State officials not shielded from Medicaid suits

Poor may sue for benefits law promises, courts rule


WASHINGTON - In an important victory for patients, two federal appeals courts have ruled that poor people may sue state officials to compel them to provide benefits promised under the federal Medicaid law.

Michigan, North Carolina and other states had argued that they were shielded from such lawsuits by the doctrine of sovereign immunity.

But in separate rulings this month, three-judge panels of the 4th U.S. Circuit Court of Appeals, in Richmond, Va., and the 6th Circuit, in Cincinnati, Ohio, unanimously rejected those arguments.

The decisions are significant because 40 million people receive health insurance through Medicaid, and the ability to enforce a right to benefits is the essence of insurance.

The plaintiffs in the Michigan case, Westside Mothers vs. Haveman, were parents seeking one of the many benefits guaranteed by the federal Medicaid law: "early and periodic screening, diagnostic and treatment services" for people under 21.

Ann Rudolph of Detroit, the chairwoman of Westside Mothers, an advocacy group for low-income people, said her daughter, My-Esha Handberry, had serious hearing problems that could have been prevented if the girl, now 7, had received the proper medical tests and treatment.

Emboldened by Supreme Court decisions upholding state prerogatives, officials from Michigan and other states have argued that the Medicaid law is not enforceable by individual Medicaid recipients. The appeals courts rejected those arguments in simple, clear and unequivocal rulings.

Doctrines of sovereign immunity provide "no shield" for state officials accused of depriving citizens of a federal right, said Judge Gilbert S. Merritt of the 6th Circuit. Thus, he declared, the intended beneficiaries of the Medicaid program may sue state officials in federal court to enforce their right to benefits.

Judge Paul V. Niemeyer, writing for the 4th Circuit panel, said North Carolina officials could not use the state's "sovereign immunity shield" to avoid being brought to court.

"A state officer acting in violation of federal law loses the cloak of state immunity," Niemeyer said.

In the North Carolina case, Antrican vs. Odom, the plaintiffs were children who contended that they could not obtain dental care and other services promised under federal law.

Officials in Michigan and North Carolina said they were studying the decisions and had no immediate comment.

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