UNITED STATES DISTRICT COURT WESTERN DISTRICT OF MISSOURI
CENTRAL DIVISION

JULIA M, on her behalf and on behalf of her minor child, lW.M.,and all others similarly situated,
Plaintiffs,
v.
DEBORAH E. SCOTT, as the Director of the Missouri Department of Social Services, JANELR. LUCK, as the Interim Director of the Missouri Family Support Division, and STEVE RENNE, as the Interim Director of the Missouri Division of Medical Services,
Defendants.

Case No. 07-4036-CV-C-NKL

COMPLAINT

PRELIMINARY STATEMENT

1. Plaintiff Julia M.'s severely disabled daughter, J.W., relies on Missouri's State
.. -
Children's Health Insurance Program (SCHIP) to meet her extensive health care needs. Defendants

recently terminated J.W. 's coverage for six months without informing her or her mother oftheir right

to appeal, and without continuing J.W.'s benefits while she challenged the state's action. Ms. M

brings this .action pursuant to 42 U.S.C. § 1983 and Article VI ofthe United States Constitution on

'.

.

behalf of herself and her minor daughter and a class of needy Missouri children challenging

defendants' policies and practices of discontinuing desperately-needed medical benefits without a)

notifying them of their right to an appeal; b) notifying them of and providing the opportunity for

continued em-ollment and coverage pending the outcome of an appeal; and c) first determining

whether they are otherwise eligible for medical assistance under another eligibility category, all in

violation of federal law. 2. Plaintiffs bring this action for declaratory and injunctive reliefon behalfofthemselves
and a class ofMC+ recipients who are subject to the SCRIP cost-sharing premium under Mo. Rev. Stat. § 208.640 and those who are subject to the six-month disenrollment penalty provisions under Mo. Rev. Stat. § 208.646, and for whom the defendants have failed to a) provide written notice of their right to an appeal upon termination from the program; b) provide notice ofand aid paid pending that appeal; and c) first determine whether the recipients are otherwise eligible for medical assistance as required by federal law.
3. Plaintiffs seek preliminary and permanent injunctions enjoining the defendants to: a) notify all MC+ recipients who are disenrolled from MC+ health coverage for failure to meet premium requirements of their right to appeal; b) notice and provision of the opportunity for continued enrollment and aid paid pending a hearing; and c) first determine whether such MC+ recipients are otherwise eligible for medical assistance under another eligibility category.
4. Plaintiffs seek a declaratoryjudgment that the challenged policies and practices violate: a) 42 U.S.c. § 1396a(a)(3), its implementing regulations at 42 C.F.R. §§ 431.206(b) and 431.230, and the Due Process Clauses of the Fifth and Fourteenth Amendments to the u.S. Constitution, which, inter alia, require notice of fair hearing rights and aid continuing while the hearing is pending; b) 42 U.S.C. § 1397aa-jj and its implementing regulations at 42 C.F.R. § 457.1170, which, inter alia, require defendants to provide the opportunity for continued enrollment pending the completion of a review of disenrollment, including decisions to disenroll for failure to pay costsharing premiums; and c) 42 § U.S.C. 1396(a)(8) and its implementing regulation at 42 C.F.R. § 435.930(b), which prohibits discontinuing medical assistance benefits without first determining
2

whether the child is otherwise eligible for medical assistance. JURISDICTION AND VENUE
5. This action is authorized by 42 U.S.C. § 1983 and Article VI ofthe U.S. Constitution (the Supremacy Clause) as an action seeking redress ofthe deprivation ofstatutory and constitutional rights under color of state law.
6. Jurisdiction over this action is conferred upon this court by 28 U.S.C. § 1331, which provides for jurisdiction in the United States district courts of civil actions arising under the Constitution, laws, or treaties of the United States.
7. Venue properly lies with this district pursuant to 28 U.S.C. § 139l(b). PARTIES
8. Plaintiff J.W.M. resides in Farmington, Missouri. 9. Plaintiff Julia M. resides in Farmington, Missouri. 10. Defendant Deborah E. Scott is the Director of the Missouri Department of Social Services (DSS). She is responsible for the general administration and implementation of laws concerning the social welfare ofthe people ofthe State ofMissouri, including the Medicaid program. Defendant Scott is designated the chiefadministrative officer ofthe Department and is charged with its ultimate control and administration. She is responsible for, inter alia, the administration ofthe State's Medicaid program and supervision ofthe administration ofthe Medicaid and SCRIP program by the local social services districts. 11. Defendant Janel R. Luck is the Interim Director of the Missouri Family Support Division (FSD), a division ofDSS, and, as such, is responsible for the general administration of public welfare programs in the State of Missouri, including determinations of eligibility for the
3

Missouri SCHIP and Medicaid program. Defendant Luck is the designated chief administrative officer of the DFS and holds ultimate administrative power within DFS subject to the supervision of Defendant Scott.
12. Defendant Steve Renne is the Interim Director of the Missouri Division of Medical Services (DMS), a division of DSS, and, as such, is responsible for the administration of the Missouri SCHIP and Medicaid program, including disenrollment for failure to meet premium requirements. Defendant Renne is the designated Chief Executive Officer and holds ultimate administrative power within the DMS subject to the supervision of Defendant Scott.
STATUTORY AND REGULATORY FRAMEWORK SCHIP Framework
13. SCHIP is a jointly funded state and federal program that provides health assistance to uninsured, low-income children whose family income is above the State's Medicaid income limits, but who cannot afford private health insurance. SCHIP, Title XXI of the Social Security Act, is codified at 42 U.S.C. § 1397aa-jj.
14. A state receiving federal matching funds for its SCHIP program must comply with the requirements ofthe federal SCHIP Act and its implementing regulations promulgated by the U.S. Department of Health and Human Services (HHS). 42 U.S.C. § 1397aa(a)(2).
15. Missouri operates SCHIP as part ofits Medicaid program and accepts federal matching funds for its program expenditures. Missouri SCHIP recipients receive their medical coverage through Missouri's Medicaid/MC+ for Children category of assistance. Missouri's 1115 Waiver
16. HHS can waive certain federal Medicaid requirements upon receipt and approval of a
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waiver proposal related to the coverage and delivery of health care services. 42 U.S.c. § 1315. Commonly known as Section 1115 Research and Demonstration Waivers, they must be couched in terms of an "experimental, pilot, or demonstration project which, in the ju,dgment of the Secretary, is likely to assist in promoting the objectives" ofthe Act. § 1315(a). Such waivers can be granted for the period HHS finds necessary to enable the State to carry out the project, and are typically approved for five years and may be renewed upon completion. § 1315(a)(1).
17. In 1998, HHS approved Missouri's request for a Section 1115 Demonstration Waiver extending medical assistance coverage to children under the age of nineteen whose family income is below 300 % of the federal poverty level (fpl) through the MC+ for Children program. See MO Medicaid Section 1115 Demonstration Managed Care Plus No. 11-W-0012217. In August 2003, HHS approved Missouri's request for an extension of its Section 1115 Waiver until March 2007. See Department of Health and Human Services, Extension Approval Letter, Aug. 25, 2003. In September 2006, HHS accepted Missouri's amendment modifying its premium structure, w.hich had the effect of expanding the number of recipients required to pay premiums. See Department of Health and Human Services, Award Letter, Sept. 20,2006. The amendments were also approved until March 2007. ld.
18. Under the Tenns and Conditions of Missouri's 1115 Waiver, all requirements ofthe Medicaid program including 42 U.S.C. § 1396a, implementing regulations, and policy statements that are not expressly waived as not applicable, shall apply to the Medicaid/MC+ Program. See Missouri 1115 Demonstration - Managed Care Plus Special Terms and Conditions, last updated 9115106, Part III.
19. The statutes and regulations this complaint seeks to enforce have not been waived
5

through Missouri's 1115 Waiver. See Department of Health and Human Services, Award Letter, Sept. 20, 2006; Department of Health and Human Services Approved Waiver and Expenditure Authorities, Attachment 2. Right to Notice of and Continuing Aid Pending an Administrative Fair Hearing
20. Defendants must give notice of every recipient's right to a fair hearing and the method for obtaining a fair hearing at the time of any action affecting her claim for benefits. 42 U.S.C.§ 1396a(a)(3) and 42 C.F.R. 431.206(b) and (c).
21. Defendants must grant the opportunity for a fair hearing to any individual whose claim for medical assistance is denied or terminated, and, when such a request has been made within ten days ofthe decision, defendants may not terminate or reduce services until a final determination after a hearing has been made. 42 U.S.C. § 1396a(a)(3) and 42 C.F.R. § 431.230.
22. Defendants must ensure the opportunity for continuation ofSCHIP enrollment pending the completion of review of a suspension or termination of enrollment, including a decision to disenroll for failure to pay cost sharing. 42 U.S.C. § 1397aa-jj and 42 C.F.R. § 457.1170. Cost sharing includes monthly premium charges that the enrollee is responsible for paying. 42 C.F.R. § 457.10.
23. 42 U.S.c. § U.S.C. 1396(a)(8) and 42 C.F.R. § 435.930(b) require defendants to detennine a recipient's continuing eligibility for Medicaid under any alternative basis of eligibility before terminating Medicaid or SCHIP benefits because the recipient is no longer eligible under the original eligibility category.
FACTUAL ALLEGATIONS COMMON TO THE CLASS 24. In Missouri, families with incomes between 151 % and 300 % of the fpl are required
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to pay a premium for receipt of MC+ benefits. Mo. Rev. Stat. § 208.640. For families whose income is between 226 % and 300 % of fpl, any child who fails to pay a required premium in a timely manner is disenrolled from the MC+ program and is not eligible for MC+ coverage for six months after the department provides notice of such failure to the parent or guardian. Mo. Rev. Stat. § 208.646,
25. There are approximately 3,000 children in Missouri who receive MC+ coverage and whose family income is between 226 % and 300 % of fpI. See Missouri Family Support Division, Annual Report Data, Fiscal Year 2006, Page 16 (CHIP Premium Children).
26. Defendants fail and refuse to provide notification ofthe right to appeal and to provide MC+ benefits pending the outcome of an administrative fair hearing to those MC+ recipients who defendants seek to suspend from participation in MC+ for at least six months due to an alleged failure to timely pay the MC+ premium.
27. Missouri has the capacity to determine on an ex parte basis the eligibility of the plaintiffs, and the class they seek to represent, for continued enrollment in some other category of Medicaid assistance for those class members who are detremined no longer eligible in the MC+ category and requires such reviews to be conducted. See Missouri Department of Social Services, Family Support Division, Income Maintenance Manual, Medical Assistance for Families, MC+ Health Care Coverage Manual, §§ 0905.025.16 MAP / MC+ Closing Review Procedures and 0905.025.16.05 Ex Parte Review.
CLASS ALLEGATIONS 28. The named plaintiffs bring this action on their own behalf and, pursuant to Rule 23(a) and (b)(2) of the Federal Rules of Civil Procedure, for certification of a class consisting of the
7

following members: All children residing in Missouri and who are receiving or who will receive MC+ health coverage and are required to pay a premium under Mo. Rev. Stat. § 208.640.
29. The class is so numerous that joinder of all members is impracticable. Approximately 20,000 Missouri families are subject to the cost-sharing premium and approximately 3,000 are also subject to the six month penalty upon failure to timely pay the premium.
30. There are numerous questions of law and fact common to the class as a whole concerning defendants' policies and practices of disenrolling eligible MC+ beneficiaries. At issue are the policies and practices of defendants of: (1) failing to notify those families of their right to a fair hearing upon disenrollment from the program; (2) failing to provide those families with the opportunity for continued enrollment pending completion ofa review ofsuch disenrollment; and (3) failing to provide to those families an ex parte review to determine whether the MC+ beneficiary is otherwise eligible for medical assistance.
31. Declaratory and injunctive relief are appropriate with respect to the class as a whole because the defendants have acted on grounds applicable to the class.
32. The named plaintiffs' claims are typical ofthe claims of the class. 33. The named plaintiffs will fairly and adequately protect the interests of the class. Because oftheir indigence, the named plaintiffs are represented by the National Center for Law and Economic Justice and the National Health Law Program, whose attorneys have litigated numerous class actions, including three in this District. Plaintiffs know of no conflicts of interest among members of the class. 34. A class action is superior to other available methods for a fair and efficient adjudication
8

of this matter in that it will avoid numerous separate actions by class members. FACTS OF INDIVIDUAL NAMED PLAINTIFFS
Background 35. Plaintiff Julia M. and her minor daughter J.W.M. live in Farmington, Missouri. 36. Since she was eight-years-old, after being involved in an accident, J.W. has suffered
from numerous and severe medical and psychiatric conditions necessitating ongoing medical treatment.
37. Throughout the subsequent years, J.W. has needed constant medical attention, medicines, and therapies. Recently, she developed cysts on her face that require medication.
38. Due to her anxiety disorders, since Spring 2006, J.W. has not been able to attend school and has required home schooling. Experiences with MC+ Program
39. In June 2006, Julia M. applied for J.W. to be enrolled in the MC+ program, which required a $151 monthly premium. Thereafter, Julia M. received a letter dated June 20, 2006 stating that coverage could start on July 1, 2006 if the $151 payment was made by that date and that if payment was received after that date, coverage would start on the date the payment was received.
40. Julia M. made the required premium payment by check on July 20, 2006. 41. On or about July 24, 2006, Julia M. received a notice stating that the premium payment had been received and had been applied to J.W.'s coverage for July 20,2006 through August 19, 2006. This notice also advised that future payments could be made through an autowithdrawal by SUbmitting an attached form and voided check. 42. On or about July 24,2006, Julia M. received another notice stating that her monthly
9

premium was now $156 and that payment was due on August 3,2006 for next month's coverage. This notice also advised that future payments could be made through an autowithdrawal by submitting an attached form and voided check. This notice further stated that if payment was not received by August 23, 2006, coverage would stop and that, ifher income was above 225% ofthe fpl, her child would not be eligible for coverage for six months.
43. Pursuant to the previous notices, on August 4, 2006, Julia M. chose to participate in the autowithdrawal where future premium payments would automatically be deducted from her account by providing defendants with a voided check and a completed autowithdrawal fonn.
44. On August 11, 2006, Missouri Social Services made a test run-through on Julia M.'s account, but did not withdraw the premium payment.
45. Over the next few days, Julia M. continuously called the defendants' toll-free number and was never able to get through. Julia M. then called her bank who informed her that normally, after a run-through, defendants would take the payment out in a few days.
46. Not being able to get through to defendants or hearing anything to the contrary, Julia M. thoug!1t her account would be debited and the payment would cover the August premium.
47. On August 22,2006, a notice was sent to Julia M. which said that the $156 premium would be taken out of her bank account on September 5, 2006 and, in bold, "Do not mail a check or money order to pay your premium."
48. In September 2006, Julia M. went to speak with J.W. 's caseworker who informed her that J.W.'s benefits had been canceled on August 24, 2006 because Julia M. had not paid the premium.
49. In late September 2006, Julia M. received a failure to pay notice dated August 3, 2006,
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which stated that she must pay the premium before August 24, 2006 or lW. would be disenrolled from MC+ for six months. The letter was received after the dates mentioned.
50. None ofthe notices referenced above, including the notice stating thatJ.W. 's coverage would be terminated for six months for failure to pay the premium, included a reference to the right to appeal.
51. Thereafter, Julia M. went to herlocal Family Support Division office to .appeal J.W.'s termination. She was told by the supervisor in charge, Robin Nolan, that the rules had changed and there was no possibility of appeal from a termination for non-payment. Ms. Nolan refused to give Julia M. this statement in writing or a copy of the new rule.
52. Subsequently, Julia M. sent a letter requesting a hearing to the Premium Collections Unit at the Division of Medical Services in Jefferson City, Missouri.
53. Julia M. never received a final cancellation notice nor any notice including her right to appeal or to receive aid pending an appeal.
54. In early January 2007, Julia M. received a document entitled Missouri Medicaid Hearing Request. She immediately filled it out and returned it to the Recipient Hearings Unit in the Division ofMedical Services. She has not heard anything since and a hearing date has not been set.
55. At the time of her disenrollment, defendants did not inform Julia M. that they had assessed whether J.W. could receive medical assistance under an alternative benefit category, such as Medical Assistance for Disabled Children, which provides medical assistance to children who meet the Social Security Income definition of disability and certain income requirements. Actual Harm Necessitating a Preliminary Injunction
56. As a result of J.W. 's disenrollment, she has not been able to receive critical medicines
11

and medical services. Thus, she is no longer taking her eleven different anxiety and asthma medicines.
57. J.W. has been forced to cancel an appointment with a neurologist in St. Louis and to forgo needed therapies. She was also unable to attend her scheduled follow-up dermatologist appointments at St. Louis University's SLUCare program in order to deal with her cysts and facial scaring.
FIRST CLAIM FOR RELIEF 58. Defendants' policy and practice of failing to notify plaintiffs and plaintiff class members of their right to a fair hearing upon disenrollment from the MC+ health coverage program violates 42 U.S.C. § 1396a(a)(3) and its implementing regulation, 42 C.F.R. § 431.206(b) and (c).
SECOND CLAIM FOR RELIEF 59. Defendants' policy and practice of failing to notify plaintiffs and plaintiff class members of their right to a fair hearing upon disenrollment from the MC+ health coverage program violates the Due Process Clauses of the Fifth and Fourteenth Amendments to the United States Constitution.
THIRD CLAIM FOR RELIEF 60. Defendants' policy and practice of failing to provide plaintiffs and plaintiff class members with MC+ pending an appeal violates 42 U.S.C. § 1396a(a)(3) and its implementing regulation, 42 C.F.R. § 431.230, and 42 U.S.C. § 1397aa-jj and its implementing regulation at 42 C.F.R. § 457.1170.
FOURTH CLAIM FOR RELIEF
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61. Defendants' policy and practice of failing to provide plaintiffs and plaintiff class members with aid pending an appeal violates the Due Process Clauses of the Fifth and Fourteenth Amendments to the United States Constitution.
FIFTH CLAIM FOR RELIEF 62. Defendants' policy and practice of failing to provide plaintiffs and plaintiff class members with MC+ pending an appeal stands in conflict with 42 U.S.C. § 1396a(a)(3) and its implementing regulation, 42 C.F.R. § 431.230, and in conflict with 42 U.S.C. § 1397aa-jj and its implementing regulation at 42 C.F.R. § 457.1170, and is thus preempted by the Supremacy Clause ofthe United States Constitution, art.VI.
SIXTH CLAIM FOR RELIEF 63. Defendants' policy and practice of disenrolling plaintiffs and plaintiff class members in the MC+ program without first detennining whether they are eligible for other medical assistance, including engaging in ex parte determinations, violates 42 § U.S.C. 1396(a)(8) and and its implementing regulation, 42 C.F.R. § 435.930(b).
SEVENTH CLAIM FOR RELIEF 64. Defendants' policy and practice of disenrolling plaintiffs and plaintiff class members in the MC+ program without first detennining whether they are eligible for other medical assistance, including engaging in ex parte determinations stands in conflict with 42 § U.S.C. 1396(a)(8) and and its implementing regulation, 42 C.F.R. § 435.930(b), and is thus preempted by the Supremacy Clause of the United States Constitution, art.VI.
REOUEST FOR RELIEF WHEREFORE, Plaintiffs respectfully requests that this Court
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( a)

Certify this action as a class action pursuant to Rule 23 of the Federal

Rules of Civil Procedure on behalf of a class all children residing in

Missouri and who are receiving or who will receive MC+ health

coverage and are required to pay a premium under Mo. Rev. Stat. §

208.640;

(b)

Enter a declaration pursuant to 28 U.S.C. § 2202 that defendants' policy

and practice of failing to notify recipients of their right to a fair hearing

upon disenrollment from the MC+ health coverage program violates 42

U.S.C. § 1396a(a)(3) and its implementing regulation at 42 C.F.R. §

431.206(b) and the Due Process Clauses of the Fifth and Fourteenth

Amendments to the United States Constitution;

(c)

Enter a declaration pursuant to 28 U.S.C. § 2202 that defendants' policy

and practice of refusing to provide aid paid pending to eligible children

who have been disenrolled from the MC+ program for failure to meet

premium requirements violates 42 U.S.C. § 1396a(a)(3) and its

implementing regulation at 42 C.F.R. § 431.230 and the Due Process

Clauses ofthe Fifth and Fourteenth Amendments to the United States

Constitution;

(d)

Enter a declaration pursuant to 28 U.S.C. § 2202 that defendants' policy

and practice of refusing to provide the opportunity for continued

enrollment to eligible children who have been disenrolled from the MC+

program for failure to meet premium requirements violates 42 U.S.C. §

14

1397aa-jj, and its implementing regulation at 42 C.F.R. § 457.1170 and

the Due Process Clauses ofthe Fifth and Fourteenth Amendments to the

United States Constitution;

(e)

Enter a declaration pursuant to 28 U.S.C. § 2202, that, in the alternative,

defendants' policy and practice of refusing to provide aid paid pending to

eligible children who have been disenrolled from the MC+ program for

failure to pay a premium stands in conflict with 42 U.S.C. § 1396a(a)(3)

and its implementing regulation at 42 C.F.R. § 431.230 and 42 U.S.C. §

1397aa-jj, and its implementing regulation at 42 C.F.R. § 457.1170, and

is thus preempted by the Supremacy Clause of the United States

Constitution, art. VI;

(f)

Enter a declaration pursuant to 28 U.S.C. § 2202 that defendants' policy

and practice of disenrolling plaintiffs and plaintiff class members from

the MC+ program without first determining whether they are eligible for

other medical assistance violates 42 § U.S.C. 1396(a)(8) and its

implementing regulation at 42 C.F.R. § 435.930(b);

(g)

Enter a declaration, in the alternative, that, pursuant to 28 U.S.C. § 2202,

defendants' policy and practice of disenrolling plaintiffs and plaintiff

class members from the MC+ program without first determining whether

they are eligible for other medical assistance stands in conflict with 42 §

U.S.C. 1396(a)(8) and its implementing regulation at 42 C.F.R. §

435.930(b), and is thus preempted by the Supremacy Clause of the

15

United States Constitution, art. VI;

(e)

Preliminarily and permanently enjoin defendants from refusing to notify

plaintiffs and plaintiff class of their right to a fair hearing upon

disenrollment from the MC+ health coverage program;

(f)

Preliminarily and permanently enjoin defendants from refusing to

provide an opportunity for continued enrollment during review of the

disenrollment to all children who have been disenrolled in the MC+

program for failure to meet premium requirements;

(g)

Preliminarily and permanently enjoin defendants from refusing to notify

recipients of their right to the opportunity for aid paid pending an appeal

and ofthe circumstances under which that assistance may be terminated;

(h)

Preliminarily and permanently enjoin defendants from disenrolling MC+

recipient children, unless and until the defendants have determined, in

accordance with the declaration of this Court, that such children are not

otherwise eligible for medical assistance;

(I)

Award plaintiffs their costs and reasonable attorneys' fees as provided

for by 42 U.S.C. § 1988; and

G)

Grant such other and further relief as the Court may deem just and

proper.

DATED: February 15, 2007.

Respectfully submitted: 16

By: s/Petra T. Tashe(f PETRA T. TASHEFF (Bar #31719) NATIONAL CENTER FOR LAW AND ECONOMIC JUSTICE, INC. MARC COHAN LAURA F. REDMAN 275 Seventh Avenue, Suite 1506 New York, New York 10001 (212) 633-6967 STEVEN A. HITOV NATIONAL HEALTH LAW PROGRAM, INC. 1101 14th Street, N.W., Suite 405 Washington, D.C. 20005 (202) 289-7661 Attorneys for Plaintiff
17

 </s> IN THE UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF MISSOURI CENTRAL DIVISION

JULIA M., on behalf of herself and her )

minor child, J.W.M., and all others similarly )

situated,

)

)

Plaintiffs,

)

)

v.

)

)

DEBORAH E. SCOTT, Director of the )

Missouri Department of Social Services, )

JANEL R. LUCK, Interim Director of the )

Missouri Family Support Division, and )

STEVE RENNE, Interim Director of the )

Missouri Division of Medical Services, )

)

Defendants.

)

Case No. 07-4036-CV-C-NKL

ORDER Plaintiff Julia M. seeks injunctive relief on behalf of her daughter, J.W.M, and a class of “[a]ll children residing in Missouri and who are receiving or who will receive MC+ health coverage and are required to pay a premium under Mo. Rev. Stat. § 208.640.”1 Specifically, Plaintiff asks the Court to enjoin Defendants (a) to notify all MC+ recipients who are disenrolled from MC+ health coverage for failure to meet premium requirements of their right to appeal prior to disenrollment; (b) to provide the

1MC+ is a statewide medical assistance program for low-income families, pregnant women, and children under the age of 19. The Court certified a class of such recipients in its June 25, 2007 Order [Doc. # 39]
1

opportunity for continued enrollment and aid pending a hearing; and (c) to first determine
whether such MC+ recipients are otherwise eligible for medical assistance. Pending
before the Court is Plaintiffs’ Motion for Preliminary Injunction [Doc. # 11]. For the
reasons set forth below, the Preliminary Injunction is granted.
I. Regulatory Background
Missouri’s State Children’s Health Insurance Program (SCHIP) is a jointly funded
state and federal program that provides health assistance to uninsured, low income
children whose family income is above the State’s Medicaid income limits, but who
cannot afford private health insurance. 42 U.S.C. § 1397aa-jj. Congress has provided
that states participating in such a joint program have two options for its implementation.
The state may either create (1) a separate child health program or (2) provide insurance
through an expansion of its existing Medicaid program. 42 U.S.C. § 1397aa(a)(2); 42
C.F.R. § 457.70(a)(1)-(2). Both parties agree that Missouri has chosen the latter option
by creating Medicaid MC+, a Medicaid expansion program under which
Parents and guardians of uninsured children with incomes between one hundred fifty-one and three hundred percent of the federal poverty level who do not have access to affordable employer-sponsored health care insurance or other affordable health care coverage may obtain coverage pursuant to this section. . . . The parents and guardians of eligible uninsured children pursuant to this section are responsible for a monthly premium equal to the average premium required for the Missouri consolidated health care plan . . . .
Mo. Rev. Stat. § 208.640. However, if a participating parent fails to make a payment,
“the child shall not be eligible for coverage under [Mo. Rev. Stat.] sections 208.631 to
208.660 for six months after the department provides notice of such failure to the parent
2

or guardian.” Mo. Rev. Stat. § 208.646. At issue in this lawsuit is what amount of process is due to MC+ recipients before their benefits are terminated for nonpayment of the required premium.
When a state elects to provide health insurance for the children of the working poor through an expansion of its Medicaid program rather than through a separate child health program, the expansion program “must . . . [b]e consistent with the State's Medicaid State plan, or an approvable amendment to that plan, as required under title XIX [of the Social Security Act].” 42 C.F.R. § 457.70(c)(2). Thus, as both parties agree, the regulations governing Medicaid generally, 42 C.F.R. § 430 et seq., rather than those governing separate child health insurance programs specifically, 42 C.F.R. § 457 et seq., dictate Missouri’s obligations to the participants in its Medicaid expansion program.
Under Title XIX of the Social Security Act and its implementing regulations, Missouri is obligated to provide a certain level of due process before it can terminate benefits. See 42 U.S.C. § 1396a(a)(3) (“A State plan for medical assistance must . . . (3) provide for granting an opportunity for a fair hearing before the State agency to any individual whose claim for medical assistance under the plan is denied or is not acted upon with reasonable promptness.”). Therefore, “[a]t the time of any action affecting his or her claim,” “[t]he agency must . . . inform every applicant or recipient in writing--(1) Of his right to a hearing; (2) Of the method by which he may obtain a hearing; and (3) That he may represent himself or use legal counsel, a relative, a friend, or other spokesman.” 42 C.F.R. § 431.206(b)(1)-(3),(c)(2). With immaterial exceptions, the
3

notice required under § 431.206(c)(2) must be mailed to the recipient “at least 10 days
before the date of action,” 42 C.F.R. § 431.211, and must inform the recipient of
(a) A statement of what action the State, skilled nursing facility, or nursing facility intends to take; (b) The reasons for the intended action; (c) The specific regulations that support, or the change in Federal or State law that requires, the action; (d) An explanation of--(1) The individual's right to request . . . a State agency hearing; . . . and (e) An explanation of the circumstances under which Medicaid is continued if a hearing is requested.
42 C.F.R. § 431.210. Further, a “State agency must grant an opportunity for a hearing to .
. . (2) Any recipient who requests it because he or she believes the agency has taken an
action erroneously.” 42 C.F.R. § 431.220. Although the Agency “may require that a
request for a hearing be in writing,
(b) The agency may not limit or interfere with the applicant's or recipient's freedom to make a request for a hearing. (c) The agency may assist the applicant or recipient in submitting and processing his request. (d) The agency must allow the applicant or recipient a reasonable time, not to exceed 90 days from the date that notice of action is mailed, to request a hearing.
42 C.F.R. § 431.221. Most importantly, and with immaterial exceptions,
(a) If the agency mails the 10-day . . . notice as required under § 431.211 . . . of this subpart, and the recipient requests a hearing before the date of action, the agency may not terminate or reduce services until a decision is rendered after the hearing . . . .
42 C.F.R. § 431.230. And finally, “[t]he agency must (a) Furnish Medicaid promptly to
recipients without any delay caused by the agency's administrative procedures; [and] (b)
4

Continue to furnish Medicaid regularly to all eligible individuals until they are found to be ineligible.” 42 C.F.R. § 435.930. II. Factual Background
Under the MC+ program, families with an income between 151 and 300 percent of the federally determined poverty level are required to pay a monthly premium for their insurance benefits. Mo. Rev. Stat. § 208.640. For families with an income between 226 and 300 percent of the poverty level, nonpayment of the premium after notice of delinquency results in termination of benefits for six months. Mo. Rev. Stat. § 208.646.
Through a series of bank errors, JWM’s August MC+ premium was not automatically deducted from her mother’s account in a timely fashion. Defendants assert that Julia M. was notified of the nonpayment by letter dated August 3, 2006 and told that she had until August 15 to pay the premium or JWM’s benefits would be terminated. Neither party has produced this original letter to the Court, and there is a factual dispute as to what state officials told Julia M. during her efforts to get the premium paid. In any event, Julia M. received a second letter dated August 25 which stated as follows:
This is to confirm that your children’s MC+ health care coverage ended effective 8-23-2006. MC+ coverage ended because the full premium of $156.00 was not paid. Your children may not be eligible for MC+ health care coverage for six (6) months. . . . You have the right to appeal this decision. You can ask for a hearing within 90 days of the date of this letter by [calling or writing the Division of Medical Services].
5

Def. Sugg. Opp. Class Cert., Ex. A. [Doc. # 25-2]. Defendants admitted in their class certification brief that “this notification letter is standard correspondence” sent to MC+ recipients who fail to pay their monthly premium. Def. Sugg. Opp. Class Cert. at 5.
Following the initiation of this lawsuit, J.W.M.’s MC+ coverage was voluntarily reinstated by the Defendants. Because the Court found that termination without a predeprivation hearing is an act capable of repetition yet evading review, the Court concluded that J.W.M’s lawsuit was not moot. After full consideration of the standards for class certification, the Court certified a proposed class of “[a]ll children residing in Missouri and who are receiving or who will receive MC+ health coverage and are required to pay a premium under Mo. Rev. Stat. § 208.640.” It is on their behalf that Plaintiffs now seek a preliminary injunction. III. Preliminary Injunction
The Eighth Circuit has held that “whether a preliminary injunction should issue involves consideration of (1) the threat of irreparable harm to the movant; (2) the state of balance between this harm and the injury that granting the injunction will inflict on other parties litigant; (3) the probability that movant will succeed on the merits; and (4) the public interest.” Dataphase Systems, Inc. v. C L Systems, Inc., 640 F.2d 109, 114 (8th Cir. 1981) (en banc). “The burden of establishing the propriety of a preliminary injunction is on the movant.” Baker Elec. Coop. v. Chaske, 28 F.3d 1466, 1472 (8th Cir. 1994).
A. Irreparable Harm
6

Although Defendants contest the potential for irreparable harm to the plaintiff class as speculative and unsupported by evidence, the Court concludes that the potential for irreparable harm is patently obvious. J.W.M.’s benefits were terminated and could not be reinstated for six months because of a banking error. A potential lapse in medical coverage for the children of the working poor who are otherwise unable to pay for needed medical attention is an irreparable harm of the highest order. Although Julia M. has not produced specific evidence that other children in the class would face the same potential harm, the “standard correspondence” letter issued by the Defendants when J.W.M.’s benefits were terminated suggests that other MC+ recipients have received similar letters and therefore face the same potential for irreparable harm. Counsel for the Defendants in fact indicated that it was the policy of the Department to send out such letters when timely payments were not received. .
B. Likelihood of Success on the Merits At oral argument, Defendants also contested the likelihood of Plaintiffs succeeding on the merits. However, from the evidence presently before the Court, namely the termination letter of August 23, 2006, and the admissions by defense counsel that such correspondence is “standard,” the Court finds a high probability of success on the merits. The regulations which both parties agree govern the state’s obligations under the MC+ program require that “[a]t the time of any action affecting his or her claim,” “[t]he agency must . . . inform every applicant or recipient in writing--(1) Of his right to a hearing; (2) Of the method by which he may obtain a hearing; and (3) That he may represent himself
7

or use legal counsel, a relative, a friend, or other spokesman.” 42 C.F.R. § 431.206(b)(1)-
(3),(c)(2). With immaterial exceptions, the notice required under § 431.206(c)(2) must be
mailed to the recipient “at least 10 days before the date of action,” 42 C.F.R. § 431.211,
and must inform the recipient of
(a) A statement of what action the State, skilled nursing facility, or nursing facility intends to take; (b) The reasons for the intended action; (c) The specific regulations that support, or the change in Federal or State law that requires, the action; (d) An explanation of--(1) The individual's right to request . . . a State agency hearing; . . . and (e) An explanation of the circumstances under which Medicaid is continued if a hearing is requested.
42 C.F.R. § 431.210. Further, a “State agency must grant an opportunity for a hearing to .
. . (2) Any recipient who requests it because he or she believes the agency has taken an
action erroneously.” 42 C.F.R. § 431.220. Although the Agency “may require that a
request for a hearing be in writing,
(b) The agency may not limit or interfere with the applicant's or recipient's freedom to make a request for a hearing. (c) The agency may assist the applicant or recipient in submitting and processing his request. (d) The agency must allow the applicant or recipient a reasonable time, not to exceed 90 days from the date that notice of action is mailed, to request a hearing.
42 C.F.R. § 431.221. Most importantly, and with immaterial exceptions,
(a) If the agency mails the 10-day . . . notice as required under § 431.211 . . . of this subpart, and the recipient requests a hearing before the date of action, the agency may not terminate or reduce services until a decision is rendered after the hearing . . . .
8

42 C.F.R. § 431.230 (emphasis added). And finally, “[t]he agency must (a) Furnish Medicaid promptly to recipients without any delay caused by the agency's administrative procedures; [and] (b) Continue to furnish Medicaid regularly to all eligible individuals until they are found to be ineligible.” 42 C.F.R. § 435.930.
The only correspondence in the record pertaining to the termination of J.W.M.’s MC+ benefits arrived, at the earliest, on the date benefits were actually terminated. Although the Defendants suggested at oral argument that Julia M. received a prior notice on August 3, that letter is not before the Court and there is no way of knowing what rights it informed Julia M. of. The letter that has been filed with the Court provides only that “coverage ended effective 8-23-2006 . . . because the full premium of $156.00 was not paid. Your children may not be eligible for MC+ health care coverage for six (6) months.” Although the letter also notified Julia M. of her “right to appeal” by requesting “a hearing within 90 days of the date of this letter,” this “standard correspondence” from the state agency makes no mention of J.W.M.’s right to have her benefits continued pending the outcome of that hearing under 42 C.F.R. § 431.230. Perhaps when the record is more fully developed, the state will be able to produce evidence that shows the missing August 3 letter did so apprise Julia M. of her rights to a hearing and to continued benefits pending its outcome, but that evidence is not presently before the Court.
Defense counsel also admitted during oral argument that no ex parte review of J.W.M.’s eligibility for continued benefits under any other Medicaid program was performed prior to the termination of her benefits. Counsel claims that any such review
9

would be futile in J.W.M.’s case because the MC+ program is already a backstop program and represents coverage of last resort. Nevertheless, after this suit was filed, the state did perform an ex parte review of J.W.M.’s status and determined that switching to a Medicaid spenddown program based on disability would be cost ineffective. Pl. Reply, Ex. A. Irrespective of the conclusion in J.W.M.’s case, the fact remains that the state does not routinely preform ex parte reviews of eligibility before benefits are terminated, as required by 42 C.F.R. § 435.930. Thus, the likelihood of success on the merits on this point is also high.
C. Remaining Factors As for the balance between the harm to plaintiffs and the injury that granting the injunction would inflict on other parties, as well as a consideration of the public interest, the Court concludes that both weigh in favor of granting the preliminary injunction. If the injunction is granted, the state will be required to rewrite its notices of nonpayment, grant pre-deprivation hearings to those who request them, and continue benefits pending the outcome of such hearings, none of which is a trivial expense. However, such expense–which the regulations would seem to require anyway–is easily outweighed by a potential six-month lapse in health care coverage for children of the working poor. This is particularly true in the case of the Named Plaintiff since the bank error resulting in the coverage lapse would likely have been established and rectified while coverage remained in place if Plaintiff had just been given a pre-deprivation hearing. The public interest is also overwhelmingly served by resolving such errors quickly at a hearing while benefits
10

remain in place rather than forcing potentially expensive emergency room visits for uninsured children who are unable to pay for the cost of their care. In sum, the Court is satisfied that Plaintiffs have satisfied their burden to demonstrate that the Dataphase factors weigh in their favor. IV. Conclusion
Accordingly, it is hereby ORDERED that Plaintiffs’ Motions for Preliminary Injunction [Doc. # 11] is GRANTED. Defendants are ENJOINED from terminating any class member’s benefits for nonpayment without mailing a notice of pending termination to the recipient ten days prior to the termination which informs the recipient of her right to request a hearing within ten days and to receive continued benefits pending the outcome of that hearing. Defendants are further ENJOINED to conduct ex parte reviews of individual recipients’ eligibility under any other Medicaid program prior to termination of benefits.

Dated: July 9, 2007 Jefferson City, Missouri

s/ Nanette K. Laughrey NANETTE K. LAUGHREY United States District Judge

11

 </s> IN THE UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF MISSOURI CENTRAL DIVISION

JULIA M, et al., Plaintiffs,
v. DEBORAH E. SCOTT, et al.,
Defendants.

) ) ) ) ) Case No. 07-4036-CV-C-NKL ) ) ) ) )

ORDER

WHEREAS, this action was brought as a class action pur suant to Rule 23 of the Federal

Rules of Civil Procedure;

WHEREAS, by Order dated June 25, 2007, t he Court certified a class consisting of AAll

children residing in Missouri and who are recei ving or who will receive MC+ health coverage

and are required to pay a premium under Mo. Rev. Stat. ' 208.640”;

WHEREAS, counsel for Plaintiffs and couns el for Defendants have entered into a

Release and Settlem ent Agreement (ASettlement@) which, if approved by the Court, would

dispose of the claims made in this action by plaintiffs; and

WHEREAS, counsel for the parties have jointly m oved the Court, pursua nt to Rule 23

(e)(1) (c) of the Federal Rules of Civi l Procedure, for approval of the proposed Settlem ent, for a

hearing thereon, and for authorization of the noti ce of the hearing to be provided to m embers of

the plaintiff class;

NOW, THEREFORE, IT IS ORDERED THAT:

1. A hearing pursuant to Rule 23(e) of the Federal Rules of Civil Procedure shall be held before the undersigned on April 18, 2008, for the purpose of determining whether the

Case 2:07-cv-04036-NKL Document 77 Filed 03/11/08 Page 1 of 2

proposed Settlement is fair, reasonable, and adequate, and should be approved by the Court. The hearing shall take place before the Honorable Nanette Laughrey, United States Courthouse, 131 W. High Street, Jefferson City, Missouri 65101, and will begin at 9:00 a.m. The hearing may be adjourned or continued from time to time without further notice.
2. The Notice of Proposed Settlement of Class Action (ANotice@) attached hereto is hereby approved.
3. On or before March 21, 2008, the Defendants shall cause the Notice in English and Spanish to be posted in a public area at all Family Support Division local county offices, and in public areas of all DSS offices. Defendants shall cause the notice to be distributed to all Family Support Division caseworkers. The Notice distributed to caseworkers shall be the same size as all notices posted by the Defendants. On or before March 21, 2008, Defendants shall also publish the Notice in English and Spanish on the DSS web site http://www.dss.mo.gov/pr_health.htm. Defendants shall also cause the Notice to be published in English and Spanish in the legal notice section of The St. Louis Post- Dispatch, Kansas City Star, Springfield News-Leader, Columbia Daily Tribune, and Southeast Missourian on Monday, March 24, 2008, Saturday April 5, 2008 and Sunday April 13, 2008. Additionally, by March 21, 2008, plaintiffs= counsel shall distribute the Notice in English and Spanish to advocacy groups in Missouri and shall request that those organizations post the Notice in common area waiting rooms. Plaintiff=s counsel shall identify the advocacy groups to which such request is made by affidavit submitted to the Court prior to the hearing. Additionally, by March 28, 2008, the National Center for Law and Economic Justice and the National Health Law Program shall post the Notice in English and Spanish on their respective web sites, www.nclej.org and www.healthlaw.org.
4. Any member of the plaintiff class may appear at the aforesaid hearing on April 18, 2008 at 9:00 a.m., in person or by counsel, and object to the Settlement or give reasons why the proposed settlement should not be approved as fair, reasonable, and adequate.
5. Any member of the plaintiff class may also object to or comment on the Settlement by submitting objections in writing. Objections or comments must be post-marked by April 11, 2008, to the Court at the address listed above.
Dated: March 11, 2008 Jefferson City, Missouri
s/ NANETTE LAUGHREY Nanette Laughrey
United States District Judge
Case 2:07-cv-04036-NKL Document 77 Filed 03/11/08 Page 2 of 2

 </s> UNITED STATES DISTRICT COURT WESTERN DISTRICT OF MISSOURI
CENTRAL DIVISION

JULIA M, on her behalf and on behalf of her minor child, J.W.M., and all others similarly situated,
Plaintiffs,
v.
DEBORAH E. SCOTT, as the Director of the Missouri Department of Social Services, JANEL R. LUCK, as the Interim Director of the Missouri Family Support Division, and STEVE RENNE, as the Interim Director of the Missouri Division of Medical Services,
Defendants.

Case No. 07-4036-CV-C-NKL

ORDER Having reviewed the Release and Settlem ent Agreement, having conducted a fairness hearing pursuant to Fed. R. Civ. P. 23(e), and having heard the argum ent of plaintiffs = and defendants= counsel, and being fully advised in the pr emises, this Court finds that the proposed release and settlement is fair, reasonable, and adequate. On June 25, 2007, this Court certified a class consisting of AAll children residing in Missouri and who are receiving or who will receive MC+ health coverage and are required to pay a premium under Mo. Rev. Stat. ' 208.640.@ On July 9, 2007, this Court granted plaintiffs= motion for a preliminary injunction against defendants, enjoining defendants from terminating the MC+ coverage of any plaintiff class member due to non-paym ent without mailing a notice ten days prior to term inating coverage, informing the participant of the right to request a hearing within ten days, and to receive continued benefits pending the outcome of the hearing. The preliminary injunction order further enjoined

Case 2:07-cv-04036-NKL Document 84 Filed 04/21/08 Page 1 of 2

defendants to conduct ex parte reviews of individual recipients = eligibility under any other Medicaid program prior to terminating MC+ benefits for non-payment of a premium.
This Court further finds that the proposedsettlement agreement executed by the attorneys for the parties protects theinterests of members of the class and that the interests ofthe members of the class would not be prejudiced by the proposed settlement and release.
NOW, THEREFORE, IT IS: ORDERED that the proposed settlement with defendants by plaintiffs in the manner set forth in the Release and Settlem ent Agreement is fair, adequate, and reasonable, and the sam e is hereby authorized and approved; it is further ORDERED that under Fed. R. Civ. P. 41(a)(2) theclaims of the plaintiffs are dismissed in their entirety with prejudice; it is further ORDERED that this Court retains jurisdiction until October 15, 2008, or such later date as may be necessary under Paragraph 16 of the Settlement Agreement, for purposes of enforcement of the Settlement Agreement. Each party to bear its own costs beyond those already apportioned by the settlement agreement.

DATED: April 21, 2008

s/ NANETTE LAUGHREY The Honorable Nanette Laughrey U.S. District Court Judge

2 Case 2:07-cv-04036-NKL Document 84 Filed 04/21/08 Page 2 of 2

 </s> Release and Settlement Agreement The parties are "All children residing in Missouri and wlio are receiving or who will receive health coverage [from MO HealthNet for Kiqs, formerly known as MC+ for Children] and are required to pay a premium under Mo. Rev. Stat.§' 208.640" (herei~after "Plaintiff Class") and Deborah E. Scott, Director of the Missouri Department of Social Services, Janel Luck, Director ofthe Family Support Division and Ian McCaslin, Director of the MO BealthNet Division, ·and...their successors in office (hereinafter "Defendants"). The "lawsuit" referred to in this agreement is the lawsuit styled J. WM v. Scott et al., No. 07-4036-CV-C-NK.L in the United States District Court for the Western District of Missouri, Central Division. The "court" referred to in this agreement is the United States District Court for theW~stem District ofMisso\lri, Central Division. Missouri Senate Bill 577 amended state statutes concerning Medicaid and various medical assistance programs to refer to "recipients" ofprogram benefits as "p~icipants." Wherever the term 'participant' is used in this agreement, "participant" shall be understood to have the same meaning as the term ''recipient." Plaintiffs bring the lawsuit on behalfofthemselves and a class ofMissouri children who were receiving or in the future will receive MC+ health coverage and are required to pay a premium under Mo. Rev. Stat. §208.640. Pla,intiffs enter into this. agreement by and through their attorneys Marc Cohan, Petra Tasheff, and Laura Redman of the National Center for Law and Economic Justice and Steve Hitov of the National Health Law Program. Defendants enter into this agreement by and through their attorney, E!nily A. Dodge, Assistant Attorney General of the State ofMissouri. For due and good consideration recited herein, the parties agree and state as follows:: 1. The Lawsuit. Plaintiffs' complaint alleged that the Department of Social Services was not notifying MC+ participants of their right to an appeal and to notice and provision ofaid continuing pending a hearing beforeterminating coverage for non-payment ofa premium. In their complaint, Plaintiffs also claimed Defendants were not performing ex parte reviews to determine participants' eligibility under another eligibility category prior to terminating MC+ coverage for non-payment of a premium. On June 25,2007, the district court certified the Plaintiff Class. On July 9, 2007, the district court entered a preliminary injunction enjoining Defendants from tenninating the MC+ coverage of any PlaintiffClass member due to non-payment without mailing a notice ten days p~or to terminating coverage
1 Case 2:07-cv-04036-NKL Document 74 Filed 02/08/08 Page 1 of 22

informing the participant of the right to request a hearing withip. ten days and to receive continued benefits pending the outcome of the hearing. The preliminary injunction order further enjoined Defendants to conduct ex parte reviews ofindividual recipients' eligibility under any other Medicaid program, as required by 42 C.P.R. §435.930, a regulation applicable to Medicaid expansion programs such as MC+ under Title XIX, prior to terminating MC+ benefits for non-payment ofa premium. The parties agree that Missouri's State Children's Health Insurance Program (SCHIP) for participants over 150% of the Federal Poverty Level ("FPL") is now administered and operated by Defendants under Title XXI of the Social Security Act, thus, the portion of the district court's July 9, 2007, preliminary injunction order requiring Defendants to conduct ex parte reviews for class members prior to terminating benefits due to non-payment ofapremium does not now apply to those persons.
2. Scope of Agreement. This agreement ~mbodies the enf4'e agreement and understanding ofthe parties with respect to the subject matter contained herein. The parties hereby declare and represent that no promise, inducement, or agreement not herein expressed has been made, and the parties acknowledge that the terms and conditions ofthis agreement are contractual and not a mere recital.
3. Non-Admission. No actions taken by the parties hereto, or any ofthem, either previously or in connectio~ with thi~ agreement shall be deemed or construed to be an admission ofthe truth or falsity of any matter pertaining to any claim or defense alleged in the pleadings filed on behalf of the parties in the lawsuit, or an acknowledgment by any of the parties hereto of any liability to the other parties or to any person for ~y other claim, demand, or action, all liability being expressly denied by the parties.
4. Approval of Class Settlement and Dismissal of Claims
A. . The parties hereto stipulate and agree·that under Federal Rilles ofCivil Procedure 23(e) and 4l(a)(2) the United States District Court for the Western District of Missouri, Central Division,. must approve any settlement and dismissal ofPlaintiffs ~ claims.
B. hnmediatelyupon the Court's approval ofthis Agreement, the parties will seek an Order from the Court dismissing Plaintiffs' claims in their entirety under Rule 41(a)(2) of the Fed~ral Rules of Civil Procedwe with prejudice for all acts or omissions covered by those claims. The Court shall retain jurisdiction through October 15, 2008, for
2 Case 2:07-cv-04036-NKL Document 74 Filed 02/08/08 Page 2 of 22

the sole purpose ofpermitting the parties to seek enforcement ofthe terms oftbis agreement.

In the event Plaintiffs move for enforcement pursuant to Paragraph 16 herein, the Court shall

continue to retain jurisdiction with regard to issues related to the enforcement of tbis

Agreement for so long as necessary to enforce the terms of this agreement.

C. The parties hereto stipulate and agree that this agreement becomes effective

and binding when and only when the United States District Court for theWestern District of

Missouri, Central Division, approves this agreement and enters an order retaining

jurisdiction for purposes ofenforcement as agreed in subparagraph 4(B) ofthis agreement,

and unless the parties agree to any changes to this agreement sought by" the Court.

D. · The parties further agree that the notices attached to this Agreement as

Exhibits A through C will be ·sent to participants of benefits under Missouri's Title XXI

SCRIP as set forth in Paragraph 5 of this Agreement,' and that notification of such participants as pro~ded in Paragraph 5 fulfills Defendants' notice obligations under the

terms of the Preliminary Injunction Order.

5. Notice to SCHIP participants.

A. Defendants will take all steps needed to p~ogram all pertinent computer

systems to implement the generation and. sending of the notices attached as Exhibits A

through C to this Agreement by regular mail to SCRIP participants above 150% ofFPL as

set forth in Paragraphs 5(B) and 5(C) of this Agreement. Defendants stipulate ·that the .

implementation ofthese notices occun-ed onJanuaty 14 and 15,2008. Defendants provided

Plaintiffs' counsel with written notification of that implementation on January 22,2008.

B. Failure to Pay Notice. Beginning on the date ofimplementation ofthe notices ·

attached as Exhibits A through· C as set forth in Paragraph 5(A) of tbis Agreement, the

"Failure to Pay Notice LOC 2" attached as Exhibit A_ to this Agreement and incorporated

·herein by reference shall be sent to all SCRIP participants above·150% of federal poverty

level ("FPL") and at or below 225% 9fFPL whose premium payn:tent has not been received

15 days after payment was due. Beginning on the date of implementation of the notices

.

.

Exhibits A through Cas set forth in Paragraph 5(A) ofthis Agreement, the "Failure to Pay

Notice LOC 3" attached as Exhibit B to this Agreement and incorporated herein by reference

shall be sent to all SCRIP patiicipants above 225% ofFPL whose premium payment has not

been received 15 days after' payment was due.

Case 2:07-cv-04036-NKL Documen3t 74 Filed 02/08/08 Page 3 of 22

C. Notice ofCase Action. For any SCRIP participant to whom Defendants have

sent a Failure to Pay Notice as provided in Paragraph 5(B) and from whom Defendants have

not received a premium payment within 20 days after sending the Failure to Pay Notice,

Defendants will send the Notice of Case Action in the form attached as Exhibit C.

D. The parties agree that Exhibit C ofthis Agreement adequately notJ?es SCRIP

participants whose premium payments have not been received by Defendants oftheir right to

hearing and to continuing benefits ("aid continuing") pending ]fearing outcome, and that,

except as otherwise provided in Paragraph 5(A) through 5(C) ofthis Agreement, Defendants

may continue to use existing notices and for:nls concerning SCRIP premium payments.

Notices may be modified to remain consistent with applicable law, or changed as needed for

efficient program administration as long as changes are consistent with due process.

E. On the 15th day of the months of February, March, April, May, June, and

July, 2008, Defendants will provide:

1. 'The number- of LOC 2 Failure to Pay Notices ("Exhibit A") sent in the

previous month; and

2.

The ntunber of LOC 3 Failure to Pay Notices ("Exhibit B") sent in the

previous month; and

3. The number of Notices of Case Action ("Exhibit C") sent in the previous

month

to Laura Redman, attorney for Plaintiffs, by facsimile transmission or electronic mail.

Defendants will owe no duty to report numbers of notices sent after July 15, 2008.

Information that Defendants are required to report concerning notices during the months of

February through July 2008 shall be limited to information concerning numbers of notices

sent, as described in Paragraph 5(E), and shall not include any individually ident~fying

information or personal information of any participant to whom a Failure to Pay Notice .or

Notice of Case Action was sent. The parties stipulate and agree that nothing in the reports

concerning numbers· of notices during the months of February through July 2008 ·shall

constitute a presumption as to the efficacy of th~ SCRIP program or how well the SCRIP

program is functioning.

6. . · Reports of Hearing and Aid Continuing Requests.

4
Case 2:07-cv-04036-NKL Document 74 Filed 02/08/08 Page 4 of 22

On the 15th day of the months of April, June, and August; 2008, Defendants will

provide:

A. The number of hearings requested concerning nonpayment of a

SCHIP premium in the previous two months; and

B. The nUD+ber of hearing requests·id~ntified in Paragraph 6(A) of.this

Agreement in which aid continuing was requested; and

C. The number of individuals for whom aid continuing was provided

pending the requested hearing

to Laura Redman, attorney for Plailitiffs, by facsimile transmission or electronic mail. For

purposes ofthis Agreement, aid continuing shall mean the continuation of SCHIP benefits

·uninterrupted until the issuance of a decision by the Department of Social Services after a

hearing where participant's hearing request-was timely under applicable state and federal

law.

The p~ies further agree· that for the purposes of the June 2008 report, and ·for the

purposes ofthe August 4.008 report, concerning hearing and aid continuing requests, i1i the

event that Defendants receive more than 125 hearing requests, Defendants will n:ot be

obligated to provide information to Plaintiffs' counsel concerning requests beyond the first

125 hearing requests received during the applicable two month reporting period.· The

information Defendants will report to Plaintiffs' counsel concerning hearing requests and aid

continuing requests is limitedto information concerning the number ofhearing requests and

the number ofinstances in which aid continuing was provided, as described in Paragraph 6,

and shall not include any individually identifying information orpersonal information ofany

participant wJ;10 has requested, or on whose behalf a hearing has been requested, concerning

nonpayment ofa SCHIP preinium. The parties stipulate and agree that nothing in the reports

ofnumbers ofhearings requested or ofaid continuingrequests shall constitute apresumption

as to the efficacy ofthe SCHIP program or how well the SCHIP program is functioning.

7. Notice to Participants who Transitioned to a Premium-Paying Category

following July 9, 2007.

The parties agreethatifanyparticipantlostSCHIP coverage

due to non-payment of a premium while in transition from LOC 1 to LOC 2 or LOC 3

between July 9, 2007, and the implementation date ofExhibits A through C, Defendants will

reinstate SCRIP coverage for any such participants, will send those participants the notice

5
Case 2:07-cv-04036-NKL Document 74 Filed 02/08/08 Page 5 of 22

attached hereto as Exhibit D to notify them of such reinstatement, and will reimburse such

participants for covered medical expenses incurred during the period such participants were

.

.

not covered by MC+_, SCRIP or another Medicaid program, in accordance with the MO

HealthNet fee· schedule and with MO HealthNet coverage policies.

8. Ex parte Review. A. On or before February 20, 2008, Defendants

will mail by regular mail a copy ofthe notice attached as Exhibit E to this Agreement to each

MO RealthNetfor Kids or MC+ or SCRIP participant who between September 1, 2005, and

January 16,2008: 1) had a MO HealthNet for Kids or MC+ or SCRIP case closed due to

non-payment ofa premium and 2) did not become covered under another Medicaid program,

MO HealthNet for Kids, or SCRIP within ninety days following MO HealthNet for Kids or

MC+ or SCRIP case closure due to non-payment.

B. For those participants who respond to the notice attached as Exhibit E,

Defendants will perform an ex parte review to determine whether the responding participant

was in fact eligible for any Medicaid program administered by the State ofMissouri on the

date or dates that participant's case ~as closed due to non-payment of a premium and. other

.

.

coverage was not obtained within ninety days as s~t ·forth in Paragraph_ 8(A) of this

Agreement. In the event that a participant had multiple MO HealthNet for K.i~s, MC+ or

SCHIP case closures between September 1, 2005, an4 January 16, 2008, after which the

participant was not covered by MO RealthNet for Kids, MC+, SCRIP, or a Medicaid

program for more than nin~ty days~ Defendants will perform an ex parte review for each

_such case closure. In performing ex parte reviews uri.der Paragraph 8 of this Agreement,

Defendants will only review· information available to Defendants in the participant's case

. file, and through Defendants' computer records, on the date oftp.e case closure due to non-

payment ofpremium. Defendants further agree that ifa responding participant indicates he

or she was disabled on the date of case closure, Defendants will consult Social Security

Administration records to _which the Department has access to determine whether the Social

Security Administration has found that participant to be disabled. A Social Security

Administration finding of disability will be information used by Defendants to determine

participant eligibility for programs in the ex parte review determination performed. as

_provided in Paragraph 8 ofthis Agreement.

6 Case 2:07-cv-04036-NKL Document 74 Filed 02/08/08 Page 6 of 22

C. If, as a result of an ex parte review performed pursuant to Paragraph 8 ofthis

Agreement, Defendants determine that a participant was eligible for coverage under any

Medicaid program adminfstered by the State of Missouri on the applicable date of .case

closure under Paragraph 8(B), Defendants will reinstate·coverage under that program for the

individual effective the date of the applicable case closure, and will reimburse such

participants for covered medical expenses incurred during the period such participants were

not covered by MO HealthNet for Kids, MC+, SCRIP, or another Medicaid program, in

accordance with the MO HealthNet fee schedule, and withMO HealthNet coverage policies.

9. Premium Collection Unit Telephone Number. BeginningonFebruar)r

13, 2008, on each business day for thirty consecutive days, a district court staff member

designated by Judge William A. Knox will attempt to make contact at a random time

'between 8:00 a.m; and 5:00 p.m. with one of Defendant MO HealthNet's Premium

Collection Unit staff members whose regular job duties involve answering the 1-877-888-

2811 telephone number. The Premium Collection Unit will maintain.its existingprocedures

for answe~g the 1-877-888-2811 telephonenumberduringthe thirtydaytestingperiod. If

Judge Knox's designee calls and is unable to get through to one ofthese Premium Collection

Unit staff within five minutes, the Judge's designee will make one additional attempt at a

random time before 5:00p.m. that day: Ifthe designee makes contact with one of the five

individuals on that day, the attempt will be deemed successful. If no contact is made after

two attempts, the attempt will be deemed unsuccessful.

If, on 1'4arch 13, 2008, the Judge's designee made successful contact with one ofthe

Premium Collection Unit stafflisted in Paragraph 9 ofthis Agreement on at least 75% of the

days attempts were made, Defendants will have no further obligation under Paragraph 9 of

this Agreement. Ifthe Judge's designee makes successful contact with one ofthe Premium.

Collection Unit staff listed in Paragraph 9 of this Agreement less than 75% of the days

attempts were made, :qefendants agree to reassign one additional full-time equivalent staff

member to answer the 1-877-888-2811 phone number.

10. Release.

Plaintiffs do hereby release, acquit, and forever discharge

Defendants, the State of Missouri, and any employee or former employee of the State of Missouri of all and froiJ?. any and all liability, claims, actions, cau~es of action, demands,

rights, damages, cost, interest, loss of service, expenses, and co~pensation whatsoever,

7 Case 2:07-cv-04036-NKL Document 74 Filed 02/08/08 Page 7 of 22

whether or not now known or contemplated, which Plaintiffs now have, or which may
hereafter accrue, against Defendants, the State of Missouri, and any employee O! former
employee of the State of Missouri based on or arising out of (!on.ditions, incidents, or occurrences taking place .before the date of this Agreement that relate to notice, or lack of notice to MO RealthNet for Kids, MC+ or SCRIP participants oftheir right to a hearing and aid continuing prior to termination ofMO RealthNet for Kids, MC+ or SCRIP benefits or coverage due to non-payment ofpremium. This rel~ase does not prevent participants from requesting or pursuing administrative· hearings concerning non~payment of SCRIP premiums, including any appeals filed pursuant to the notices referenced in Paragraphs 5 and 6 of this Agreement, nor shall it have any effect on the decision of the merits of any such hearing. Plaintiffs agree that any claim by any member of the Plaintiff Class aris~ng from any failure or alleged failure ofDefendants to comply with this Agreement shall be pursued only through an action to enforce this Agreement. Nothing in this release shall preclude a:riy member of the Plaintiff class from challen_ging Defendants' determination of a Plaintiffs individual eligibility for any Medicaid or SCRIP program to the extent pennitted by law. Plaintiffs specifically acknowledge that they are forever barred from suit against the · Defendants, the State of Missouri, and any employee or former employee of the State of Missouri based on any matter released by this agreement.
11. Attorney's Fees and Expenses. In exchange forpayment of$165,000.00, representing all fees through the date ofsigning ofthe Settlement Agreement, and $866.00, representing all expenses through the date of signing of the Settlement Agreement, it is agreed between and among the parties to this agreement that no party is a "prevmling party" within the meaning of42 U.S.C. § 1988, or any other statute, rule, or other provision oflaw which is or may be in any way applicable thereto in connection with their representation of any party in the lawsuit. All other attorney's fees, costs, and expenses are hereby waived. Plaintiffs specifically recognize that they shall not be entitled to seek attorney's fees in connection with: a) any fairness hearing required by the Court pursuant to Rule 23(e), orb) themonitoringprovidedinParagraphs 5(E) and6 ofthe Settlement Agreement. Defendants specifically recognize that they will pay Plaintiffs' reasonable expenses .incurred in connection with any fairness hearing required by the Court pursuant to Rule 23(e). Plaintiffs specifically recognize that Defendants will have no responsibility to pay any ofPlaintiffs.'
8 Case 2:07-cv-04036-NKL Document 74 Filed 02/08/08 Page 8 of 22

expenses relating to the monitoring plaintiffs will engage in as provided in Paragraphs 5(E)

and 6 of the Settlement Agreement.

A check in the amount of$165,866.00, in payment ofPlaintiffs' fees and expenses

prior to the date of signing of the Settlement Agreement shall be delivered to Plaintiffs'

counsel within thirty days of the signing of this agreement or as soon thereafter as ·is

reasonable possible. A check in payment of Plaintiffs' re~sonable expenses incurred in

connection with.any fairness hearing required by the Court will be requested promptly after

such hearing, and shall be delivered to Plaintiffs' counsel within thirty days ofthe signing of

this agreement or as soon thereafter as is reasonably possible. Defendants shall in no way be

responsible for the division or allocation of any payments. .

Defendants sha. ll be deemed to

have fully performed its duties unde! this Agreement upon the deliv~ry to Plaintiffs' counsel

ofgood and valid checks in payment ofthe fees and expenses Defendants have agreed to pay

under Paragraph 11 of this Settlement Agreement.

12. Court Costs. Each party to the lawsuit is to bear its own court costs;

13. .' ·Non-Assignment. On the date ofthis Agreement's execution, counsel for

.

.

the parties certify that they do not know ofany plaintiffclass member who has assigned atiy

claims or reimbursement rights based on or arising out of the allegations contained in the

lawsuit. Prior to reimbursing each individual .class memb~r for medical expenses as

provid~d in Paragraphs 7 and 8 ofthis Agreement,' each individual class member, or his or

her parent or legal guardian, shall state whether he or she has assigned any claim for payment

or reimbursement of said medical expenses to any other party. If the class member has

assigned a claim for reimbursement of medical e1Cpenses under Paragraph 7 or 8 of this

. Agreement, Defendants will reimburse the assignee, rather than the class member; If

Defendants~ after reimbursing any individual class member as provided in Paragraph 7 or

Paragraph 8 ofthis Agreement, subsequently discovers that the class member had assigned a

claim for payment or reimbursement ofa covered medical expense and an assignee presents

an assignment ofsuch a claim to Defendants, Defendants. and the State ofMissouri will have

a right to indemnification from the class member who made the assignment of his or her

reimbursement claim.

14. Binding Effect. The persons signing this agreement represent that they have

the authority to enter into this agreement on behalf of the respective parties that they

9 Case 2:07-cv-04036-NKL Document 74 Filed 02/08/08 Page 9 of 22

represent and that tbis agreement shall be binding upon, and inure to the benefit ofthe heirs, ·

.personal representatives, successors, and assigns of the parties hereto.

15. Preparation of Documents. This agreement is the jOiJ?.t work product ofthe

part~es hereto and, in the event ofany ambiguity herein, no inference shall be drawn against

a party by reason of docum.ent preparation.

16. Forum Selection. The parties may enforce this Agreement in the United

States District Court for the.Westem District ofMissouri, Central Division, by application

therefor filed no later than October 15, 2008. Within fifteen days of the final report that

. '· .• .. . • . • '• , . · - .. ,, ., ,.,..•..:"'"""-''' ,_..,,, •; "''·' ••• ,,.,, •.:: •••·.>~·-'"' · '"·'•'' •••r ~~ ••·-t•• ,.. • • ._,....., • • .,.,,•.,.,.,•.• -. ,· . ,.,.,..... , .•_,,_,, ··~ -.~··,. ••• ,..•• ••• ·······.···.·,•- •• , ••••• ,• ••,•• .••, , .,, •••,·-~···-,, • . . . "- ..• ·-~· •••.:.• • ••: •• '"'"-" • --..· ·..-=-~:·.,

-~--··•·

-~·•••-,.,.,.,,

•~•''""'·"'"'

Defendants will provide as set forth in Paragraph 6 ofthis Agreement, Plaintiffs will notify ·

Defendants in writing of any objections to Defendants' perfonnance of the terms of this

Agreement, and will allow Defendants thirty days to respond to any such.objections and to

take action to cure. any asserted non-performance or non-compliance with this Agreement

prior to filing a motion to enforce this Agreement with the Court based on such objections.

17. Further Execution. Each party hereto shall execute any and all documents as

are necessary or desirable to consummate the transactions contemplated hereby.

18. Execution in Counterparts; This agreement may be executed in two or more

counterparts, each ofwhich shall constitute an original instrument and all ofwhich together

shall constitute one and the same agreement

IN WITNESS WHEREOF, the parties hereto have caused this agreement to be

deemed executed as of the date the agreement is signed by all parties hereto.

10 . Case 2:07-cv-04036-NKL Document 74 Filed 02/08/08 Page 10 of 22

State ofMissoUri County of Cole

)
) ss
)

Before me, a notary·public for the State of Missouri, personally appeared Emily A. Dodge, who did upon her oath state tha~ she is an attorney for the Defendants with respect to the matter set forth in this Agreement, that she is authorized to execute this Agreement on behalfofthe Defendants, and that she executed this Agreement as her free act and deed.

. +ln

.

. Subscribed and sworn to before me this b_day of February, 2008. ~~strE'~Eif'~!J

Notarv Public- Notary Seal

State of Missouri - County of Moniteau

My Commission Expires Nov. 5, 2008

Commission #04486033 .

~~~~"~~~~~~

Notary Public

r..-s-org I My commission expires' on

11 Case 2:07-cv-04036-NKL Document 74 Filed 02/08/08 Page 11 of 22

I, Petra T. Tasheff, am an attorney for the Plaintiff Class with respect to the matter set forth in this Agreement. I am authorized to execute this Agreement on behalfofthe Plaintiff Class, and I execute this Agreement on behalf of the Plaintiff Class.
f.t,_Tr~
Petra T. Tasheff Bar#31719 February 8, 2008.
12 Case 2:07-cv-04036-NKL Document 74 Filed 02/08/08 Page 12 of 22

FAILURE TO PAY NOTICE LOC2

Our records show that we have not received your premium payment of

, which

was due on [date] to pay for your children's MO HealthNet for Kids health care coverage

for the period of [date] to [date]. The reason we are sending you this notice is because

the law requires you to pay a premium to continue to receive·health care coverage

through the MO HealthNet Healthcare Program, 208.640; 208.631-208.657 RSMo and 13

CSR 70-4.080

.

We must get your late payment or a response .to this notice no later than [20 days . from date of notice} or coverage will STOP oil [DATE] MO HealthNet will not pay for any medical bills after that date. However, if we receive your payment after [date], coverage will begin on the day we receive your payment

HOW TO PAY THE PREMIUM 1. Write a check or money order out to MO HealthNet Division for 2. Write your case/policy number on the check or money order. 3. Tear off the invoice below. Mail the invoice .with your check or money order to Premium Payments at the address listed on the invoice. Allow 57 days for the post.office to deliver your payment.

Future premium amounts may change if your monthly income or family size changes.

Report changes in income, family size,.or address to your Eligibility Specialist at the .

local Family Support Division (FSD) Office. Report any changes within 10 days. Be

sure FSD ha~ your correct income, family size, and address..

·

Automatic Withdrawal:

You ~an have future premium amounts taken out of your

bank account each month. This is called automatic withdrawal and will help make sure

your payment is received on time. Until you receive notice that the automatic withdrawal

is in place, you should continue making payments by check. You can get the automatic

withdrawal form on-line at www.dss.mo.gov/mhd.

·

For payment and automatic withdrawal questions, call the Pre:tnium Collections unit toll free: 1.-877-888-2811..
If you believe you have already paid your premium or that we are wrong for some other
reason, please call the Premium Collections Unit toll free at 1-877-888-2811.

ExhibitA, 1
Case 2:07-cv-04036-NKL Document 74 Filed 02/08/08 Page 13 of 22

Before we stop coverage due to your failure to pay the premium you have the right to show that

• your family's income has changed, and/or

.

• there has been a change in the number ofpeople in your household

If you have one of these changes please report these changes to your eligibility specialist with the Family Support Division within 10 days of the date of this letter. The Family Support Division will review the information you have provided and decide whether the premium amount needs to be changed. FSD may ask you to provide additional information to decide ifyou are eligible.

[premium payment slip]

Exhibit A, 2
Case 2:07-cv-04036-NKL Document 74 Filed 02/08/08 Page 14 of 22

FAILURE TO PAY NOTICE LOC3

Our records show that we have not received your premium payment <?f .

, which

was due on [date] to pay for your children's MO HealthNet for Kids health care coverage

for the period of [date] to [date]. The reason we are sending you this notice is because

the law requires you to pay a premium to continue to receive health care coverage

through the the MO HealthNet Healthcare Program, 208.640, 208.631~208.657 RSMo

and 13 CSR 70~4.080

We must get your late payment or a response to this notice no later than [20 days from date of notice] or coverage will STOP on [DATE]· MO HealthNet will not pay ·for any medical bills after that date and you children will not have coverage for (6) months if full payment is not received by [date]:

HOW TO PAY THE PREMIUM 1. Write a check or money order out to MO HealthNet Division for 2. Write your case/policy number cin the check or money order. · 3. Tear off the invoice below. Mail the invoice with.your check or money order to Premium Payments.at the address listed on the invoice. Allow 5~ 7 days for the post office to deliver your payment.

Future premium amounts may change if your monthly income or family size changes. . Report changes in income, family size, or address to your Eligibility Specialist at the
local Family Support Division (FSD) Office. Report any changes within 10 days. Be sure FSD has your correct income, family size, and address .

. Automatic Withdrawal: You can have future premium amounts taken out of your bank account each month. This is called automatic withdrawal and will help make sure · .your payment is received on time. Until you receive notice that the automatic withdrawal is in place, you should continue making payments by check. You can get the automatic withdrawal form on-line at www.dss.mo.gov/mhd.

For payment and automatic withdrawal questions, call the Premium Collections unit toll

free: 1~877~888-2811.

·

If you believe you have already paid your premium or that we are wrong for some other reason, please call the Premium C~llections Unit toll free at 1'-877~8 88~2811.

Exhibit B, 1
Case 2:07-cv-04036-NKL Document 74 Filed 02/08/08 Page 15 of 22

Before we stop coverage due to your failure to pay the premium you have the right to show that
• your family's income has changed, and/or • there has been a change in the number ofpeople in your household If you have one of these changes please report these changes to your eligibility specialist with the Family Support Division within 10 days of the date of this letter. The Family Support Division will review the information you have provided and decide whether the premium amount needs to ·be changed. FSD may ask you to provide additional information to decide if you are eligible. [premium payment slip]
Exhibit B, 2
Case 2:07-cv-04036-NKL Document 74 Filed 02/08/08 Page 16 of 22

NOTICE OF CASE ACTION
According to our records you have not paid the premium amount of$ , which was due on [date] to pay for your child's MO HealthNet coverage for _ _ _ _ to

On

medical coverage for the children listed below will STOP. The reason

for this action is that you have not paid your premium as required by MO HealthNet. See ·

. §208.631-657 and 208..640 RSMo. and 13 CSR 70-4.080.

Ifyou disagree with this decision you have a right to ask for a hearing. If you ask for a hearing by [date 10 days], your benefits will, continue until a decision has been made after your hearing. If the hearing decision shows that MO HealthNet Division's decision to stop your coverage was correct, your household will be responsible for repaying the cost of any services you received and were not entitled to receive while your h~aring was pending. On the other hand, if you elect to discontinue receiving benefits while your hearing is pending and the hearing decision is ruled in your favor, any benefits you were eligible.to receive will be testored to you after you pay any premium that you owe.

Ifyou want a hearing you can ask for a hearing by mail, in person or by telephone. To ask for a hearing cal11-877-888-2811; write to the MO HealthNet Division at, P.O. Box 6500, Jefferson City, MO 65102; or visit your local Family Support Division (FSD) and talk with your eligibility specialist.

if you ask for a hearing, we will schedule it for you and notify you of the time ofthe

heari_ng. At the hearing, you may present your information yourself; you may be

represented by your own attorney or by other persons who know your situation. If you

do not have an attorney or cannot afford one, and live in an area serviced by Legal Aid or

Legal Services, call:

. You have the right to present witnesses in your own

behalf and to question witnesses who appear at the request of the MO HealthNet

Division. You also have the right to look at your case file. Your records relating to the

premium payment issue are kept by the Mo HealthNet Division. If you would like to

· arrange to look at your records with the Mo HealthNet Division you can call the MO

HealthNet Division at 1-877-888-2811

If you agree with this decision, you do not have to request a hearing.

Exhibit C
Case 2:07-cv-04036-NKL Document 74 Filed 02/08/08 Page 17 of 22

REINSTATEMENT NOTICE
MO Health.Net for Kids health care coverage for the child/children listed below has been reinstated for the time periods listed below:

Take this notice and the children's red Medicaid or MC+ card(s) with you to the children's health care provider the next time the children need MO HealtbNet services so that you can show that the children are covered.

If you live in a managed care area the child/children listed above will have MO Health.Net

coverage until they go into a managed care health plan.

·

If you received 1.11edical services for the above child/children during the period(s) listed .above thru the date ofthis notice MHD can pay for the services at MO HealtbNet approved. rates ifthe service was the kind the MO Health.Net covers. We can pay for a covered seryice at'MO Health.Net rates even ifyou have not yet paid the bill. Ifyou have a bill that you have not paid, you can tell your provider that you have MO HealtbNet cove:r;age .and tell your provider to send the bill to MO HealtbNet. We have sent you two copies of this notice so you can send one to·your provider ifyou decide to do that by mail. Ifyou have already paid th~ bill, please send a legible copy ofthe bill(s) and the paid receipt(s) and one copy o~this notice to:

MO HealthNet Division Participant Services Unit· P.O. Box 6500 Jefferson City, MO 65102

.

.

The MO Health.Net Division may contact you if additional information is needed.

Please include a phone number and address where you can be reached.

If you have questions regarding this notice or other MO Health.Net issues, please contact the Participant Services Unit toll free at 1-800-392-2161 or you can call 573-751-6527 at your expense.

Sincerely, ·

Participant Services Unit

ExhibitD
Case 2:07-cv-04036-NKL Document 74 Filed 02/08/08 Page 18 of 22

Proposed exparte letter for Julie M v Scott Case(2)

On Month Date, Year, the child(ren) listed bel9w lost coverage/eligibility for MC+ for Kids (MO Healthr:Jet for Kids) because the premium payment was not received:

Name

DCN

The child(ren) listed above may have been eligible for another MO HealthNet healthcare

program if any of the following applied at the time heaithcare coverage was lost

·

because:

• A child(ren) had a physical or mental disability;
• A child(ren) was pregnant; or • A child(ren) age i 8 up to age i 9 was blind.

If you would like us to review your file to see if any of the children may have been

eligible for another kind of MO HealthNet coverage at the time the case was closed,

please call your eligibility specialist or write to the address shown above by ·

_ _ _ _ _ _ to have your child(ren)'s eli.gibility reviewed. Any written response

must be postmarked by

. If we do not hear from you we will not

review your file.

What we will do: If you ask us to review your case, your eligibility specialist will review your case file to see if one or more of the children may have been eligible for anoth~r kind of MO HealthNet coverage at the time the. case was closed ~nd for how long the child may have been eligible for coverage. When we review your case, you will be notified if one or more of the children were eligible and for how long.

If the children were eligible and received medical services during the time we determine the children were eligible for coverage, MO HealthNet Division can pay the services at MO HealthNet approved rates if the service was the kind that MO HealthNet covers. MO HealthNet can pay for a covered service at the MO Health Net rates even if you have not yet paid the bill. If you have a bill that YQU have not paid and you are determined eligible for MO HealthNet coverage, tell the provider to send the bill to MO Health Net. If you have already paid the bill, send a legible copy of the bill(s) and paid receipt(s) and a copy of your approval notice to:

MO HealthNet Division Participant Services Unit

Exhibit E, 1

Case 2:07-cv-04036-NKL Document 74 Filed 02/08/08 Page 19 of 22

PO Box 6500 Jefferson City, MO 65i 02
Exhibit E, 2 .
Case 2:07-cv-04036-NKL Document 74 Filed 02/08/08 Page 20 of 22

UNITED STATES DISTRICT COURT WESTERN DISTRICT OF MISSOURI
CENTRAL DIVISION

JULIA M, on her behalf and on behalf ofher minor child, J.W.M., and all others similarly situated,
Plaintiffs,
v.
DEBORAH E. SCOTT, as the Director of the Missouri Department of Social Services, JANEL R. LUCK, as the Interim Director of . the Missouri Family Support Division, and STEVE RENNE, as the Interim Director of the . Missouri Division ofMedical Services,
Defendants.

Case No. 07-4036-CV-C-NK.L

PROPOSED ORDER
Having reviewed the Release and Settlement Agre~ment, having conducted a fairness hearing pursuant to Fed. R. Civ. P. 23(e), and having heard the argument of p~aintiffs' and defendants' counsel, and being fully advised in the premises, this Court finds that the proposed release and settlement is fair, reasonable, and adequate. On June 25, 2007, this Court certified a class consisting of "All children residing in Missouri and who are receiving or who will receive MC+health coverage and are required to pay a premium under Mo. Rev..Stat.§ 208..640."
On July 9, 2007, this Court granted plaintiffs' motion for a preliminary injunction against
\
defendants, enjoining defendants from terminating the MC+ coverage ofanyplaintiffclass member due to non..:payment without mailing a notice ten dEl.YS prior to terminating coverage, informing the participant of the right to request a hearing within ten days, and to receive continued bene:P.ts pending the ·outcome ofthe hearing. The preliminary injunction orderfurther enjoined defendants

Case 2:07-cv-04036-NKL Document 74 Filed 02/08/08 Page 21 of 22

to conduct ex parte reviews ofindividual recipients' eligibilityunder any other Medicaid program

prior to terminating MC+benefits for non-payment of a premium.

This Court further finds that the proposed settlement agreement executed by the attomeys

for the parties protects the interests ofmembers ofthe class andthat the interests ofthe members of

the class would not be prejudiced by the proposed settlement and release.

.NOW, THEREFORE, IT IS:

ORDERED that the proposed settlement with defendants by plaintiffs in the manner set

forth in the Release and Settlement Agreement is fair, adequate, and reasonable, and the same is

hereby authorized and approved; it is further

ORDERED that underFed. R. Civ. P. 4l(a)(2) the claims ofthe·p~aintiffs are dismissed in

their entirety with prejudice; it is further

.

.

ORDERED that this Court retain,s jurisdiction until October 15, 2008, or such later date as

may be necessary under Paragraph 16 ofthe Settlement Agreement, for purposes ofenforcement of

.

.

the Settlement Ag1·eement. Each party to bear its own costs beyond those already apportioned by the

· settlement agreement.

DATED: _____________

The Honorable Nanette Laughrey U.S. District Court Judge
2 Case 2:07-cv-04036-NKL Document 74 Filed 02/08/08 Page 22 of 22

 </s> Julia M. ex rel. J.W.M. v. Scott, 243 F.R.D. 365 (2007)

243 F.R.D. 365 United States District Court,
W.D. Missouri, Central Division.
JULIA M., on behalf of herself and her minor child, J.W.M., and all others similarly situated,
Plaintiffs, v.
Deborah E. SCOTT, Director of the Missouri Department of Social Services, Janel R. Luck, Interim Director of the Missouri Family Support Division, and Steve Renne, Interim Director of the
Missouri Division of Medical Services, Defendants.
No. 07-4036-CV-C-NKL. | June 25, 2007.
Attorneys and Law Firms
*366 Laura F. Redman, Marc Cohan, Petra T. Tasheff, New York, NY, Steven A. Hitov, National Health Law Program, Washington, DC, for Plaintiffs.
Douglas G. Leyshock, Missouri Attorney General, Jefferson City, MO, for Defendants.
Opinion

ORDER

LAUGHREY, District Judge.
Plaintiff Julia M. brings this action on behalf of her daughter, J.W.M., and a proposed class of MC+ recipients,1 to enjoin Defendants (a) to notify all MC+ recipients who are disenrolled from MC+ health coverage for failure to meet premium requirements of their right to appeal prior to disenrollment; (b) to provide the opportunity for continued enrollment and aid pending a hearing; and (c) to first determine whether such MC+ recipients are otherwise eligible for medical assistance. Pending before the Court are Plaintiffs’ Motions for Class Certification [Doc. # 5] and Preliminary Injunction [Doc. # 11]. For the reasons set forth below, class certification is granted and oral argument is ordered on the Preliminary Injunction Motion.

1

MC+ is a statewide medical assistance program for

low-income families, pregnant women, and children

under the age of 19.

I. Background Missouri’s State Children’s Health Insurance Program (SCHIP) is a jointly funded state and federal program that provides health assistance to uninsured, low income children whose family income is above the State’s Medicaid income limits, but who cannot afford private health insurance. 42 U.S.C. § 1397aa-jj. Missouri’s SCHIP program, called Medicaid MC+, provides that
Parents and guardians of uninsured children with incomes between one hundred fifty-one and three hundred percent of the federal poverty level who do not have access to affordable employersponsored health care insurance or other affordable health care coverage may obtain coverage pursuant to this section.... The parents and guardians of eligible uninsured children pursuant to this section are responsible for a monthly premium equal to the average premium required for the Missouri consolidated health care plan....
Mo.Rev.Stat. § 208.640. However, if a participating parent fails to make a payment, “the child shall not be eligible for coverage under [Mo.Rev.Stat.] sections 208.631 to 208.660 for six months after the department provides notice of such failure to the parent or guardian.” Mo.Rev.Stat. § 208.646.
By accepting matching funds from the federal government, the MC+ program is bound by the requirements of the SCHIP Act and regulations promulgated by the Department of Health and Human Services (HHS). Although there are many regulations applicable to this case, at a minimum, the SCHIP Act requires that
(a) The State must give enrollees reasonable notice of and an opportunity to pay past due premiums, copayments, coinsurance, deductibles or similar fees prior to disenrollment.
...
(c) The State must provide the enrollee with an opportunity for an impartial review to address disenrollment from the program in accordance with § 457.1130(a)(3).
42 C.F.R. § 457.570(a), (c). Such reviews include
1

Julia M. ex rel. J.W.M. v. Scott, 243 F.R.D. 365 (2007)
“disenrollment for failure to pay cost sharing,” id. § 457.1130(a)(3), and the “State must ensure the opportunity for continuation of enrollment pending the completion of review of a suspension or termination of enrollment, including a decision to disenroll for failure to pay cost sharing.” Id. § 457.1170. Finally, the State must determine a recipient’s *367 continuing eligibility for Medicaid under any alternative bases before terminating SCHIP benefits for ineligibility under the original basis. 42 U.S.C. § 1396(a)(8); 42 C.F.R. § 435.930(b).
Through a series of bank errors, J.W.M.’s monthly MC+ premium was not automatically deducted from her mother’s account in a timely fashion and J.W.M.’s benefits were terminated. Julia M. received a notice of termination after benefits had already been terminated. Although the notice referenced a right to appeal, it did not indicate that J.W.M. had a right to continued benefits pending the outcome of that appeal. Nor did the notice indicate that the State had conducted any evaluation to determine whether J.W.M. was eligible for benefits under any other category before her benefits were terminated. Only after Julia M. initiated this lawsuit did the Defendants consent to reinstating J.W.M.’s MC+ benefits.
Plaintiffs allege that the Defendants routinely terminate benefits for nonpayment as they did in J.W.M.’s case without notifying recipients of their right to appeal and their right to continued benefits pending the outcome of that appeal. Plaintiffs seek to certify a class of plaintiffs which includes “[a]ll children residing in Missouri and who are receiving or who will receive MC+ health coverage and are required to pay a premium under Mo.Rev.Stat. § 208.640.” They further seek a preliminary injunction requiring Defendants to provide notice and continued benefits required by the regulation to all class members.
II. Mootness [1] Defendants contend that the Court should consider neither Plaintiffs’ request for injunctive relief nor for class certification since J.W.M.’s case has been mooted by the restoration of her benefits. Generally, “where [a] named plaintiff’s personal claim becomes moot prior to district court’s ruling on certification of a class action, the court loses jurisdiction over the action because the case or controversy requirement of Article III is violated.” Shipman v. Missouri Dep’t of Family Servs., 877 F.2d 678, 682 (8th Cir.1989). However, in Sosna v. Iowa the Supreme Court noted in dicta that
There may be cases in which the controversy involving the named plaintiffs is such that it becomes moot as to them before the district court can reasonably be expected to

rule on a certification motion. In such instances, whether the certification can be said to “relate back” to the filing of the complaint may depend upon the circumstances of the particular case and especially the reality of the claim that otherwise the issue would evade review.
419 U.S. 393, 402 n. 11, 95 S.Ct. 553, 42 L.Ed.2d 532 (1975). In a subsequent case involving pretrial detainees, the Supreme Court cited its Sosna dictum to hold that the detainee case “belongs to that narrow class of cases in which the termination of a class representative’s claim does not moot the claims of the unnamed members of the class.” Gerstein v. Pugh, 420 U.S. 103, 111 n. 11, 95 S.Ct. 854, 43 L.Ed.2d 54 (1975). The Supreme Court went on to explain that “[i]t is by no means certain that any given individual, named as plaintiff, would be in pretrial custody long enough for a district judge to certify the class. Moreover, in this case the constant existence of a class of persons suffering the deprivation is certain.” Id. at n. 11. The claim, in short, is one that is distinctly “ ‘capable of repetition, yet evading review.’ ” Id. at n. 11.
[2] In the wake of Sosna and Gerstein, the Eighth Circuit has held that “where a claim is ‘capable of repetition but evading review’ a court may rule on class certification even if the named plaintiff’s individual claim bec[o]me[s] moot before the court ha[s] considered class certification.” Shipman, 877 F.2d at 682 (quoting Gerstein, 420 U.S. at 111 n. 11, 95 S.Ct. 854). For example, in Owens v. Heckler, the Eighth Circuit affirmed injunctive relief in favor of a class of recipients whose Aid to Families with Dependent Children (AFDC) benefits were illegally reduced by the Department of Health and Human Services. 753 F.2d 675 (8th Cir.1985). In that case, Plaintiff Owens filed a putative class action on October 26, 1982 on behalf of himself and others similarly situated. Although the district court denied *368 Owen’s request for a preliminary injunction on April 7, 1983, it concluded five months later that class certification was still appropriate and, as the Eighth Circuit explained, “made the certification retroactive to February 23, 1983, under the relation-back doctrine of Sosna v. Iowa. The class action could therefore proceed even though Owens’ individual claim had become moot.” Id. at 676-677 (8th Cir.1985).
[3] The present case poses a similar situation. J.W.M.’s benefits were allegedly cut off without proper notice or an opportunity for review, nor with the opportunity for the continuation of benefits pending the outcome of such review. When her mother sued to enforce the State’s obligation on behalf of J.W.M. and others subject to the same disenrollment provisions, the State reinstated her benefits, thereby mooting her case. There is no reason to
2

Julia M. ex rel. J.W.M. v. Scott, 243 F.R.D. 365 (2007)
believe that the banking errors precipitating J.W.M.’s missed premium payment are incapable of recurring, or that others in J.W.M.’s situation are not susceptible to the same sort of accidental disenrollment. Defendants concede that it is there policy not to notify recipients of disenrollment for nonpayment prior to termination of benefits. Thus, it is likely that other recipients would find themselves disenrolled without a remedy short of bringing a lawsuit to enforce the federal regulations, at which point, the State could simply reinstate them and moot their claims. As in Shipman and Owens, the challenged conduct in this case is capable of repetition yet evading review because the State could continually eliminate potential class representatives one at a time. Thus, in considering the motion for class certification, the Court will review the relevant Rule 23 factors of J.W.M.’s claims as of the date her petition was filed under the “relation-back” doctrine of Sosna, 419 U.S. at 401-02, 95 S.Ct. 553.
III. Class Certification Before the Court may certify a class action, the representative plaintiff or plaintiffs must satisfy the four prerequisites of Rule 23(a) as well as at least one of the three requirements of Rule 23(b). Amchem Prods., Inc. v. Windsor, 521 U.S. 591, 614, 117 S.Ct. 2231, 138 L.Ed.2d 689 (1997). Rule 23(a) provides:
One or more members of a class may sue ... as representative parties on behalf of all only if (1) the class is so numerous that joinder of all members is impracticable, (2) there are questions of law or fact common to the class, (3) the claims or defenses of the representative parties are typical of the claims or defenses of the class, and (4) the representative parties will fairly and adequately protect the interests of the class.
Fed.R.Civ.P. 23(a). These prerequisites are otherwise known as (1) numerosity, (2) commonality, (3) typicality, and (4) adequacy of representation, and the burden is on the plaintiff to establish each one. General Telephone Co. of Southwest v. Falcon, 457 U.S. 147, 156, 102 S.Ct. 2364, 72 L.Ed.2d 740 (1982).
[4] During oral argument on May 8, 2007, Defendants conceded that Plaintiffs satisfy all Rule 23(a) requirements other than numerosity since Plaintiffs have not shown the existence of a number of similarly affected people so numerous as to preclude joinder. However, Defendants also conceded at oral argument that it is the State’s policy not to send predeprivation notice to those

who miss their premiums, informing them of their right to request a review and to continued benefits pending the outcome of the review. Although Plaintiffs have not shown that any other recipients have lost benefits without notice under this policy, defense counsel had no explanation for why such a policy would be necessary in the first place unless such occurrences were common. Moreover, because it is the policy itself that Plaintiffs challenge, Defendants have effectively admitted that their conduct affects the entire class of MC+ recipients who pay a monthly premium for their benefits because all such recipients are subject to the policy even if they have not yet missed a payment. There is no dispute that thousands of recipients are responsible for a monthly premium. Such a large group could not be joined in a single action absent class certification.
*369 [5] For the same reasons that Plaintiffs have satisfied the numerosity requirement of Rule 23(a), the Court also concludes that Plaintiffs have satisfied the second of three possible requisites of Rule 23(b), namely that “the party opposing the class has acted or refused to act on grounds generally applicable to the class, thereby making appropriate final injunctive relief or corresponding declaratory relief with respect to the class as a whole.” Fed.R.Civ.P. 23(b)(2). The policy to which Defendants admit fails to notify anyone within the class of their right to continued benefits pending review in the event of a missed premium. Plaintiffs need not show that the entire class has been deprived of their rights by the policy in order to warrant certification. It is enough that Defendants concede that the policy exists. Whether the policy violates the class members’ rights is a question for another day, but for purposes of class certification, Plaintiffs have met their burden. The class of “[a]ll children residing in Missouri and who are receiving or who will receive MC+ health coverage and are required to pay a premium under Mo.Rev.Stat. § 208.640” is therefore certified, for purposes of this law suit.
IV. Preliminary Injunction Defendants chose not to fully respond to Plaintiffs’ Motion for Preliminary Injunction since J.W.M.’s individual claim was moot and, until this Order, no class had been certified. Although Defendants “reserved the right to address that issue at a later date if the Court opts to grant plaintiffs’ request for class certification,” the Court concludes that brief oral argument on Plaintiffs’ Motion for Preliminary Injunction is the appropriate vehicle to resolve the issue. Had Defendants wanted to respond in writing, they had the opportunity to do so. At oral argument, at a minimum, the parties should address the relationship between the regulations cited by the Plaintiffs and the more specific statutes pertaining to SCHIP programs, i.e., 42 U.S.C. § 457 et seq.
3

Julia M. ex rel. J.W.M. v. Scott, 243 F.R.D. 365 (2007)
Oral Argument shall be heard by telephone at 10:30 a.m. on July 3, 2007. Each side shall have fifteen minutes for argument, and Plaintiffs may reserve up to three minutes of their time for rebuttal.
III. Conclusion Accordingly, it is hereby
ORDERED that Plaintiffs’ Motion for Class Certification [Doc. # 5] is GRANTED. The Court CERTIFIES a CLASS to be represented by Plaintiffs consisting of “All children residing in Missouri and who are receiving or who will receive MC+ health coverage and are required to

pay a premium under Mo.Rev.Stat. § 208.640.” It is further
ORDERED that ORAL ARGUMENT on Plaintiffs’ Motion for Preliminary Injunction [Doc. # 11] shall be heard by telephone at 10:30 a.m. on July 3, 2007.
Parallel Citations 68 Fed.R.Serv.3d 570, Med & Med GD (CCH) P 302,109
	
  

4

 </s> CLOSED,EAPJ,PHV
U.S. District Court Western District of Missouri (Jefferson City) CIVIL DOCKET FOR CASE #: 2:07−cv−04036−NKL

J.W.M. et al v. Scott et al Assigned to: District Judge Nanette K. Laughrey Cause: 42:1983 Civil Rights Act
Plaintiff

Date Filed: 02/15/2007 Date Terminated: 04/21/2008 Jury Demand: None Nature of Suit: 444 Civil Rights: Welfare (DISCONTINUED AFTER 1/1/2012) Jurisdiction: Federal Question

J.W.M. a minor

represented by Laura F. Redman National Center for Law and Economic Justice 275 Seventh Avenue Suite 1506 New York, NY 10001−6708 (212) 633−6967 Fax: (212) 633−6371 Email: redman@nclej.org LEAD ATTORNEY ATTORNEY TO BE NOTICED

Marc Cohan National Center for Law and Economic Justice 275 7th Avenue Suite 1506 New York, NY 10001 (212) 633−6967 Fax: (212) 633−6371 Email: cohan@nclej.org LEAD ATTORNEY PRO HAC VICE ATTORNEY TO BE NOTICED

Petra T. Tasheff National Center for Law &Economic Justice 275 7th Avenue Suite 1506 New York, NY 10001 (212) 633−6967 Fax: (212) 633−6371 Email: tasheff@welfarelaw.org LEAD ATTORNEY ATTORNEY TO BE NOTICED

Steven A. Hitov National Health Law Program 1101 14th Street, N.W. Washington, DC 20005 (202) 289−7661 Fax: (202) 289−7724 Email: hitov@healthlaw.org LEAD ATTORNEY ATTORNEY TO BE NOTICED

Plaintiff

Julia M.

represented by Laura F. Redman

on behalf of herself and her minor child

(See above for address)

Case: 2:07-cv-04036-NKL As of: 06/26/2012 02:58 PM CDT 1 of 9

V. Defendant Deborah E. Scott Director of the MO Dept. of Social Services
Defendant Janel Luck Interim Director of the MO Dept. of Family Services
Defendant Steve Renne Interim Director of the MO Division of Medical Services

LEAD ATTORNEY ATTORNEY TO BE NOTICED
Marc Cohan (See above for address) LEAD ATTORNEY PRO HAC VICE ATTORNEY TO BE NOTICED
Petra T. Tasheff (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Steven A. Hitov (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Douglas G. Leyshock Missouri Attorney General P.O. Box 899 Jefferson City, MO 65102 (573) 751−3321 Fax: (573) 751−9456 Email: doug.leyshock@ago.mo.gov TERMINATED: 11/29/2007 LEAD ATTORNEY
Emily A. Dodge Missouri Attorney General P.O. Box 899 Jefferson City, MO 65102 (573) 751−7344 Email: emily.dodge@ago.mo.gov LEAD ATTORNEY
represented by Douglas G. Leyshock (See above for address) TERMINATED: 11/29/2007 LEAD ATTORNEY
Emily A. Dodge (See above for address) LEAD ATTORNEY
represented by Douglas G. Leyshock (See above for address) TERMINATED: 11/29/2007 LEAD ATTORNEY
Emily A. Dodge (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Case: 2:07-cv-04036-NKL As of: 06/26/2012 02:58 PM CDT 2 of 9

Date Filed

# Docket Text

02/15/2007

1 COMPLAINT against all defendants (Filing fee $350 receipt number 1455288) Service due by 6/18/2007, filed by Petra T. Tasheff on behalf of J.W.M., Julia M.. (Attachments: # 1 Civil Cover Sheet)(Tasheff, Petra) Additional attachment(s) added on 2/15/2007 correct document substituted (James, Carrie). Modified on 2/15/2007 (James, Carrie). (Entered: 02/15/2007)

02/15/2007

2 Motion to allow Marc Cohan to appear pro hac vice (Pro Hac fee $50 receipt number 1455352) filed by Petra T. Tasheff on behalf of all plaintiffs. (Tasheff, Petra) (Entered: 02/15/2007)

02/15/2007

3 Motion to allow Laura Redman to appear pro hac vice (Pro Hac fee $50 receipt number 1455364) filed by Petra T. Tasheff on behalf of all plaintiffs. (Tasheff, Petra) (Entered: 02/15/2007)

02/15/2007

4 Motion to allow Steven Hitov to appear pro hac vice (Pro Hac fee $50 receipt number 1455371) filed by Petra T. Tasheff on behalf of all plaintiffs. (Tasheff, Petra) (Entered: 02/15/2007)

02/15/2007

5 MOTION to certify class and Suggestions in Support filed by Petra T. Tasheff on behalf of all plaintiffs. Suggestions in opposition/response due by 3/2/2007 unless otherwise directed by the court. (Attachments: # 1 Exhibit A# 2 Exhibit B)(Tasheff, Petra) (Entered: 02/15/2007)

02/15/2007

SUMMONS ISSUED as to Deborah E. Scott, Janel Luck, &Steve Renne. (Bax, Laura) (Entered: 02/15/2007)

02/15/2007

6 ORDER denying 2 3 4 motions to appear pro hac vice approved by Clerk of Court. This is a text only entry and will serve as authorization for the pro hac participation by the attorney. No document is attached. Plaintiff will refile corrected motions. (Bax, Laura) (Entered: 02/15/2007)

02/15/2007

NOTICE OF DOCKET MODIFICATION. A modification has been made to the document filed on 2/15/07 as Document No. 1, Complaint. Correct document was substituted. This is a text entry only − no document is attached. (James, Carrie) (Entered: 02/15/2007)

02/16/2007

7 Motion to allow Marc Cohan to appear pro hac vice (Pro Hac fee $50 receipt number 1455352) filed by Petra T. Tasheff on behalf of all plaintiffs. (Tasheff, Petra) (Entered: 02/16/2007)

02/16/2007

8 Motion to allow Laura Redman to appear pro hac vice (Pro Hac fee $50 receipt number 1455364) filed by Petra T. Tasheff on behalf of all plaintiffs. (Tasheff, Petra) (Entered: 02/16/2007)

02/16/2007

9 ORDER granting 7 8 motions to appear pro hac vice approved by Clerk of Court. Attornies Laura F. Redman &Marc Cohan for plaintiffs allowed to appear pro hac vice. This is a text only entry and will serve as authorization for the pro hac participation by the attorney. No document is attached. (Bax, Laura) (Entered: 02/16/2007)

02/20/2007

10 Motion to allow Steven Hitov to appear pro hac vice (Pro Hac fee $50 receipt number 1455371) filed by Petra T. Tasheff on behalf of all plaintiffs. (Tasheff, Petra) (Entered: 02/20/2007)

02/20/2007

11 MOTION for preliminary injunction filed by Petra T. Tasheff on behalf of all plaintiffs. Suggestions in opposition/response due by 3/8/2007 unless otherwise directed by the court. (Attachments: # 1 Affidavit Tasheff Declaration# 2 Exhibit A# 3 Exhibit B# 4 Exhibit C# 5 Exhibit D# 6 Exhibit E# 7 Exhibit F# 8 Exhibit G# 9 Exhibit H)(Tasheff, Petra) (Entered: 02/20/2007)

02/20/2007

12 SUGGESTIONS in support re 11 MOTION for preliminary injunction filed by Petra T. Tasheff on behalf of Plaintiffs J.W.M., Julia M.. (Related document(s) 11 ) (Tasheff, Petra) (Entered: 02/20/2007)

02/21/2007

13 ORDER granting 10 motion to appear pro hac vice approved by Clerk of Court. Attorney Steven A. Hitov for plaintiffs allowed to appear pro hac vice. This is a text only entry and will serve as authorization for the pro hac participation

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by the attorney. No document is attached. (Bax, Laura) (Entered: 02/21/2007)

02/27/2007

14 ORDER ON PRETRIAL PROCEDURES entered by Judge Nanette Laughrey. Service must be obtained within forty (40) days of the date of this Order unless otherwise authorized by the Court. (Kanies, Renea) (Entered: 02/27/2007)

02/27/2007

15 RETURN OF SERVICE of complaint executed by J.W.M.. Deborah E. Scott served on 2/16/2007, answer due 3/8/2007. (Tasheff, Petra) (Entered: 02/27/2007)

02/27/2007

16 RETURN OF SERVICE of complaint executed by J.W.M., Julia M.. Janel Luck served on 2/16/2007, answer due 3/8/2007. (Tasheff, Petra) (Entered: 02/27/2007)

02/27/2007

17 RETURN OF SERVICE of complaint executed by J.W.M., Julia M.. Steve Renne served on 2/16/2007, answer due 3/8/2007. (Tasheff, Petra) (Entered: 02/27/2007)

03/01/2007

18 RETURN OF SERVICE of complaint executed by J.W.M., Julia M.. (Tasheff, Petra) (Entered: 03/01/2007)

03/02/2007

19 NOTICE of appearance by Douglas G. Leyshock on behalf of Deborah E. Scott, Janel Luck, Steve Renne (Leyshock, Douglas) (Entered: 03/02/2007)

03/02/2007

20 SUGGESTIONS in opposition re 5 MOTION to certify class and Suggestions in Support filed by Douglas G. Leyshock on behalf of Defendants Deborah E. Scott, Janel Luck, Steve Renne. Reply suggestions due by 3/19/2007 unless otherwise directed by the court (Attachments: # 1 Attachment 1)(Related document(s) 5 ) (Leyshock, Douglas) (Entered: 03/02/2007)

03/08/2007

21 MOTION for extension of time to Respond to Request for Preliminary Injuctive Relief and Answer filed by Douglas G. Leyshock on behalf of Deborah E. Scott, Janel Luck, Steve Renne. Suggestions in opposition/response due by 3/23/2007 unless otherwise directed by the court. (Leyshock, Douglas) (Entered: 03/08/2007)

03/09/2007

22 RESPONSE to motion re 21 MOTION for extension of time to Respond to Request for Preliminary Injuctive Relief and Answer filed by Petra T. Tasheff on behalf of Plaintiffs J.W.M., Julia M.. Reply suggestions due by 3/26/2007 unless otherwise directed by the court (Related document(s) 21 ) (Tasheff, Petra) (Entered: 03/09/2007)

03/13/2007

23 ORDER entered by Judge Nanette Laughrey granting 21 MOTION for extension of time to Respond to Request for Preliminary Injuctive Relief and Answer. The deadline is extended to March 19, 2007. (Text entry only − no document attached) (Kanies, Renea) (Entered: 03/13/2007)

03/19/2007

24 REPLY SUGGESTIONS to motion re 5 MOTION to certify class and Suggestions in Support filed by Petra T. Tasheff on behalf of Plaintiffs J.W.M., Julia M.. (Related document(s) 5 ) (Tasheff, Petra) (Entered: 03/19/2007)

03/19/2007

25 SUGGESTIONS in opposition re 11 MOTION for preliminary injunction filed by Douglas G. Leyshock on behalf of Defendants Deborah E. Scott, Janel Luck, Steve Renne. Reply suggestions due by 4/5/2007 unless otherwise directed by the court (Related document(s) 11 ) (Leyshock, Douglas) (Entered: 03/19/2007)

04/05/2007

26 REPLY SUGGESTIONS to motion re 11 MOTION for preliminary injunction filed by Petra T. Tasheff on behalf of Plaintiffs J.W.M., Julia M. Attachments, Exhibit A and B (Related document(s) 11 ) Modified on 4/30/2007 to substitute exhibits with redacted exhibits.(Kanies, Renea). (Entered: 04/05/2007)

04/30/2007

NOTICE OF DOCKET MODIFICATION. A modification has been made to the document filed on 4/5/2007 as Document No. 26, REPLY suggestions to Motion for Preliminary Injunciton. The exhibit attachments were substituted with redacted exhibits. This is a text entry only − no document is attached. (Kanies, Renea) (Entered: 04/30/2007)

05/01/2007

27 ORDER entered by Judge Nanette Laughrey. Proposed scheduling order due by 5/18/2007, rule 26 conference due by 5/11/2007. (Kanies, Renea) (Entered: 05/01/2007)

05/03/2007

28 MOTION for leave to file Answer filed by Douglas G. Leyshock on behalf of Deborah E. Scott, Janel Luck, Steve Renne. Suggestions in opposition/response

Case: 2:07-cv-04036-NKL As of: 06/26/2012 02:58 PM CDT 4 of 9

05/03/2007 05/03/2007 05/04/2007
05/08/2007
05/15/2007 05/15/2007 05/15/2007 05/23/2007 05/23/2007 06/20/2007 06/25/2007
06/26/2007

due by 5/18/2007 unless otherwise directed by the court. (Leyshock, Douglas) (Entered: 05/03/2007)
29 ANSWER to Complaint filed by Douglas G. Leyshock on behalf of Defendants Deborah E. Scott, Janel Luck, Steve Renne.(Leyshock, Douglas) (Entered: 05/03/2007)
30 ORDER entered by Judge Nanette Laughrey granting 28 Motion for Leave to File Answer. (Text entry only − no document attached) (Kanies, Renea) (Entered: 05/03/2007)
31 ORDER SETTING ORAL ARGUMENT. Oral arguments will be heard in this case on Tuesday, May 8, 2007, at 3:00 p.m. The hearing will be held by telephone and the parties will have 15 minutes each to present their arguments. The parties shall email my assistant, Fran Smith (Fran_Smith@mow.uscourts.gov), 24 hours in advance, to advise her of the number where they may be reached for the hearing.(Smith, Fran) (Entered: 05/04/2007)
32 Minute Entry. Proceedings held before Judge Nanette K. Laughrey : TELEPHONE CONFERENCE held on 5/8/2007. Teleconference held. Oral argument presented on the Motion to Certify Class (Doc. 5). The Court will permit the parties leave to file additional briefing within seven days. Oral argument presented on the Motion for Preliminary Injunction (Doc. 11). (Court Reporter Katie Wirt.) (Kanies, Renea) (Entered: 05/08/2007)
33 SUGGESTIONS in support re 5 MOTION to certify class and Suggestions in Support filed by Petra T. Tasheff on behalf of Plaintiffs J.W.M., Julia M.. (Attachments: # 1 Exhibit A# 2 Exhibit B# 3 Exhibit C# 4 Exhibit D# 5 Exhibit E)(Related document(s) 5 ) (Tasheff, Petra) (Entered: 05/15/2007)
34 PROPOSED SCHEDULING ORDER , Joint by J.W.M., Julia M.. (Tasheff, Petra) (Entered: 05/15/2007)
35 SUGGESTIONS in opposition re 5 MOTION to certify class and Suggestions in Support filed by Douglas G. Leyshock on behalf of Defendants Deborah E. Scott, Janel Luck, Steve Renne. Reply suggestions due by 6/1/2007 unless otherwise directed by the court (Related document(s) 5 ) (Leyshock, Douglas) (Entered: 05/15/2007)
36 SCHEDULING ORDER:Discovery due by 11/30/2007. Dispositive Motions due by 1/4/2008. Pretrial Conference set for 4/24/2008 at 03:00 PM in District Courtroom, Jefferson City(djc). Jury Trial set for 5/5/2008 at 09:00 AM in District Courtroom, Jefferson City(djc) before Judge Nanette Laughrey. (Attachments: # 1 Memo on PTC)(Kanies, Renea) (Entered: 05/23/2007)
37 RULES OF TRIAL entered by Judge Nanette Laughrey. (Kanies, Renea) (Entered: 05/23/2007)
38 Notice of EAPJ (Attachments: # 1 General Order)(Bax, Laura) (Entered: 06/20/2007)
39 ORDER entered by Judge Nanette Laughrey. Plaintiffs' Motion for Class Certification [Doc. # 5] is GRANTED. The Court CERTIFIES a CLASS to be represented by Plaintiffs consisting of All children residing in Missouri and who are receiving or who will receive MC+ health coverage and are required to pay a premium under Mo. Rev. Stat. § 208.640. It is further ORDERED that ORAL ARGUMENT on Plaintiffs' Motion for Preliminary Injunction [Doc. # 11] shall be heard by telephone at 10:30 a.m. on July 3, 2007. The parties shall email Renea_Kanies@mow.uscourts.gov to provide a telephone number where they can be reached at for the call. (Kanies, Renea) (Entered: 06/25/2007)
40 ORDER SETTING TELECONFERENCE. Oral Argument on Plaintiffs' Motion for Preliminary Injunction [Doc. # 11] shall be heard by telephone at 10:30 a.m. on July 3, 2007. The parties shall email Renea_Kanies@mow.uscourts.gov to provide a telephone number where they can be reached at for the call. (Text entry only − no document attached) (Kanies, Renea) (Entered: 06/26/2007)

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07/03/2007

41 Minute Entry. Proceedings held before Judge Nanette K. Laughrey : TELEPHONE CONFERENCE held on 7/3/2007.Teleconference held. Oral argument presented on the Plaintiffs' Motion for Preliminary Injunction (Doc. 11). (Court Reporter Katie Wirt.) (Kanies, Renea) (Entered: 07/03/2007)

07/09/2007

42 ORDER entered by Judge Nanette Laughrey. Plaintiffs' Motions for Preliminary Injunction [Doc. # 11] is GRANTED. Defendants are ENJOINED from terminating any class members benefits for nonpayment without mailing a notice of pending termination to the recipient ten days prior to the termination which informs the recipient of her right to request a hearing within ten days and to receive continued benefits pending the outcome of that hearing. Defendants are further ENJOINED to conduct ex parte reviews of individual recipients' eligibility under any other Medicaid program prior to termination of benefits. (Kanies, Renea) (Entered: 07/09/2007)

09/28/2007

43 CERTIFICATE OF SERVICE by all plaintiffs filed by Laura F. Redman on behalf of Plaintiffs J.W.M., Julia M..(Redman, Laura) (Entered: 09/28/2007)

09/28/2007

44 CERTIFICATE OF SERVICE by all plaintiffs filed by Laura F. Redman on behalf of Plaintiffs J.W.M., Julia M..(Redman, Laura) (Entered: 09/28/2007)

09/28/2007

45 CERTIFICATE OF SERVICE by all plaintiffs filed by Laura F. Redman on behalf of Plaintiffs J.W.M., Julia M..(Redman, Laura) (Entered: 09/28/2007)

10/19/2007

46 NOTICE of hearing:Mediation set for 11/19/2007 01:00 PM in Magistrate Courtroom, Jefferson City (WAK) before Judge William Knox. (Bax, Laura) (Entered: 10/19/2007)

10/22/2007

47 NOTICE FROM THE COURT. The portion of CM/ECF responsible for noticing failed from Friday, Oct 19 through 11:00 AM Monday Oct 22. Our records indicate that there was at least one entry in this case during that time frame. All attorneys of record in this case should have received an actual email from the court with the document attached. All secondary email recipients who wish to view filings will be required to access the case through PACER and incur the indicated fees for doing so. We apologize for any inconvience." (Price, Jackie) (Entered: 10/22/2007)

10/26/2007

48 NOTICE of CANCELLATION OF MEDIATION HEARING previously set for 11/19/07. Mediation will be rescheduled. (Bax, Laura) (Entered: 10/26/2007)

11/05/2007

49 Mediation Hearing set for 12/12/2007 at 10:00 AM in Magistrate Courtroom, Jefferson City (WAK) before Judge William Knox. (Bax, Laura) (Entered: 11/05/2007)

11/21/2007

50 ORDER SETTING TELECONFERENCE (text entry only − no document attached). A telephone Conference is set for Monday, 11/26/2007, at 11:30 AM, before Judge Nanette Laughrey regarding discovery disputes. The parties shall fax a one page summary of the discovery dispute to 573−636−5108, by 4:00 PM today. The parties shall email Fran Smith (Fran_Smith@mow.uscourts.gov), 24 hours in advance, to provide a phone number where they can be reached for the conference.(Smith, Fran) (Entered: 11/21/2007)

11/21/2007

51 AMENDED ORDER SETTING TELECONFERENCE (text entry only − no document attached). The Telephone Conference previously set for 11/26/2007, is RESET for Wednesday, 11/28/2007, at 03:30 PM, before Judge Nanette Laughrey regarding discovery disputes. The parties shall fax a one page summary of the discovery dispute to 573−636−5108, 24 hours in advance of the conference. The parties shall email Fran Smith (Fran_Smith@mow.uscourts.gov), 24 hours in advance, to provide a phone number where they can be reached for the conference.(Smith, Fran) (Entered: 11/21/2007)

11/21/2007

52 MOTION for extension of time to complete discovery filed by Douglas G. Leyshock on behalf of Deborah E. Scott, Janel Luck, Steve Renne. Suggestions in opposition/response due by 12/6/2007 unless otherwise directed by the court. (Leyshock, Douglas) (Entered: 11/21/2007)

11/27/2007

53 SECOND AMENDED ORDER SETTING TELECONFERENCE. The Telephone Conference previously set for 11/28/2007, is RESET for Thursday, 11/29/2007, at 02:45 PM, before Judge Nanette Laughrey regarding discovery disputes. The

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11/28/2007 11/29/2007
11/29/2007 12/07/2007 12/07/2007 12/07/2007 12/07/2007 12/11/2007 12/12/2007
12/17/2007 12/19/2007

parties shall fax a one page summary of the discovery dispute to 573−636−5108, 24 hours in advance of the conference. The parties shall email Fran Smith (Fran_Smith@mow.uscourts.gov), 24 hours in advance, to provide a phone number where they can be reached for the conference. (Text entry only − no document attached) (Kanies, Renea) (Entered: 11/27/2007)
54 NOTICE of appearance by Emily A. Dodge on behalf of Deborah E. Scott, Janel Luck, Steve Renne (Dodge, Emily) (Entered: 11/28/2007)
55 Minute Entry. Proceedings held before Judge Nanette K. Laughrey : Teleconference held regarding a Motion for Enlargement of Time (Doc. 52). The parties requested a 60 day extension of time. The parties agreed this is a bench tried case. The parties understood that if the Court moves the deadlines back 60 days the dispositive motions will be taken with the trial. The Court will move all discovery deadlines back 60 days. All other deadlines remain unchanged.The Court ordered the defendant to respond to plaintiffs document requests and interrogatories filed September 28, 2007 by December 10, 2007. The defendant shall notify plaintiff before December 10, 2007 if there are any problems providing the information. (Court Reporter None.) (Kanies, Renea) (Entered: 11/29/2007)
56 AMENDED SCHEDULING ORDER:Discovery due by 1/29/2008. Dispositive Motions due by 3/4/2008. Pretrial Conference set for 5/5/2008 AT 08:30 AM in District Courtroom, Jefferson City. Bench Trial set for 5/5/2008 AT 09:00 AM in District Courtroom, Jefferson City(djc) before Judge Nanette Laughrey. (Attachments: # 1 Memo on PTC)(Kanies, Renea) (Entered: 11/29/2007)
57 CERTIFICATE OF SERVICE by Deborah E. Scott, Janel Luck, Steve Renne Response ro Plaintiffs' First Interrogatories and Request for Production of Documents filed by Emily A. Dodge on behalf of Defendants Deborah E. Scott, Janel Luck, Steve Renne.(Dodge, Emily) (Entered: 12/07/2007)
58 CERTIFICATE OF SERVICE by Deborah E. Scott, Janel Luck, Steve Renne Defendants' Response to Plaintiffs' First Interrogatories and Request for Production of Documents to Defendant Missourt Department of Social Services filed by Emily A. Dodge on behalf of Defendants Deborah E. Scott, Janel Luck, Steve Renne.(Dodge, Emily) (Entered: 12/07/2007)
59 CERTIFICATE OF SERVICE by Deborah E. Scott, Janel Luck, Steve Renne response to Plaintiffs' First Interrogatories and Request for Production of Documents to Defendant Missouri Family Support Division filed by Emily A. Dodge on behalf of Defendants Deborah E. Scott, Janel Luck, Steve Renne.(Dodge, Emily) (Entered: 12/07/2007)
60 TRANSCRIPT of Teleconference regarding preliminary injunction held on July 3, 2007 before Judge Nanette K. Laughrey. Court Reporter: Kathleen M. Wirt. (Carr, Lori) Modified on 2/3/2010 to add transcript; paper copy purged (Price, Jackie). (Entered: 12/10/2007)
61 NOTICE of hearing: The mediation previously scheduled for 10:00 on December 12, 2007, will be held by telephone. (Bax, Laura) (Entered: 12/11/2007)
62 Minute Entry of confidiential settlement negotiations held before Judge William A. Knox on 12/12/2007. Negotiations on−going. Follow−up phone conference to be scheduled for 10:00 am on December 20, 2007. Plaintiff should initiate this call and telephone the court last at 573−634−3418. TEXT ENTRY ONLY − no document is attached. (Court Reporter Price FTR − 1o mins) (Price, Jackie) (Entered: 12/13/2007)
63 AMENDED NOTICE of Status Conference reset for **12/19/2007 02:15 PM in Magistrate Courtroom, Jefferson City (WAK) before Judge William Knox. Plaintiff to initiate the call. TEXT ENTRY ONLY − no document is attached. Conflicts to Jackie at 573−636−4015. (Price, Jackie) (Entered: 12/17/2007)
64 Minute Entry. Settlement proceedings held before Judge William A. Knox on 12/19/2007. Negotiations ongoing. Follow−up telephone conference to be scheduled on 12/21/2007 at 9:00 a.m.. TEXT ENTRY ONLY − no document attached. (Bode, Kay) (Entered: 01/09/2008)

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12/21/2007 01/02/2008 01/07/2008 01/09/2008 01/11/2008 01/11/2008 01/15/2008 01/28/2008 02/01/2008 02/06/2008 02/08/2008 02/13/2008
03/03/2008

65 Minute Entry. Settlement proceedings held before Judge William A. Knox on 12/21/2007. Negotiations ongoing. Follow−up telephone conference to be scheduled for 10:00 a.m., 1/2/2008. TEXT ENTRY ONLY − No document attached. (Bode, Kay) (Entered: 01/09/2008)
66 Minute Entry. Settlement proceedings held before Judge William A. Knox on 1/2/2008. Negotiations ongoing. Follow−up telephone conference to be scheduled for 1:30 p.m., 1/7/2008. TEXT ENTRY ONLY − No document attached. (Bode, Kay) (Entered: 01/09/2008)
67 Minute Entry. Settlement proceedings held before Judge William A. Knox on 1/7/2008. Negotiations ongoing. Follow−up telephone conference scheduled for 1/9/2008 at 1:00 p.m. TEXT ENTRY ONLY − No document attached. (Bode, Kay) (Entered: 01/09/2008)
68 Minute Entry. Settlement proceedings held before Judge William A. Knox on 1/9/2008. Negotiations ongoing. Follow−up telephone conference scheduled on 1/11/2008 at 9:00 a.m. TEXT ENTRY ONLY − No document attached. (Bode, Kay) (Entered: 01/09/2008)
Minute Entry. Settlement proceedings held before Judge William A. Knox on 1/11/2008. Settlement appears promising. Follow−up telephone conference scheduled on 1/15/2008 at 1:30 p.m. TEXT ENTRY ONLY − No document attached. (Bode, Kay) (Entered: 01/11/2008)
69 ORDER by Judge Nanette Laughrey (text entry only − no document attached). Discovery deadline is extended to and including February 1, 2008. All other deadlines remain unchanged.(Smith, Fran) (Entered: 01/11/2008)
70 Minute Entry. Settlement proceedings held before Judge William A. Knox on 1/15/2008. Negotiations ongoing. Follow−up telephone conference scheduled on 1/17/2008 at 2:30 p.m. TEXT ENTRY ONLY −− No document attached. (Bode, Kay) (Entered: 01/17/2008)
71 ORDER entered by Judge Nanette Laughrey. At the request of the parties, the discovery deadline is extended to February 8, 2008. All other deadlines, however, remain the same. No further extensions will be granted. (Text entry only − no document attached) (Kanies, Renea) (Entered: 01/28/2008)
72 Minute Entry of confidential settlement hearing held before Magistrate Judge William A. Knox on 2/1/2008. CASE SETTLED. Fairness hearing to be held before Judge Laughrey. Marc Cohan, Laura Redman and Emily Dodge participated via telephone. TEXT ENTRY ONLY − no document is attached. (Court Reporter Price − FTR 15 mins) (Price, Jackie) (Entered: 02/04/2008)
73 ORDER SETTING TELECONFERENCE. A Telephone Conference is set for 2/13/2008 at 11:00 AM before Judge Nanette Laughrey to discuss scheduling a fairness hearing. (Text entry only − no document attached) (Kanies, Renea) (Entered: 02/06/2008)
74 SETTLEMENT AGREEMENT and Proposed Order by J.W.M., Julia M.. (Redman, Laura) (Entered: 02/08/2008)
75 Minute Entry. Proceedings held before District Judge Nanette K. Laughrey: TELEPHONE CONFERENCE held on 2/13/2008. Teleconference held. The Court was informed by Judge Knox that the case has been settled and a fairness hearing needs to be scheduled. The parties have agreed upon notice to the certified class. The Court ordered the parties to file a proposed stipulation and order regarding the notice to class members through publication and posting.A fairness hearing is tentatively set for April 18, 2008, at 9:00 a.m. (Court Reporter None.) (Kanies, Renea) (Entered: 02/13/2008)
76 STIPULATION of Proposed Rule 23(e) Order and attached Notice to Class of Proposed Settlement by J.W.M., Julia M., Deborah E. Scott, Janel Luck, Steve Renne. (Attachments: # 1 Appendix Notice to Class of Proposed Settlement)(Redman, Laura) (Entered: 03/03/2008)

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03/11/2008
03/14/2008
03/14/2008 03/14/2008 04/04/2008 04/04/2008 04/18/2008 04/21/2008
04/30/2008

77 ORDER entered by Judge Nanette Laughrey re: Notice to Class of Proposed Settlement. A hearing pursuant to Rule 23(e) of the Federal Rules of Civil Procedure shall be held on April 18, 2008 at 9:00 a.m., for the purpose of determining whether the proposed Settlement is fair, reasonable, and adequate, and should be approved by the Court. The hearing shall take place before the Honorable Nanette Laughrey, United States Courthouse, 131 W. High Street, Jefferson City, Missouri 65101, and will begin at 9:00 a.m. (Kanies, Renea) (Entered: 03/11/2008)
78 NOTICE of Telephone Conference set for 3/31/2008 at 3:15 PM or soon thereafter before Judge William Knox to schedule pretrial mediation at Judge Laughrey's request. Court will initiate the call. Parties are advised that the following mediation dates are not available for Judge Knox. April 3, 4, 10, 11, 15am, 16, 17, 18, 21am, 30, May 1 and 2. Counsel should have their calendars available at the conference. Questions can be directed to Jackie at 573−636−4015 or jackie.price@mow.uscourts.gov TEXT ENTRY ONLY − no document is attached. (Price, Jackie) (Entered: 03/14/2008)
79 NOTICE OF CANCELLATION: Phone conference scheduled for 3/31/08 with counsel to schedule pretrial mediation has been CANCELLED. It will not be rescheduled at this time. TEXT ENTRY ONLY − no document is attached. (Price, Jackie) (Entered: 03/14/2008)
80 ORDER SETTING MONDAY, MAY 5, 2008, TRIAL DOCKET (TWO−WEEK DOCKET).(Smith, Fran) (Entered: 03/14/2008)
81 AFFIDAVIT Declaration in Support of Proposed Settlement Agreement by J.W.M., Julia M.. (Redman, Laura) (Entered: 04/04/2008)
82 AFFIDAVIT re 77 Order,, Declaration Regarding Notice to the Class by J.W.M., Julia M.. (Attachments: # 1 Exhibit A (List of Advocacy Organizations), # 2 Exhibit B (Notice))(Related document(s) 77 ) (Redman, Laura) (Entered: 04/04/2008)
83 Minute Entry. Proceedings held before District Judge Nanette K. Laughrey: EVIDENTIARY HEARING held on 4/18/2008. Fairness hearing held. The Court found the settlement to be fair adequate and reasonable. The Court will enter an order approving the settlement. Defendants provided to plaintiffs a check for attorney fees and expenses. (Court Reporter Katie Wirt.) (Kanies, Renea) (Entered: 04/18/2008)
84 Order entered by Judge Nanette Laughrey. The Court finds the proposed settlement with defendants by plaintiffs in the manner set forth in the Release and Settlement Agreement is fair, adequate, and reasonable, and the same is hereby authorized and approved; it is further ORDERED that under Fed. R. Civ. P. 41(a)(2) the claims of the plaintiffs are dismissed in their entirety with prejudice; it is further ORDERED that this Court retains jurisdiction until October 15, 2008, or such later date as may be necessary under Paragraph 16 of the Settlement Agreement, for purposes of enforcement of the Settlement Agreement. Each party to bear its own costs beyond those already apportioned by the settlement agreement. (Kanies, Renea) (Entered: 04/21/2008)
85 TRANSCRIPT of Proceedings held on 4/18/08 before Nanette K. Laughrey. Court Reporter: Kathleen M. Wirt. (Francis, Alexandra) Modified on 2/3/2010 to add transcript; paper copy purged (Price, Jackie). (Entered: 04/30/2008)

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[CONTENT] the Western District | Missouri | Missouri | State Children's | Health Insurance Program | first ||| the Missouri Department of Social Services | Family Support Division | the state Division of Medical Services ||| Julia M. | Missouri | monthly | Julia M.'s ||| Julie M. |||  ||| June 25, 2007 | the District Court | Nanette K. Laughrey | Missouri | Missouri ||| Laughrey | Julia M. | the Missouri Department of Social Services ||| February 2, 2008 | a Consent Decree | Defendants |||  ||| over $165,000 ||| Court | October 15, 2008 | the Consent Decree [SUMMARY] This is a class action filed in the Western District of Missouri, in which the plaintiffs are seeking to prevent the state from disenrolling recipients in Missouri's State Children's Health Insurance Program (SCHIP) who fail to meet their premium requirements without first notifying them of their right to appeal and to continue to receive program benefits pending the outcome of the appeal.  The defendants are the Missouri Department of Social Services, and the interim directors of the state Family Support Division and the state Division of Medical Services.  According to the named plaintiff, Julia M., Missouri terminated the benefits of her minor child, when, after a series of bank errors, the monthly premium was not deducted from Julia M.'s account in a timely fashion. Julie M. received the notice after the benefits already had been terminated. While the notice indicated a right to appeal, it did not indicate a right to continue benefits pending the outcome of the appeal or that the state had conducted any evaluation to determine eligibility for other benefits. 

On June 25, 2007, the District Court (Judge Nanette K. Laughrey) certified the class, defining it as "[a]ll children residing in Missouri and who are receiving or who will receive [Missouri SCHIP] health coverage and are required to pay a premium under [state law]." 

Judge Laughrey, however, did not immediately rule on the request of the representative plaintiff, identified as Julia M., to issue a preliminary injunction requiring the Missouri Department of Social Services to provide recipients with sufficient notice of disenrollment and continued benefits pending any appeal.

On February 2, 2008, the parties signed a Consent Decree in which the Defendants agreed to notify participants in SCHIP who have fallen behind in their payments. The notification must tell the participant that he/she has a right to appeal, and that during the appeals process he/she is entitled to continued benefits until the matter is resolved. Defendants also agreed to pay the plaintiffs over $165,000 in attorneys fees and expenses.   

The Court was to retain jurisdiction until October 15, 2008 in order to monitor the execution of the Consent Decree.

