Tort- Suit over alleged denied Medicaid benefits to child is dismissed

Where a parent alleged a Virginia agency denied benefits to her child in violation of the Medicaid Act, but none of the four Medicaid provisions upon which she relies supports a privately enforceable cause of action, her suit was dismissed.  

Background

Stella Croffe is the parent of B.C., a minor child who is a Medicaid beneficiary, and eligible for services under the Virginia State Medicaid Plan. Cheryl Roberts is the Director of the Virginia Department of Medical Assistance Services  where she is responsible for “administering Virginia’s Medicaid program in compliance with federal law.”

Croffe sued Roberts, asserting four violations of the Medicaid Act, which she raises pursuant to 42 U.S.C. § 1983. Roberts has filed a motion to dismiss.

Individual standing

Plaintiff alleges that B.C. has “experienced increased aggression, behavioral instability, and risk of harm to self and caregivers” in the wake of defendant’s failure to establish a payment plan with Kennedy Krieger Institute for B.C.’s treatment. Plaintiff never claims to have suffered an injury to herself because of defendant’s conduct.

In her opposition, plaintiff states that she has suffered injuries of her own in the form of “emotional distress” because “her child is being denied medically necessary treatment’ and because she is suffering “interference with parental decision-making.” Because these injuries were not alleged in the complaint, the court will not consider them now.

Accordingly, plaintiff has failed to allege an injury in fact to herself. Therefore, plaintiff’s complaint will be dismissed to the extent that plaintiff asserts claims in her individual capacity for lack of standing.

Claim

Defendant argues that plaintiff does not have a privately enforceable cause of action the four Medicaid provisions upon which she relies. Plaintiff’s first claim comes under 42 U.S.C. § 1396a(a)(8), which requires states to “provide that all individuals wishing to make application for medical assistance under the plan shall have opportunity to do so, and that such assistance shall be furnished with reasonable promptness to all eligible individuals.”

In Medina v. Planned Parenthood S. Atl., 606 U.S. 357 (2025), the Supreme Court specifically rejected that the words “must,” “provide” or “shall,” even when applied to “individuals,” create a private right of enforcement. Another judge in this district also recently held that § 1396a(a)(8) does not contain rights-creating language for the purposes of a § 1983 claim. Although plaintiff focuses on the mandatory nature of the word “shall,” this argument was squarely rejected by the Supreme Court in Medina.

Plaintiff next attempts to rely on 42 U.S.C. § 1396a(a)(30)(A), the “equal access provision.” As with § 1396a(a)(8), this section lacks the necessary rights-creating language that would grant plaintiff the opportunity to pursue a claim. Although states “must provide” the listed “procedures,” the Supreme Court rejected that this creates a private right of enforcement even before Medina.

Even if the provision contained rights-creating language, it does not speak to the individual rights of citizens. The provision focuses on providing “methods and procedures” that make available “care and services.” It does not discuss any individual or class of people with specificity. This interpretation is in line with other circuits’ interpretation of the statute.

Turning to 42 U.S.C. § 1396a(a)(10)(B), known as the comparability provision, Medina’s rejection of the words “must” or “provide’ as rights-creating language, precludes plaintiff’s claim. The word ‘shall” is intended as a mandate for the state to follow and does not reflect an intention to confer a private right in persons like plaintiff. Therefore, plaintiff cannot state a claim in reliance on this provision.

Finally, plaintiff relies upon 42 U.S.C. § 1396a(a)(43)(C), which states that states “must . . . provide for” “arranging for (directly or through referral to appropriate agencies, organizations, or individuals) corrective treatment the need for which is disclosed by such child health screening services.” This provision, like the others plaintiff listed in the complaint, does not contain rights-creating language that gives a private plaintiff the right to file suit under 42 U.S.C. § 1983. As squarely addressed in Medina, the words “must,” ‘provide” and “shall” alone, or in conjunction with one another, are not rights-creating language.

Defendant’s motion to dismiss granted.

Croffe v. Roberts, Case No. 1:25-cv-02036, April 17, 2026. EDVA at Alexandria (Alston). VLW 026-3-182. 13 pp.

Full-Text Opinion

VLW 026-3-182
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