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Case Name M.V. v. Lyon PC-MI-0043
Docket / Court 2:17-cv-11184 ( E.D. Mich. )
State/Territory Michigan
Case Type(s) Prison Conditions
Case Summary
On April 14, 2017, plaintiff, a Medicaid eligible individual who had been diagnosed with hepatitis C Virus, filed this class action complaint against Nick Lyon, in his capacity as executive director of the Michigan Department of Health and Human Services (MDHHS). The complaint was filed in the ... read more >
On April 14, 2017, plaintiff, a Medicaid eligible individual who had been diagnosed with hepatitis C Virus, filed this class action complaint against Nick Lyon, in his capacity as executive director of the Michigan Department of Health and Human Services (MDHHS). The complaint was filed in the United States District Court for the Eastern District of Michigan, and it alleged that the MDHHS violated several provisions of the Medical Assistance Program, Title XIX of the Social Security Act, 42 U.S.C. § 1396 by its then existing prior-authorization criteria for hepatitis C treatment.

The complaint alleged that the criteria's requirement that individuals suffer certain levels of measurable liver damage before they could become eligible for direct-acting antiviral medications. More specifically, this practice violated three separate provisions of 42 U.S.C. § 1396 by: (1) excluding qualified Medicaid recipients from "medically necessary" treatment as required by 42 U.S.C. § 1396a(a)(10)(A); (2) discriminating among similarly situated Medicaid recipients in violation of 42 U.S.C. § 1396a(a)(10)(B); and (3) failing to provide medically necessary treatment with "reasonable promptness" as required by 42 U.S.C. § 1396a(a)(8).

The defendants initially filed a motion to dismiss the claim, but in October of 2017 the parties began discussing settlement possibilities and agreed to mediation. The parties then reached an agreement after a formal mediation with Magistrate Judge R. Steven Whalen on January 27, 2018.

On May 29, 2018, the court granted preliminary approval of the proposed class action settlement and set a date for a fairness hearing. The court granted final approval of the settlement on August 31, 2018, and awarded plaintiff's counsel $199,000 in attorney fees, an amount the defendants had agreed not to contest in the settlement.

The settlement class was defined as: All individuals that: are or will be enrolled in Michigan's Medicaid Program at the time of class certification; have been or will be diagnosed with a chronic infection of Hepatitis C virus; are 18 years or older; and require or in the future will require treatment for Hepatitis C with direct-acting antiviral medication and who do not meet the MDHHS current treatment criteria, which restricts direct-acting antiviral treatment to individuals with a minimum metavir fibrosis score criteria of F-2.

The defendants denied any liability in the settlement, but agreed to replace the MDDHS prior-authorization criteria and institute amended criteria to provide coverage for direct-acting antiviral treatment to all Eligible Michigan Medicaid beneficiaries diagnosed with chronic hepatitis C. The schedule for expanding direct-acting antiviral treatment coverage was set as follows: (a) defendant will provide coverage for all eligible beneficiaries with a metavir fibrosis score of F-1 and above on October 1, 2018; (b) defendant will provide coverage for all beneficiaries with a metavir fibrosis score of F-0 and above on October 1, 2019.

Chris Pollack - 03/20/2019


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Issues and Causes of Action
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Issues
Constitutional Clause
Cruel and Unusual Punishment
Defendant-type
Jurisdiction-wide
Medical/Mental Health
Hepatitis
Plaintiff Type
Private Plaintiff
Causes of Action 42 U.S.C. § 1983
Defendant(s) Michigan
Plaintiff Description All individuals that: are or will be enrolled in Michigan's Medicaid Program at the time of class certification; have been or will be diagnosed with a chronic infection of Hepatitis C virus; are 18 years or older; and require or in the future will require treatment for Hepatitis C with direct-acting antiviral medication and who do not meet the MDHHS current treatment criteria, which restricts direct-acting antiviral treatment to individuals with a minimum metavir fibrosis score criteria of F-2.
Class action status sought Yes
Class action status granted Yes
Filed Pro Se No
Prevailing Party Plaintiff
Public Int. Lawyer No
Nature of Relief Attorneys fees
Injunction / Injunctive-like Settlement
Source of Relief Settlement
Form of Settlement Court Approved Settlement or Consent Decree
Filing Year 2017
Case Ongoing Yes
Additional Resources
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  Civil Rights Injunctions Over Time: A Case Study of Jail and Prison Court Orders
N.Y.U. Law Review
Date: May 2006
By: Margo Schlanger (Washington University Faculty)
Citation: 81 N.Y.U. L. Rev. 550 (2006)
[ Detail ] [ PDF ] [ External Link ]

  Judicial Policy Making and the Modern State: How the Courts Reformed America's Prisons
Book
Date: Jan. 1, 1998
By: Malcolm M. Feeley & Edward Rubin (UC Berkeley Boalt Hall School of Law & Vanderbilt School of Law Faculty Faculty)
Citation: (1998)
[ Detail ]

Docket(s)
2:17-cv-11184 (E.D. Mich.)
PC-MI-0043-9000.pdf | Detail
Date: 08/31/2018
Source: PACER [Public Access to Court Electronic Records]
General Documents
Complaint [ECF# 1]
PC-MI-0043-0001.pdf | Detail
Date: 04/14/2017
Source: PACER [Public Access to Court Electronic Records]
Motion for Approval of Settlement and Attached Settlement Agreement [ECF# 42] (2018 WL 6975002)
PC-MI-0043-0002.pdf | WESTLAW | Detail
Date: 08/15/2018
Source: PACER [Public Access to Court Electronic Records]
Order Approving Class Settlement [ECF# 43] (2018 WL 4179635) (E.D. Mich.)
PC-MI-0043-0003.pdf | WESTLAW | Detail
Date: 08/31/2018
Source: PACER [Public Access to Court Electronic Records]
show all people docs
Judges Hood, Denise Page (E.D. Mich.) show/hide docs
PC-MI-0043-0003 | PC-MI-0043-9000
Whalen, R. Steven (E.D. Mich.) [Magistrate] show/hide docs
PC-MI-0043-9000
Plaintiff's Lawyers Burrell, Aaron V. (Michigan) show/hide docs
PC-MI-0043-0001 | PC-MI-0043-0002 | PC-MI-0043-9000
Estes, Morris Reid Jr. (Tennessee) show/hide docs
PC-MI-0043-0001
Holmes, Martin D. (Tennessee) show/hide docs
PC-MI-0043-0001
Traylor, John M. (Michigan) show/hide docs
PC-MI-0043-0002 | PC-MI-0043-9000
Young, Robert P. Jr. (Michigan) show/hide docs
PC-MI-0043-9000
Defendant's Lawyers McLean, Kelley Turnock (Michigan) show/hide docs
PC-MI-0043-9000
Smith, Joshua S (Michigan) show/hide docs
PC-MI-0043-9000

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