceable right to transportation. 23 89 We turn first to the methods of administration provision primarily relied upon by the plaintiffs and by the court below. We conclude that the plaintiffs do not have an enforceable right to methods of administration. Just last term, in Blessing v. Freestone, 520 U.S. 329, 117 S.Ct. 1353, 137 L.Ed.2d 569 (1997), the Court distinguished between provisions of Title IV-D intended to benefit individual recipients and provisions intended only to guide the State in structuring its systemwide efforts at enforcing support obligations. Id. at ----, 117 S.Ct. at 1361. We conclude that the methods of administration statute is intended only to guide the State in structuring its efforts to provide care and services to Medicaid recipients and, therefore, that it does not create a federal right enforceable by the plaintiffs. Because we conclude that Congress did not intend to confer upon the plaintiffs a federal right to methods of administration, it follows that a regulation defining the precise content of that statutory requirement cannot create a federal right. 90 We reach a similar conclusion regarding § 1396a(a)(19), which requires that State plans provide such safeguards as may be necessary to assure that ... care and services will be provided ... in a manner consistent with simplicity of administration and the best interests of the recipients. We conclude that this section imposes only a generalized duty on the States--in other words, the provision is insufficiently specific to confer any particular right upon the plaintiffs. See Suter, 503 U.S. at 363, 112 S.Ct. at 1370 ([T]he 'reasonable efforts' language does not unambiguously confer an enforceable right upon the Act's beneficiaries. The term 'reasonable efforts' in this context is at least as plausibly read to impose only a rather generalized duty on the States.). Other courts have reached similar conclusions with respect to § 1396a(a)(19). See Bumpus v. Clark, 681 F.2d 679, 683 (9th Cir.1982) (Section 1396a(a)(19) is not the sort of specific condition for receipt of federal funds which can be said to create substantive rights in Medicaid recipients.), opinion withdrawn as moot, 702 F.2d 826 (9th Cir.1983); Stewart v. Bernstein, 769 F.2d 1088, 1093 (5th Cir.1985) (citing Bumpus with approval); Cook v. Hairston, No. 90-3437, 948 F.2d 1288 (6th Cir. Nov.26, 1991) (unpublished disposition) ([T]he district court did not err in finding that the [provisions] in question were not sufficiently specific and definite to permit enforcement through § 1983.). 24 Again, we do not believe that in the absence of a federal right created by Congress, an implementing regulation can create a right enforceable under § 1983. 91 Next, we turn to the provision of § 1396a which requires that a State plan provide that it shall be in effect in all political subdivisions of the State, and, if administered by them, be mandatory upon them. § 1396a(a)(1). The gist of the plaintiffs' argument with regard to this provision seems to be that providing transportation to and from providers is necessary to ensure that the plan is truly in effect in all areas of the State. However, the Supreme Court has rejected a similar argument in the Title IV-D context. In Suter, the plaintiffs relied on the analogous provision in Title IV-D 25 to argue that the State had a substantive obligation enforceable in a § 1983 action to make the reasonable efforts required elsewhere in the statute; if such efforts were not made, the argument apparently went, the plan would not be in effect. The Court rejected this argument: [W]e think that 'in effect' is directed to the requirement that the plan apply to all political subdivisions of the State, and is not intended to otherwise modify the word 'plan.'  Suter, 503 U.S. at 359, 112 S.Ct. at 1368. The Court's conclusion that the shall be in effect provision of the Adoption Assistance Act requires only that the plan apply to all political subdivisions would seem to foreclose arguments (such as the plaintiffs') that attempt to use shall be in effect provisions in other State-plan legislation as a bootstrap for enforcing requirements imposed on such plans by other statutory provisions. 92 Finally, we find no right under the regulation read in conjunction with any of the remaining statutory sections cited by the plaintiffs: § 1396a(a)(8), which requires that State plans provide that individuals wishing to make application for medical assistance under the plan shall have opportunity to do so, and that such assistance shall be furnished with reasonable promptness to all eligible individuals; § 1396a(a)(10)(B), which requires that State plans provide that medical assistance provided to any categorically needy recipient shall not be less in amount, duration, or scope than the assistance made available to other categorically needy recipients or to medically needy recipients; 26 or § 1396a(a)(23), which requires that the State plan provide that individuals eligible for medical assistance may obtain such assistance from qualified providers who undertake to provide the service or services required. It may be that each of these statutes creates some federal right; 27 similarly, it may be that the transportation regulation is a valid interpretation of each of these provisions under Chevron. However, we do not think these two factors, even if we found both to be true, would add up to a federal right to transportation. In each case the transportation regulation would be valid not because it reasonably defines the content of rights created by the statutory provisions, as did the regulation in Wright, but only because the regulation furthers the broad objectives underlying each statutory provision. In other words, we do not think that transportation to and from providers is reasonably understood to be part of the content of a right to prompt provision of assistance, comparable assistance, or choice among providers. Instead, if the regulation is a valid interpretation of these provisions, it would be because transportation may be a reasonable means of ensuring the prompt provision of assistance, comparable assistance, or choice among providers. Such links to Congressional intent may be sufficient to support the validity of a regulation; however, we think they are too tenuous to support a conclusion that Congress has unambiguously conferred upon Medicaid recipients a federal right to transportation enforceable under § 1983.