DC Medicaid Beneficiaries Win Reversal in Federal Appeals Court Which Allows Them to Press their Claims That the District of Columbia Fails to Provide Due Process

Maldonado v. District of Columbia is a class action filed in 2010 by Terris, Pravlik & Millian, LLP (TPM) and the National Health Law Program on behalf of District of Columbia Medicaid beneficiaries and applicants which seeks to establish their constitutional right to receive procedural due process, in the form of individualized written notice, when their claims for prescription drug coverage are denied at the pharmacy. 

In March 2022, the district court dismissed the case as moot. This was the third time the district court had dismissed the case.

Today, the United States Court of Appeals for the District of Columbia Circuit reversed the lower court’s decision, as it had done twice before. 

In a unanimous opinion by Senior Judge David S. Tatel, the Court of Appeals held that the District of Columbia failed to meet its “heavy burden of demonstrating mootness” when it relied solely on a 2020 policy which it claimed was “largely successful” in requiring pharmacies to provide Plaintiffs with individualized written notice. Because the lower court had been presented with “evidence that pharmacies are in fact failing to provide notice,” the Court of Appeals concluded that “the case is no more moot than Brown v. Board of Education would have been if, in the wake of the Supreme Court’s 1954 decision, the Topeka Board of Education had issued a memorandum directing its schools to desegregate and record evidence demonstrated that Black children were still attending segregated schools.” The Court of Appeals further instructed the district court “to proceed expeditiously with discovery and allow plaintiffs to make their case.” 

“Today’s decision is emphatic that the high standard for mootness cannot be met by simply having a policy on paper,” said TPM partner Michael L. Huang, who argued the appeal. “After thirteen years without progress, Plaintiffs look forward to finally having their case resolved on the merits.”

Jane Perkins, Litigation Director for the National Health Law Program, commented that: “The problems in the District of Columbia are by no means unique. Medicaid beneficiaries, nationwide, are leaving their pharmacies each day without the necessary prescriptions, empty-handed with no explanation of why they have been told no. The D.C. Plaintiffs now have the opportunity to engage in discovery from the Medicaid agency and to shed light on this issue as they prove their case in court.”

Follow the links to download the Court of Appeals’ opinion and order.