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Ciarpaglini v. Norwood

United States Court of Appeals, Seventh Circuit

March 25, 2016

ROBERT B. CIARPAGLINI, Plaintiff-Appellant,
v.
FELICIA NORWOOD, in her official capacity as Director of Illinois Department of Healthcare and Family Services, et al., Defendants-Appellees

Page 542

          Appeal from the United States District Court for the Northern District of Illinois, Western Division. No. 13 C 50213 -- Philip G. Reinhard, Judge.

         For ROBERT B. CIARPAGLINI, Plaintiff - Appellant: Barry Levenstam, Attorney, Erica L. Ross, Attorney, JENNER & BLOCK LLP, Chicago, IL.

         For BRUCE V. RAUNER, in his official capacity as Govenor of the State of Illinois, FELICIA F. NORWOOD, in her official capacity as Director of Illinois Department of Healhcare and Family Services, LISA ARNDT, in her official capacity of Bureau Chief of Healthcare and Family Services Pharmacy Services, JAMES PARKER, in his official capacity as Deputy Director of Medical Services of Healthcare and Family Services, HEATHER STEANS, in her official capacity as Senator of the State of Illinois, Defendants - Appellees: Timothy M. Maggio, Attorney, OFFICE OF THE ATTORNEY GENERAL, Chicago, IL.

         Before WOOD, Chief Judge, and MANION and HAMILTON, Circuit Judges.

          OPINION

Page 543

          HAMILTON, Circuit Judge.

          Plaintiff Robert B. Ciarpaglini, an Illinois Medicaid participant, challenges Illinois legislation that caps at four the number of prescriptions a Medicaid recipient can receive without prior approval within a thirty-day period. See 305 Ill. Comp. Stat. 5/5-5.12(j). At the time he filed suit, he was subject to that legislation and alleged he was struggling to obtain his medications because of it. While his suit was pending, though, he was moved to a managed care program. As a result he is no longer subject to that cap.

         The main dispute before us, though not the only one, is whether the transfer to managed care rendered moot Ciarpaglini's claims for declaratory and injunctive relief. The district court held that it did. Ciarpaglini v. Quinn, No. 13 C 50213, 2014 WL 1018146 (N.D.Ill. Mar. 17, 2014). Although Ciarpaglini offered evidence that the switch might not be permanent, the court held his arguments were " simply speculation," " no more than a guess," and insufficient to create a " reasonable expectation" that the four-prescription limit would apply to him in the future. Id. at *3.

         We hold that there is insufficient evidence in the record to determine whether Ciarpaglini's claims for injunctive relief are moot, a conclusion we explain further below. We remand this matter to the district court for limited fact-finding proceedings aimed at permitting both sides to develop a record on the question of mootness. We retain jurisdiction of this matter pending completion of those proceedings.[1]

         I. Factual and Procedural Background

         The central claim in this appeal is plaintiff's challenge under federal law to what he calls the " four-prescription limitation" in Illinois's Medicaid program. The Medicaid program covers prescription medicines. As a cost-control measure, Illinois enacted legislation in 2012 requiring prior approval for reimbursement for more than four prescriptions for one patient within a thirty-day period. 305 Ill. Comp. Stat. 5/5-5.12(j). We refer to this provision as the prior-approval requirement.

         We accept plaintiff Robert Ciarpaglini's well-pled allegations as true for purposes of this appeal. See St. John's United Church of Christ v. City of Chicago, 502 F.3d 616, 625 (7th Cir. 2007), quoting Long v. Shorebank Development Corp., 182 F.3d 548, 554 (7th Cir. 1999). Because courts may properly look beyond the jurisdictional allegations of a complaint and view evidence to determine whether subject matter jurisdiction exists in fact, id., we also consider Ciarpaglini's declaration, the truth of which defendants have not challenged at this stage of the case.

         Plaintiff Ciarpaglini is an Illinois Medicaid recipient. He suffers from several chronic conditions, including bipolar disorder, attention deficit hyperactivity disorder, panic disorder, and generalized anxiety disorder. Doctors have prescribed at least seven medications to manage these conditions. Ciarpaglini alleges that after the prior-approval requirement took effect, he could not, at least at times, obtain the medications he needed. (He acknowledges the prior-approval mechanism but calls the system " fraught with flaws" and says it does not guarantee he will be able to get his medications.) He alleges that as a result he has contemplated committing suicide, committing petty crimes so that he would be jailed, or checking himself into

Page 544

hospitals just to get the medications he needed.

         After informal complaints to state officials failed to produce action, Ciarpaglini filed this pro se lawsuit in June 2013. He challenges the prior-approval requirement as a violation of federal Medicaid law, the Americans ...


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