Opinion ID: 200155
Heading Depth: 3
Heading Rank: 2

Heading: Unfilled Waiver Slots

Text: The district court rested its finding for the plaintiffs on the ground we have rejected: that the state waiver plan must serve at least 200 individuals. Bryson, No. 99-558-M, at 4. Plaintiffs have, however, asserted a separate and distinct argument alleging a violation of the reasonable promptness provision of § 1396a(a)(8). They argue that New Hampshire has failed to fill even the number of individual waiver slots it has requested, and so the plaintiff class members have not been furnished medical assistance with reasonable promptness. We first consider whether there is an actionable claim.
There is liability against persons who act under color of law to deprive individuals of any rights, privileges, or immunities -17- secured by the Constitution and laws of the United States under 42 U.S.C. § 1983. This provision creates a cause of action for federal statutory as well as constitutional rights, Maine v. Thiboutot, 448 U.S. 1, 4-8 (1980), including, in some circumstances, violations of the Medicaid Act, Wilder, 496 U.S. at 524. Not all violations of federal law result in a cause of action under § 1983. A plaintiff must assert the violation of a federal right, not merely the violation of federal law. Blessing v. Freestone, 520 U.S. 329, 340 (1997) (emphasis in original). Moreover, a federal right must be unambiguously conferred in order to support a cause of action under § 1983. Gonzaga Univ. v. Doe, 122 S. Ct. 2268, 2275 (2002). Blessing set out a three-part test for guidance in determining whether a statutory provision confers an enforceable federal right. First, Congress must have intended that the provision benefit the plaintiff. Second, the right must not be vague and amorphous. Third, the statute must unambiguously impose a binding obligation on the states. Blessing, 520 U.S. at 340-41. Ultimately, of course, this is an issue of congressional intent, and the three tests are just a guide. Gonzaga, 122 S. Ct. at 2279 (Breyer, J., concurring). The statute satisfies the three tests as to claims about unfilled waiver slots that are part of an approved state Medicaid plan. -18- First, the statute, on its face, does intend to benefit the plaintiffs. Section 1396a(a)(8) requires that state Medicaid plans provide that medical assistance shall be furnished with reasonable promptness to all eligible individuals. This paragraph is a part of the litany of procedural and substantive protections which state Medicaid plans must provide, such as the opportunity for a hearing, see § 1396a(a)(3), and safeguards against the disclosure of private information, see id. § 1396a(a)(7). By its terms, it benefits eligible individuals. Id. § 1396a(a)(8). Those patients who are on the waiting list and for whom slots are available7 are, we think, eligible under the statute such that they are entitled to reasonable promptness. See Boulet v. Celluci, 107 F. Supp. 2d 61, 77 (D. Mass. 2000) (The cap on waiver services is simply a constraint on eligibility.). The first prong of Blessing has been met. Second, the right conferred is not vague or amorphous. A statute is not impermissibly vague simply because it requires judicial inquiry into 'reasonableness.' Albiston v. Maine Comm'r of Human Servs., 7 F.3d 258, 267 (1st Cir. 1993) (construing the reasonable promptness provision of 42 U.S.C. § 602(a)(10)). 7 The parties advise us that it is not an easy matter to determine the patients on the waiting list for whom slots are available. It is not a matter, necessarily, of who is next on the list. The slots opening up may be in one geographic location; a particular patient may be in another. These are issues that can be considered on remand. -19- Common law courts have reviewed actions for reasonableness since time immemorial. See, e.g., 1 W. Blackstone, Commentaries  (analyzing the reasonableness of customs). Finally, § 1396a(a)(8) does unambiguously bind the states. The subsection mandates that state plans must provide that medical assistance shall be provided with reasonable promptness. These are not mere guidelines, but rather requirements which states must meet under the Medicaid system. One other circuit court has found that the reasonable promptness provision of § 1396a(a)(8) provides a cause of action under § 1983. See Doe v. Chiles, 136 F.3d 709, 719 (11th Cir. 1998); cf. Cospito v. Heckler, 742 F.2d 72, 81 n.14 (3rd Cir. 1984) (interpreting § 1396a(a)(8) in a procedural due process context and finding that eligible patients have a legitimate claim of entitlement to be able to avail themselves of Medicaid benefits). While this Court has never before addressed this precise question, we did uphold a § 1983 cause of action under the reasonable promptness provision of the Social Security Act. Albiston, 7 F.3d at 264 (finding that 42 U.S.C. § 602(a)(10) provides reasonably clear, judicially enforceable obligations directly on the participating States). The strictures of § 1396a(a)(8) should apply with no less force to opt-in plans such as the waiver program. Once the waiver plan is created and approved, it becomes part of the state plan and -20- therefore subject to federal law; the waiver plans must meet all requirements not expressly waived. See Doe, 136 F.3d at 714-15 (upholding a § 1983 cause of action under § 1396a(a)(8) as applied to an optional program). In sum, we find that there is a § 1983 cause of action arising from the reasonable promptness provision of 42 U.S.C. § 1396a(a)(8) under the state model waiver plan as approved.
It is not clear to us, though, whether there is a live controversy on this issue or, if so, what the dimensions of it are. No facts have been developed on this point. New Hampshire claims that there are no longer any unfilled waiver slots, while the plaintiffs believe that the issue may continue to be a live one. Even if there are currently unfilled waiver slots, we know nothing about the history of each waiver slot and the process and procedure of replacing individuals who held those slots. When an individual ceases to use the waiver plan services, there is necessarily a time gap while an individual on the waiting list is chosen to take the unfilled slot and while services are made available. Because of that lag in time, the fact that some slots are unfilled may be consistent with New Hampshire diligently filling the empty slots with reasonable promptness. It may also indicate that New Hampshire is not being reasonably prompt in its provision of medical assistance. -21- The parties have stipulated that absent extraordinary circumstances, ABD waiver services can be implemented within one year from the time that an individual is found to be eligible. More information is necessary in order to ascertain whether or not the guarantee of reasonable promptness has been satisfied. We remand this aspect of plaintiff's claim to the district court.