Sovereign Immunity Bars Suit Against State Employees of DMAHS

Deal v. Velez, 2017 U.S. Dist. LEXIS 39427 (D.N.J. March 20, 2017).

This matter was on appeal before the District Court on defendants’ motion to dismiss the Amended Complaint for lack of jurisdiction.  The issue before the Court was whether the defendants are entitled to sovereign and/or qualified immunity under the Eleventh Amendment.

This case arose out of a series of applications for assisted living benefits made by or on behalf of decedent, which was originally denied by the State of New Jersey.  Plaintiff Patrice Deal (“Patrice”), Executrix of the Estate of Grace Deal, deceased (the “estate”), filed an administrative appeal asserting that defendants wrongly determined that decedent was not eligible for the Medicaid Waiver Program to cover assisted living services.

The administrative law judge issued an initial decision affirming the denial of the decedent’s eligibility.  The Division of Medical Assistance and Health Services (“DMAHS”) issued a final agency decision affirming the administrative law judge’s decision denying the decedent’s eligibility.  Rather than appealing that decision to the Superior Court of New Jersey, Appellate Division, Patrice filed a complaint on behalf of the estate.

In the meantime, DMAHS instituted new programs and expanded Medicaid coverage beyond nursing facilities to assisted living and home care.  Patrice then filed a second Medicaid application.  Thereafter, DMAHS determined that the decedent was eligible for the Medicaid waiver program and granted her eligibility.

Defendants, each of whom are employees of DMAHS, then moved to dismiss contending that they were entitled to sovereign and/or qualified immunity as well as asserting Patrice’s claims for relief were moot in that decedent was granted eligibility.

The Court granted dismissal in part insofar as the individual defendants had been sued in their official capacities for damages as they were not amenable to suit.  The Court noted that the U.S. Supreme Court has held that neither a State nor its officials acting under their official capacities are “persons’ amenable to suit under §1983.”  Will v. Michigan Dep’t of State Police, 491 U.S. 58 (1989).  Moreover, the Eleventh Amendment incorporates a general principle of sovereign immunity that bars citizens from bringing suits for damages against any State in federal court.  Pennhurst State Sch. & Hosp. v. Halderman, 465 U.S. 89 (1984).

Further, the District Court found that the Amended Complaint contained no indication that defendants had been sued in their individual capacities and there was no factual basis to infer that either had personal involvement in denying the decedent’s eligibility for Medicaid benefits.  Thus, the motion to dismiss was granted.