Sabree ex rel. Sabree v. Richman

367 F.3d 180

Hassan SABREE, By his Mother and Next-Friend, Hana SABREE; Catherine Meade, By her Father and Next-Friend, Robert A. Meade; Joseph Frazier, By his Mother and Next-Friend, Patricia Frazier, for Themsleves and All Others Similarly Situated v. * Estelle B. RICHMAN, In Her Official Capacity as Secretary of the Department of Public Welfare of the Commonwealth of Pennsylvania Hassan Sabree, Catherine Meade, and Joseph Frazier, Appellants * {Substitution Pursuant to Clerk's Order dated 3/28/03 and F.R.A.P. Rule 43(c)}

No. 03-1226.

United States Court of Appeals, Third Circuit.

Argued September 11, 2003.

Filed May 11, 2004.

Stephen F. Gold, (Argued), Philadelphia, PA and Ilene W. Shane, Disabilities Law Project, Philadelphia, PA, for Appellants.

Doris M. Leisch, (Argued), Commonwealth of Pennsylvania, Department of Public Welfare, Philadelphia, PA and John A. Kane, Commonwealth of Pennsylvania, Office of Legal Counsel, Department of Public Welfare, Harrisburg, PA, for Appellees.

Sarah Somers, Jane Perkins, National Health Law Program, Chapel Hill, NC, for Amicus-Appellants.

Before ALITO, BARRY, and AMBRO, Circuit Judges.

OPINION OF THE COURT

BARRY, Circuit Judge.

I. INTRODUCTION

When Congress offers money to the states, it often imposes conditions on acceptance. States welcome federal funding to help underwrite many of the core services they provide to their citizens. Education, healthcare, and public safety, to name a few, while typically state concerns, are usually funded in part by federal dollars that come with strings attached. This case raises the question-not new, but of first impression in this Court following Gonzaga University v. Doe, 536 U.S. 273, 122 S.Ct. 2268, 153 L.Ed.2d 309 (2002)-of what happens when a state allegedly fails to live up to the conditions imposed on it by Congress.

Plaintiffs are a class of mentally retarded adults in need of medical services from an intermediate care facility for persons with mental retardation ("ICF/MR services"). Although they qualify for state assistance to obtain these services under the Medicaid Act, that assistance has not been forthcoming. In an effort to force Pennsylvania to provide the needed services, plaintiffs, pursuant to 42 U.S.C. § 1983, sued the Secretary of the Pennsylvania Department of Public Welfare. Pennsylvania argues that it would provide assistance if it could but that it cannot, and that, in any event, the sole remedy for its non-compliance with the Medicaid Act is the suspension or revocation of funding from Congress. We disagree.¹

The District Court, relying heavily on Gonzaga University, concluded that Congress had not unambiguously conferred the rights that plaintiffs sought to vindicate under § 1983, and dismissed the suit.² Sabree v. Houston, 245 F.Supp.2d 653, 659 (E.D.Pa.2003). At first blush, language in Gonzaga University would appear to support that conclusion. In Gonzaga University, the Court foreclosed the ability of a student to enforce, by means of § 1983, provisions of the Family Educational Rights and Privacy Act of 1974 ("FERPA").³ Gonzaga Univ., 536 U.S. at 283, 122 S.Ct. 2268. The Chief Justice, writing for the Court, stated emphatically: "We now reject the notion that our cases permit anything short of an unambiguously conferred right to support a cause of action brought under § 1983." Id. (emphasis added).

The Court, no doubt, has set a high bar for plaintiffs. Nonetheless, after having considered the relevant provisions of the Medicaid Act against the backdrop of Gonzaga University, we are convinced that Congress unambiguously conferred the rights which plaintiffs here seek to enforce. Accordingly, we will reverse the order of the District Court.

II. DISCUSSION

Title XIX of the Social Security Act, codified at 42 U.S.C. §§ 1396-1396v and popularly known as the "Medicaid Act," established a "cooperative federal-state program under which the federal government furnishes funding to states for the purpose of providing medical assistance to eligible low-income persons." Pa. Pharm. Ass'n v. Houstoun, 283 F.3d 531, 533 (3d Cir.2002). States are not required to participate in the program, but states that do accept federal funding must comply with the Medicaid Act and with regulations promulgated by the Secretary of Health and Human Services ("HHS"). Participating states must devise and implement a state medical assistance plan that is approved by the Secretary of HHS. 42 U.S.C. § 1396; 42 C.F.R. § 430.10. A state that fails to comply with its medical assistance plan runs the risk of having its funding revoked by the Secretary. 42 U.S.C. § 1396c.

There is no dispute that plaintiffs qualify for ICF/MR services under Pennsylvania's medical assistance plan. Nor is it disputed that plaintiffs have languished on waiting lists for years, unable to obtain these services. The only dispute, and the one now before us, is whether plaintiffs may sue Pennsylvania under § 1983 to enforce the provisions of Title XIX that require (1) a state to provide medical assistance covering ICF/MR services, and (2) to do so with "reasonable promptness." 42 U.S.C. §§ 1396a(a)(8),⁴ 1396a(a)(10),⁵ and 1396d(a)(15).⁶

That plaintiffs merit sympathy does not escape our notice, but neither does it govern our reasoning. Rather, Gonzaga University provides the dispassionate lens through which this matter must be viewed. A three-step analysis is required. First, we must examine Gonzaga University to determine the essential characteristics of an "unambiguously conferred right." Second, we must assess whether the statutory language of Title XIX imparts an "unambiguously conferred right." Third, we must determine-if an individual right has been unambiguously conferred-whether Congress has precluded individual enforcement of that right. This analysis, which, as will become clear, is assuredly not for the timid, compels the conclusion that the provisions invoked by plaintiffs-42 U.S.C. §§ 1396a(a)(8), 1396a(a)(10), and 1396d(a)(15)-unambiguously confer rights vindicable under § 1983.

A. Gonzaga University v. Doe and Unambiguously Conferred Rights — Step One

As the Court explained more than twenty years ago, "[i]n legislation enacted pursuant to the spending power, the typical remedy for state noncompliance with federally imposed conditions is not a private cause of action for noncompliance but rather action by the Federal Government to terminate funds to the State." Pennhurst State Sch. & Hosp. v. Halderman, 451 U.S. 1, 28, 101 S.Ct. 1531, 67 L.Ed.2d 694 (1981). Nonetheless, as the Court observed in Gonzaga University, in some instances Congress has unambiguously conferred rights that may be vindicated by individual suits brought under § 1983.⁷

In Gonzaga University, the plaintiff sought to enforce conditions imposed on the State of Washington by FERPA.⁸ "Congress enacted FERPA under its spending power to condition the receipt of federal funds on certain requirements relating to the access and disclosure of student educational records." Gonzaga Univ., 536 U.S. at 278, 122 S.Ct. 2268. Ultimately, the Court rejected the viability of plaintiff's claim because it concluded that in FERPA Congress had not "intended to create a federal right." Id. at 283, 122 S.Ct. 2268 (emphasis in original); see also id. at 291, 122 S.Ct. 2268 (Breyer, J., concurring) ("The ultimate question, in respect to whether private individuals may bring a lawsuit to enforce a federal statute, through 42 U.S.C. § 1983 or otherwise, is a question of congressional intent.") (emphasis added).

Accordingly, we must determine whether Congress intended to confer the rights claimed by plaintiffs. Gonzaga University instructs that congressional intent is manifest only when statutory language unambiguously confers such rights. Id. at 283, 122 S.Ct. 2268. To determine what statutory language is necessary to confer rights unambiguously, we turn first to the cases in which the Court addressed statutory actions brought under § 1983. We then consider what the Court means in Gonzaga University when it requires "rights-creating language." Id. at 287, 122 S.Ct. 2268.

1. Statutory Rights and 42 U.S.C. § 1983

Since Pennhurst, only twice has the Court recognized a congressional intent to confer statutory rights vindicable via § 1983: Wright v. Roanoke Redevelopment & Housing Authority, 479 U.S. 418, 107 S.Ct. 766, 93 L.Ed.2d 781 (1987), addressing the Public Housing Act; and Wilder v. Virginia Hospital Ass'n, 496 U.S. 498, 110 S.Ct. 2510, 110 L.Ed.2d 455 (1990), addressing Title XIX of the Social Security Act. The Court has foreclosed § 1983 suits in two equally significant cases (in addition to Gonzaga University): Suter v. Artist M., 503 U.S. 347, 112 S.Ct. 1360, 118 L.Ed.2d 1 (1992), addressing the Adoption Assistance and Child Welfare Act of 1980; and Blessing v. Freestone, 520 U.S. 329, 117 S.Ct. 1353, 137 L.Ed.2d 569 (1997), addressing Title IV-D of the Social Security Act.

While in Gonzaga University the Court "reject[ed] the notion that [its] ... cases permit anything short of an unambiguously conferred right to support a cause of action brought under § 1983," it carefully avoided disturbing, much less overruling, Wright and Wilder. Gonzaga Univ., 536 U.S. at 283, 122 S.Ct. 2268. Indeed, as the ensuing analysis will demonstrate, the Court relied on those cases in crafting Gonzaga University. Accordingly, we will assess the rights claimed by plaintiffs in light of Wright, Wilder, Suter, and Blessing, as construed by Gonzaga University.

(a) Wright v. Roanoke Redevelopment & Housing Authority

In Wright, the Court permitted a § 1983 suit by tenants to recover past overcharges under a rent-ceiling provision of the Public Housing Act.⁹ As explained in Gonzaga University, three factors motivated the Wright Court to conclude "that the provision unambiguously conferred `a mandatory [benefit] focusing on the individual family and its income.'" Gonzaga Univ., 536 U.S. at 280, 122 S.Ct....