Preliminary injunction granted barring state from terminating QI Medicaid

In Parker v. Louisiana Department of Health (April 30, 2024), the U.S. District Court for the Eastern District of Louisiana granted a motion for preliminary injunction prohibiting the State from terminating a grandmother’s QI Medicaid based on the State’s determination of family size.

The Plaintiff, a 71 year old widow who was raising her grandchild, received QI Medicaid, which ordinarily helps pay Medicare co-pays, deductibles and Part B premiums. The State examined her income and found that she should be treated as a single person and subject to the program’s income limits for a single person. The State’s position was that a grandchild does not meet the defition of a member of the household. The plaintiff disagreed and filed suit.

Initially, the burden is high when seeking a preliminary injunction. The Court stated the legal standard as:

“An applicant for preliminary injunctive relief must show: “(1) a substantial likelihood that he will prevail on the merits, (2) a substantial threat that he will suffer irreparable injury if the injunction is not granted, (3) his threatened injury outweighs the threatened harm to the party whom he seeks to enjoin, and (4) granting the preliminary injunction will not disserve the public interest.” A preliminary injunction is an extraordinary remedy. Accordingly, a preliminary injunction should only be granted when the party seeking it has clearly carried the burden of persuasion on all four requirements. In the end, a preliminary injunction is treated as an exception rather than the rule.”

Reviewing all four factors, the District Court found that the plaintiff satisfied them. First, she is not required at an early stage of the litigation to show with absolute certainty that she will win. Although the State’s Medicaid manual was “entitled to respectful consideration,” it was not the final word on eligibility determinations. 42 U.S.C. § 1396d(p)(1)(B), which defines the term “qualified medicare beneficiary” as those individuals “whose income (as determined under section 1382a of this title for purposes of the supplemental security income program . . . does not exceed an income level established by the State. In making eligibility determinations, the State argued that only the applicant and the applicant’s spouse  are considered when determining family size (and therefore more generous income allowances). However, the Court found that the “ordinary meaning of “family” would therefore include those living under one roof and usually under one head, such as a child or grandchild that lives with an applicant and is wholly dependent on that applicant for financial support. Accordingly, the Court finds the LDH’s interpretation of “family of the size involved” to be unreasonable.”

The Court found that, if the preliminary injunction was denied, the Plaintiff would have irreparable harm because the Eleventh Amendment prohibits the Court from awarding retroactive money damages against a State. The Court found that the injury to Plaintiff outweighed the threatened harm because “there is a robust public interest in safeguarding access to health care for those eligible for Medicaid, whom Congress has recognized as `the most needy in the country.'” Finally, finding that the State’s definition on family size violated federal law, there was no legitimate public interest in allowing the State to continue refusing to pay for Plaintiff’s Part B premiums.