Hintermaier v. Hands of Hope Physical Therapy & Wellness

Background

Mirela Hintermaier appeared without a lawyer and sued Hands of Hope Physical Therapy & Wellness, Equinox Holdings, Inc., and United Healthcare Community Plan. She alleged that she received federally funded Medicaid coverage through United Healthcare and that Hands of Hope denied medically necessary physical therapy after falsely stating that it was no longer in United Healthcare’s network. She alleged that the denial and later restrictions were motivated by discrimination based on her Medicaid status, race, and national origin. She also alleged that United Healthcare failed to advocate for her.

Hintermaier asserted claims under Section 1557 of the Affordable Care Act, Title VI of the Civil Rights Act of 1964, the Medicaid Act, the Social Security Act, 42 U.S.C. § 1981, the New York State Human Rights Law, and other state law. She sought damages, court orders requiring relief, and declarations about the parties’ rights. The court had previously allowed her to proceed without paying filing fees.

Court’s analysis

Because Hintermaier was proceeding without a lawyer and without paying filing fees, the court screened the complaint under 28 U.S.C. § 1915(e)(2)(B). The court was required to dismiss claims that were frivolous, failed to state a legally sufficient claim, or sought relief from an immune defendant. It also applied the rule requiring a complaint to provide enough factual detail to make liability plausible.

Medicaid and Social Security Act claims

The court treated Hintermaier’s discrimination and retaliation claims under the Medicaid Act and Social Security Act as claims under 42 U.S.C. § 1983. Section 1983 requires a plaintiff to show both a violation of a federal right and action taken under state authority. The court held that Hintermaier alleged no facts showing that any defendant, all of which the court described as private entities, acted as a state actor. Participation in or receipt of Medicaid-related funds was not enough. The court dismissed these Section 1983 claims for failure to state a claim.

Affordable Care Act and Title VI discrimination claims

The court dismissed Hintermaier’s discrimination claims under Section 1557 of the Affordable Care Act and Title VI. Those provisions protect against discrimination based on race, color, or national origin, among other specified grounds under the statutes incorporated by Section 1557. The court found that Hintermaier did not provide facts showing discrimination based on a protected ground, intentional discrimination, or that such discrimination was a substantial and motivating factor in the defendants’ conduct. Her allegation that the defendants discriminated because of her Medicaid status was not enough because Medicaid status, by itself, is not protected under Title VI or the provisions incorporated into Section 1557. The court granted her leave to replead these claims.

Retaliation claims under the Affordable Care Act and Title VI

The court also dismissed the retaliation claims under Title VI, including any retaliation theory incorporated into Section 1557. A retaliation claim requires facts showing that the plaintiff engaged in protected activity, the defendants knew about it, the plaintiff suffered an adverse action, and the protected activity caused that action. The court found that Hintermaier appeared to have complained about discrimination based on Medicaid status, not discrimination based on race, color, or national origin. Because Medicaid status is not protected under Title VI, the court found that she had not alleged protected activity or that the defendants knew she was engaging in protected activity. The court granted leave to replead these claims.

Section 1981 claims

The court construed Hintermaier’s allegations about discrimination in an actual or prospective contractual relationship as claims under 42 U.S.C. § 1981. Section 1981 protects contractual rights against intentional discrimination based on race, ancestry, or ethnic characteristics. The court found that Hintermaier did not identify her racial group and did not allege facts showing that the defendants intentionally discriminated against her because of race, ancestry, or ethnic characteristics, or that she would not have suffered the alleged loss but for those characteristics. The court dismissed the discrimination claims and granted leave to replead them.

The court separately dismissed the Section 1981 retaliation claims. It found that, as with the Title VI retaliation claims, Hintermaier appeared to have complained about Medicaid-status discrimination rather than discrimination protected by Section 1981. The court granted leave to replead those claims as well.

Order and next steps in the case

The court granted Hintermaier 60 days from the order’s date to file an amended complaint. The amended complaint must replace the original complaint and must include the facts and claims she wants the court to consider. The court directed her to identify the relevant people, events, dates, locations, injuries, and requested relief. No summonses would issue at that time.

The court stated that if Hintermaier failed to amend within the allowed period and could not show good cause, it would dismiss the federal claims for failure to state a claim and decline to consider the state-law claims under its supplemental jurisdiction. The court granted her motion for permission to file electronically, denied her motion to expedite proceedings, and certified that an appeal from the order would not be taken in good faith; it therefore denied permission to proceed without paying fees for an appeal.