University of Michigan Law School
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Case Name Jackson v. Secretary of the Indiana Family and Social Services Administration PB-IN-0010
Docket / Court 1:15-cv-01874 ( S.D. Ind. )
State/Territory Indiana
Case Type(s) Public Benefits / Government Services
Attorney Organization ACLU Chapters (any)
Case Summary
On November 11, 2015, a Medicaid recipient with Hepatitis C filed this putative class-action lawsuit in the U.S. District Court for the Southern District of Indiana. The case was assigned to District Judge Sarah Evans Barker. The plaintiff sued the Secretary of the Indiana Family and Social ... read more >
On November 11, 2015, a Medicaid recipient with Hepatitis C filed this putative class-action lawsuit in the U.S. District Court for the Southern District of Indiana. The case was assigned to District Judge Sarah Evans Barker. The plaintiff sued the Secretary of the Indiana Family and Social Services Administration (“the agency”) under 42 U.S.C. § 1983. The plaintiff, represented by the ACLU of Indiana and the Health and Human Rights Clinic at Indiana University’s McKinney School of Law, sought injunctive and monetary relief, claiming violation of federal Medicaid law.

The plaintiff alleged that the Agency had a formal policy of denying Medicaid recipients with Hepatitis C “medically necessary” drugs. Specifically, they alleged that the agency denied Medicaid recipients with Hepatitis C direct-acting antiviral medications (specifically Harvoni) unless and until absolutely necessary. Despite these practices, medical professional agreed that early administration of the medication was “medically necessary” to prevent liver damage and other serious conditions.

The defendants moved to dismiss the complaint on January 15, 2016. They alleged that the plaintiff had failed to state claim under 42 U.S.C. § 1983 for which relief could be granted. On April 12, 2016, Judge Barker denied defendants’ motion. She held that the plaintiff had sufficiently pled a claim, so she denied the defendants’ motion to dismiss the complaint.

The original plaintiff was provided with Harvoni by the agency, and consequently a new plaintiff intervened in the suit on January 3, 2017. Discovery and negotiations lasted through the remainder of 2017 and into 2018. On November 8, 2018, the parties settled the case. The settlement, contingent on the Court’s certification of the class, involved injunctive relief and attorneys’ fees for the plaintiff. As part of the settlement, the agency agreed to eliminate its policy of restricting Medicaid reimbursement for Harvoni to only those Medicaid recipients with advanced Hepatitis C or those who were co-infected with HIV or AIDS or were post-liver transplant. By July 1, 2019, the defendants had to implement this policy. The defendants also agreed that they would pay the plaintiffs’ counsel $117,500 in attorneys’ fees. The agreement stated that the plaintiffs could enforce it through a breach of contract claim - meaning that the Court did not maintain jurisdiction to enforce it.

Judge Barker approved class-certification on November 9, 2018. The Court defined the certified class as:

Any and all adult Medicaid recipients in Indiana, current and future, with a diagnosis of chronic Hepatitis C, genotype 1, who have been prescribed one of the direct-acting antiviral medications enumerated in the 2016 Policy or 2018 Policy, by or in consultation with an Infectious Disease or GI specialist, but do not meet the medical requirements of such policy to receive Medicaid reimbursement for that prescribed medication.

On November 26, 2018, Judge Barker approved the parties’ joint motion regarding the manner and form of notice to the class. She also set a class-action fairness hearing for February 5, 2019. The case is ongoing.

Michael Beech - 02/02/2019


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Issues and Causes of Action
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Issues
Benefit Source
Medicaid
Defendant-type
Jurisdiction-wide
General
Payment for care
Public benefits (includes, e.g., in-state tuition, govt. jobs)
Plaintiff Type
Private Plaintiff
Causes of Action 42 U.S.C. § 1983
Title XIX of the Social Security (Medicaid) Act, 42 U.S.C §1396
Defendant(s) Indiana Family and Social Services Administration
Plaintiff Description Any and all adult Medicaid recipients in Indiana, current and future, with a diagnosis of chronic Hepatitis C, genotype 1, who have been prescribed one of the direct-acting antiviral medications enumerated in the 2016 Policy or 2018 Policy, by or in consultation with an Infectious Disease or GI specialist, but do not meet the medical requirements of such policy to receive Medicaid reimbursement for that prescribed medication.
Indexed Lawyer Organizations ACLU Chapters (any)
Class action status sought Yes
Class action status granted Yes
Filed Pro Se Yes
Prevailing Party Plaintiff
Public Int. Lawyer Yes
Nature of Relief None yet
Source of Relief None yet
Filing Year 2015
Case Ongoing Yes
Docket(s)
No docket sheet currently in the collection
General Documents
No documents currently in the collection

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