Case Status:

Case Filed: March 2022

Main Concern

An individual who receives a favorable administrative hearing decision entitling him or her to Medicaid services should be allowed to enforce that decision and receive monetary compensation for harm suffered due to the delay in implementation.

Summary

CB, a DRM client, did not receive authorized Community Living Support (CLS) and respite services for approximately two years due to Livingston County Community Mental Health’s (LCCMH) failure to find providers.

CB was supposed to start receiving these services at least as early as June 2021. In March 2022, CB proceeded to a Medicaid Fair Hearing before an administrative law judge (ALJ). The judge agreed with CB and issued an order requiring LCCMH to promptly provide the services.

As LCCMH continued to delay, CB filed a complaint (a “mandamus” complaint) to enforce the ALJ’s decision. CB also sought monetary damages to compensate him for the harm suffered due to LCCMH’s delay. Only after this complaint was filed did LCCMH began providing the CLS services (still no respite). Unfortunately, the Livingston Circuit Court dismissed the case before LCCMH began providing the respite, and it did not address CB’s claim for monetary damages.

DRM appealed to the Michigan Court of Appeals (COA) in November 2022. Prior to the oral argument, LCCMH eventually provided the respite services and thereby complied with the ALJ’s order.  In December 2023, the COA issued a published decision with two important holdings:

  1. While LCCMH’s eventual compliance with the ALJ’s order made CB’s request for an order to make LCCMH comply moot (in other words, there was no longer any need for such an order), CB was still potentially entitled to monetary damages for harm suffered during the period prior to LCCMH’s compliance.
  2. The mandamus “good faith” exception to monetary damages does not apply to organizational defendants like a Community Mental Health agency.

The COA sent the case back to the Livingston Circuit Court for further proceedings and retained jurisdiction.

Outcome

The Michigan Court of Appeals (COA) issued a decision that will impact individuals statewide. Now, if an individual receives a positive administrative hearing decision entitling the individual to receive certain Medicaid services, 1) the individual could be entitled to monetary compensation in a lawsuit to enforce the administrative decision, even if the Medicaid entity complies with the decision by providing the services after the lawsuit is filed, and 2) an entity like a Community Mental Health (CMH) cannot claim the “good faith” exception to a claim for monetary damages in such a lawsuit.

 

Case name: CB by Next Friend and Guardian Debbie Macika et al v. Livingston County Community Mental Health et al.

Plaintiffs: CB, by Next Friend and Guardian Debbie Macika

Defendants: Livingston County Community Mental Health (LCCMH)

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