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D.U. v. Seemeyer

United States District Court, E.D. Wisconsin

June 4, 2018

D.U., Plaintiff,
v.
LINDA SEEMEYER, Defendant.

          FOR PLAINTIFF, D.U. PINES BACH LLP Diane M. Welsh, SBN

          FOR DEFENDANT, LINDA SEEMEYER WISCONSIN DEPARTMENT OF JUSTICE Laure Rakvic-Farr Christopher J. Blythe, SBN 1026147 Laure Rakvic-Farr, SBN 1049540 Wisconsin Department of Justice

          CONSENT DECREE

          NANCY JOSEPH, UNITED STATES MAGISTRATE JUDGE

         I. INTRODUCTION AND BACKGROUND

         1. The Plaintiff, D.U., filed this lawsuit on December 31, 2013, seeking inter alia, declaratory and injunctive relief to redress alleged violations of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) provisions of the Medicaid Act, 42 U.S.C. §1396a(a)(43), 1396d(r).

         2. Plaintiff claimed that the Defendant, in her official capacity as the Secretary of the Wisconsin Department of Health Services, violates Plaintiff's rights by failing to provide private duty nursing care, which Plaintiff claimed is required under EPSDT. The Defendant denied that such care is mandated under the applicable state and federal laws.

         3. In 1965, Congress enacted the Medicaid Act, 42 U.S.C. § 1396 et seq., as Title XIX of the Social Security Act. Moore v. Reese, 637 F.3d 1220, 1232 (11th Cir. 2011). Medicaid is a jointly financed federal-state cooperative program, designed to help states furnish medical treatment to their needy citizens. Id.; see also Bontrager v. Indiana Family and Social Services Admin., 697 F.3d 604, 605-06 (7th Cir. 2012). States devise and fund their own medical assistance programs, subject to the requirements of the Medicaid Act, and the federal government provides partial reimbursement. 42 U.S.C. §§ 1396b(a), 1396d(b). A state's participation in the Medicaid program is voluntary, but once a state opts to participate, it must comply with federal statutory and regulatory requirements. Bontrager, 697 F.3d at 606. Wisconsin participates in the Medicaid program and is therefore bound by its rules and regulations.

         4. The Plaintiff was severely injured in an automobile accident when she was three years old and suffers from a traumatic brain injury and posttraumatic hydrocephalus. Her injuries have profoundly affected her physical abilities, health, behavior, and cognitive development. The Plaintiff is eligible for the Wisconsin Medicaid Program through the Katie Beckett Program.

         5. Wisconsin Medicaid, under the direction of the Secretary of the Wisconsin Department of Health Services, authorized private duty nursing care for the Plaintiff up until November of 2013, at which time it denied the request because it determined that Plaintiff did not need at least eight hours of Medicaid reimbursable skilled nursing care per day. This litigation followed.

         6. The Parties desire to resolve this matter amicably and without going to trial. Without conceding any infirmity in their claims or defenses, the Parties have agreed in settlement negotiation to resolve the claims raised in this action. Plaintiff and Defendant have reached an agreement for settling this litigation that the Parties believe is fair, reasonable, and adequate to protect the interests of both Parties.

         7. By agreeing to this Consent Decree, Defendant does not admit to any liability, fault, wrongdoing, or violation of law regarding the allegations make in this action. Moreover, no part of this litigation may be used as evidence of Defendant's liability, fault, wrongdoing, or violation of law in any other legal proceeding.

         Therefore, based upon all of the foregoing, and the Court being otherwise fully advised, the Court hereby ORDERS, ADJUDGES, and DECREES as follows:

         DECREE

         II. ...


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