Bellin v. Zucker

Background

This was a putative class action against the State of New York and Elderserve Health, Inc. doing business as RiverSpring at Home. RiverSpring provides personal-care services through managed long-term care plans to people who receive both Medicare and Medicaid.

Rosalind Bellin alleged that managed long-term care plans do not provide new enrollees with an immediate appeal process for challenging the plans’ initial, pre-enrollment decisions about the number of personal-care hours they will provide. She claimed that this gap violates the Due Process Clause of the Fourteenth Amendment. The complaint also initially asserted claims under federal Medicaid statutes, but the court had ruled that those statutes did not provide a right to appeal, and the Second Circuit affirmed that part of the ruling.

Bellin applied to RiverSpring in 2019 and was offered eight hours of care per day, although she believed she needed 24-hour care. She enrolled, began receiving eight hours per day, and requested additional hours. While waiting for RiverSpring’s post-enrollment determination, she paid for additional care herself. RiverSpring ultimately approved 24-hour care, but the increased benefits applied retroactively only to the date of the post-enrollment determination, leaving Bellin responsible for expenses incurred before then.

Earlier Proceedings

The court had previously dismissed Bellin’s claims after finding that she had not plausibly alleged a protected property interest or a due-process right in the initial number of care hours. The Second Circuit reversed that ruling as to the due-process claims, holding that Bellin had plausibly alleged a property interest, and remanded for consideration of class certification and the merits of whether such an interest existed and whether New York’s procedures violated due process.

Proposed Classes and Legal Questions

Bellin moved for certification under Federal Rule of Civil Procedure 23(b)(2). She proposed a main class of new applicants for managed long-term care plan enrollment, along with subclasses for new RiverSpring applicants and people who would have wanted to appeal the plans’ initial pre-enrollment authorizations if an appeal had been available.

The proposed common questions concerned whether applicants had a property interest in the amount of care hours awarded, whether the Due Process Clause gave them a right to appeal the initial determination, and whether they had a right to notice of that appeal right.

Standing

The court rejected the defendants’ argument that Bellin and the proposed class members lacked Article III standing. Article III standing requires a plaintiff to show an injury that is connected to the defendants’ conduct and could be remedied by the court. The court held that denial of a constitutional right would be a legally recognizable injury if Bellin ultimately proved that she had a property interest in the initial care-hours determination and that the existing procedures did not adequately protect it.

The court also held that Bellin’s requested declaratory and injunctive relief was not barred by the Eleventh Amendment. She sought a declaration about the claimed right and an order requiring notice and processing of appeals, not damages in this lawsuit. The court therefore concluded that Bellin had standing.

Class Certification

A class must satisfy the requirements of Rule 23, including adequate size, common legal or factual questions, typical claims, and adequate representation. A class seeking certification under Rule 23(b)(2) must also seek declaratory or injunctive relief based on conduct that applies generally to the class. In addition, Second Circuit law requires the class to be ascertainable. That means its members must be identifiable using objective, administratively workable criteria without requiring a separate mini-hearing on the merits of each person’s claim.

The court stated that an appropriately narrowed class would consist of individuals who applied for personal-care services through managed long-term care plans and were not given an adequate level of hours. But the court held that even this narrower definition was not ascertainable. Whether the number of hours was “adequate” depended on each individual’s perception of how much care was needed, rather than on an objective standard.

The court further explained that allowing people to identify themselves by saying they were dissatisfied with their initial award would not solve the problem. To determine whether a person belonged in the class, the court would need to decide whether that person had suffered a due-process violation. That inquiry would require examining the person’s needs, the number of hours awarded, the effect of the shortfall, and whether the existing procedures adequately protected the person’s claimed interest. The court concluded that conducting such individualized inquiries would conflict with the ascertainability requirement.

Disposition

The court denied Bellin’s motion for class certification. It did not decide whether New York’s procedures ultimately violated the Due Process Clause. The parties were ordered to attend a status conference on October 21, 2022, and the clerk was directed to terminate the class-certification motion from the docket.