Maione v. Zucker

Background

Scott Maione and Tasha Ostler sued Dr. Howard A. Zucker, Samuel D. Roberts, Michael P. Hein, Joan Silvestri, and Susan Sherwood on behalf of themselves and their three infant children. The plaintiffs and children were Medicaid recipients. Two children, J and M, had disabling and chronic health conditions and received Supplemental Security Income.

The plaintiffs alleged that Rockland County officials denied about 99% of reimbursement requests for out-of-pocket medical expenses. After an administrative hearing, an administrative law judge issued a decision in the plaintiffs’ favor concerning J’s reimbursement claims. The plaintiffs later submitted additional receipts, but the county again denied about 99% of them. They also pursued reimbursement for transportation expenses and alleged that New York’s transportation policy conflicted with federal law.

The plaintiffs brought claims under 42 U.S.C. § 1983, the Fourteenth Amendment, Article 6 of the New York Constitution, Title II of the Americans with Disabilities Act, and the Rehabilitation Act. They sought a declaration that the denials were unlawful, more than $90,000 in reimbursements, fees and costs, and changes to the defendants’ hearing and reimbursement procedures.

The plaintiffs had previously filed related proceedings in state court and in federal court. The federal court had dismissed their earlier claims and later allowed another amended complaint concerning the children’s claims. The plaintiffs then filed the Second Amended Complaint at issue here. The State Defendants and County Defendants each filed a motion to dismiss under Rules 12(b)(1) and 12(b)(6). Rule 12(b)(1) concerns the court’s authority to hear a case; Rule 12(b)(6) concerns whether the complaint states a legally sufficient claim.

Rulings

The court held that the Eleventh Amendment barred all claims against the defendants in their official capacities under the United States and New York Constitutions or New York law. The court explained that this immunity generally protects states, state agencies, and state officials sued for damages in their official capacities.

The court also dismissed the individual-capacity claims against Roberts, Silvestri, and Zucker for failure to plead personal involvement in an alleged constitutional violation. Roberts and Silvestri were mentioned only in the caption and in descriptions of their positions and duties. Zucker was also mentioned in connection with a response from a representative acting on his behalf, but the court held that receiving a letter or grievance was not enough to establish personal involvement. The court further held that general allegations against defendants as a group were insufficient. The court did not address individual-capacity claims against Hein because the plaintiffs had not asserted them.

The court separately ruled that the claims against Sherwood had to be dismissed without prejudice because the plaintiffs had not served her with the Second Amended Complaint within the required period. The fact that Sherwood had appeared in the original complaint, or may have known about the lawsuit, did not cure the lack of service because the amended complaint replaced the original complaint.

The court also agreed that the Second Amended Complaint had not corrected the deficiencies identified in the earlier order. It concluded that both motions to dismiss were granted in full, that all claims against Sherwood were dismissed without prejudice, and that all claims against the remaining defendants were dismissed with prejudice. The Clerk was directed to terminate the pending motions.

Classification

This is a procedural order because the court dismissed the claims under threshold and pleading rules without deciding whether the alleged Medicaid reimbursement violations actually occurred or whether the plaintiffs were entitled to reimbursement.