## Facts

- Florida’s Medicaid agency mailed recipients a statewide notice stating that, due to a projected budget deficit, Medicaid benefits would be reduced effective November 1, 1977.
- The notice listed several changes, including limiting payment for non-hospital physician services to three doctor visits per month (except for emergencies), limiting consultations per specialty, and setting a $25 flat fee per consultation.
- Other listed reductions included limits relating to inpatient admissions, nursing home payment rounding, dental payments, and a per-prescription recipient charge.
- Medicaid recipients filed a federal class action challenging (1) the adequacy/legality of the notice and (2) the substantive legality of certain reductions, focusing on the three-visit cap.
- Plaintiffs argued the cap denied medically necessary care for some recipients and violated federal Medicaid requirements that covered services be sufficient in amount, duration, and scope to reasonably achieve their purpose and not be discriminatorily limited by diagnosis or condition.
- The state supported the cap with data indicating most recipients did not need more than three non-emergency physician visits per month.
- The district court granted summary judgment for plaintiffs on both the notice claim and the physician-services limitation, enjoining implementation.
- Florida appealed both rulings; the appeals were consolidated.

## Issues

1. Whether the recipients’ challenge to the adequacy of the statewide notice presented a live controversy on appeal or was moot.
2. Whether a state violates federal Medicaid law by limiting payment for non-emergency physician services to three visits per month, while allowing coverage for emergencies.
3. Whether the three-visit cap constituted an impermissible discriminatory limitation based on recipients’ diagnoses, illnesses, or conditions.

## Decision

- The appellate court treated the notice issue as moot, vacated the district court’s judgment on that count, and remanded with instructions to dismiss the notice claim as moot.
- The court reversed the district court’s ruling invalidating the three-visit limitation and lifted the injunction as to that substantive restriction.
- The court held the three-visit cap (with an emergency exception) was consistent with federal Medicaid requirements because it reasonably achieved the purpose of physician services for the Medicaid population and did not discriminate by diagnosis or condition.

## Legal Principles

- Federal courts may not decide the merits of a claim that has become moot; the appropriate disposition includes vacatur of the lower court’s judgment and remand with instructions to dismiss.
- Medicaid’s “amount, duration, and scope” requirements permit reasonable quantitative limits on covered services if, viewed programmatically, the service remains sufficient to reasonably achieve its purpose.
- A limitation that applies uniformly (e.g., a numerical cap), and does not single out particular diagnoses, illnesses, or conditions for disadvantage, does not violate Medicaid’s nondiscrimination limits merely because some recipients may need more services.
- States may use cost-containment measures within Medicaid so long as limits do not cross into unlawful denial of required services or discriminatory restrictions.

## Conclusion

The Fifth Circuit concluded that Florida’s Medicaid three-visit-per-month cap on non-emergency physician services was a permissible quantitative limit under federal Medicaid law and reversed the injunction against it, while disposing of the recipients’ notice challenge as moot by vacating and remanding for dismissal.


Curtis v. Taylor, 625 F.2d 645 (5th Cir. 1980)