Stewart v. Hargan ( 2018 )


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  •                            UNITED STATES DISTRICT COURT
    FOR THE DISTRICT OF COLUMBIA
    RONNIE MAURICE STEWART, et al.,
    Plaintiffs,
    v.                                        Civil Action No. 18-152 (JEB)
    ALEX M. AZAR II, et al.,
    Defendants.
    MEMORANDUM OPINION
    Plaintiffs are sixteen Kentucky Medicaid enrollees who brought this action under the
    Administrative Procedure Act, 5 U.S.C. §§ 701-706, challenging the federal government’s
    approval of a new Kentucky Medicaid program, Kentucky HEALTH. Defendants — the
    Department of Health and Human Services, the Centers for Medicare and Medicaid Services,
    and four officials — now move to transfer the case to the Eastern District of Kentucky pursuant
    to 28 U.S.C. § 1404(a). Because the Court finds that convenience and the interests of justice
    warrant keeping the matter in the District of Columbia, it will deny the Motion.
    I.     Background
    A. Medicaid Program
    Since 1965 the federal government and the states have worked together to provide
    medical care to certain vulnerable populations under Title XIX of the Social Security Act,
    colloquially known as Medicaid. See 42 U.S.C. § 1396-1. The Centers for Medicare and
    Medicaid Services (CMS), a federal agency within the Department of Health and Human
    Services (HHS), has primary responsibility for overseeing Medicaid programs. Under the
    1
    cooperative federal-state arrangement, participating states submit their “plans for medical
    assistance” and receive federal funding to offset some of the costs if the plan is “approved by the
    Secretary [of HHS].” 
    Id. Currently, all
    states have chosen to participate in the program.
    The Medicaid Act sets out certain parameters for states to follow, but each state is free to
    administer its Medicaid program as it wishes within those strictures. See 42 U.S.C. § 1396a.
    One such provision requires state plans to “mak[e] medical assistance available” to certain low-
    income individuals, including pregnant women, children, and their families; former foster
    children under the age of 26; the elderly; and people with certain disabilities. 
    Id. § 1396a(a)(10)(A);
    see ECF No. 1 (Complaint), ¶ 44. In 2010, Congress enacted the Patient
    Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), “to increase the
    number of Americans covered by health insurance.” 
    Id., ¶ 45
    (quoting Nat’l Fed’n of Indep.
    Bus. v. Sebelius, 
    567 U.S. 519
    , 538 (2012)). Under the ACA, states can choose to expand their
    Medicaid coverage to include low-income adults under 65 who would not otherwise qualify. See
    42 U.S.C. § 1396a(a)(10)(A)(i)(VIII). While generally a state must cover all qualified
    individuals to receive any Medicaid funding, 
    id. § 1396a(a)(10)(B),
    it may choose not to cover
    this “expansion population.” Compl., ¶ 46; see 
    NFIB, 567 U.S. at 587
    . If the state decides to
    cover the expansion group, however, those individuals become part of the state’s mandatory
    population.
    Both before and after the ACA, a state that wishes to deviate from the Medicaid Act’s
    requirements must obtain a Section 1115 waiver from the Secretary of HHS. See 42 U.S.C.
    § 1315. These waivers allow the Secretary to approve “experimental, pilot, or demonstration
    project[s]” in state medical plans outside of the statutory parameters of the Medicaid Act,
    “which, in the judgment of the Secretary, [are] likely to assist in promoting the [Act’s]
    2
    objectives.” 
    Id. § 1315(a).
    The ultimate decision whether to grant a waiver rests with the
    Secretary, but his discretion is not boundless. Before HHS can act on a waiver application, the
    state “must provide at least a 30-day public notice and comment period regarding” the proposed
    program and hold at least two hearings at least 20 days before submitting the application. See 42
    C.F.R. §§ 431.408(a)(1), (3). Once a state completes those prerequisites, it then sends an
    application to CMS. 
    Id. § 431.412
    (listing application requirements). After the agency notifies
    the state that it has received the waiver application, a federal 30-day public-notice period
    commences, and the agency must wait at least 45 days before rendering a final decision. 
    Id. §§ 431.416(b),
    (e)(1). Under very limited circumstances — e.g., “natural disaster” or “public
    health emergency” — CMS or the Secretary may waive the federal or state public-comment
    period. 
    Id. § 431.416(g).
    On January 11, 2018, Brian Neale, Director of CMS, issued a letter to state Medicaid
    Directors “announcing a new policy designed to assist states in their efforts to improve Medicaid
    enrollee health and well-being through incentivizing work and community engagement among”
    certain adult mandatory Medicaid groups. See Compl., Exh. D at 1. The nine-page letter noted
    that work-requirement-based eligibility for Medicaid “is a shift from prior agency policy,” 
    id. at 3,
    but that the agency was committed to “support state efforts to test incentives that make
    participation in work or other community engagement a requirement for continued Medicaid
    eligibility” and encouraged states to apply for Section 1115 waivers for this purpose. 
    Id. at 1.
    It
    then “identified a number of issues for states to consider as they develop” work-requirement
    Medicaid programs. 
    Id. at 4-9.
    To date, ten states have applied for such Medicaid waivers. See
    ECF No. 40 (Amicus Brief of AARP, et al.) at 2 n.1.
    3
    B. Kentucky HEALTH
    Kentucky, like all other states and the District of Columbia, participates in Medicaid.
    After the ACA went into effect, the state broadened Medicaid to include the expansion
    population. See Compl., ¶ 79. On August 24, 2016, Governor Matt Bevin submitted an
    application to CMS requesting a Section 1115 waiver to implement an experimental project,
    Helping to Engage and Achieve Long Term Health, or Kentucky HEALTH. See Compl.,
    Exh. B. The project as approved “transform[s]” the state’s Medicaid program to include
    “commercial market health insurance features,” 
    id. at 7,
    including a deductible account, an
    incentive and savings account, and a requirement that enrollees pay premiums on a sliding scale.
    
    Id. at 9-10.
    It also predicates Medicaid eligibility for most of the expansion population on
    workforce participation or community service. 
    Id. at 15-16.
    Prior to submitting the application, Kentucky’s Department for Medicaid Services held
    three public hearings and conducted two public-comment periods. See Compl., Exh. B.
    Throughout this process, the state and CMS were engaged in “continued negotiations” regarding
    the program’s terms. 
    Id., Exh. A
    at 5 & Exh. C. CMS also opened a federal public-comment
    period on Kentucky HEALTH. 
    Id., Exh. C
    at 7. On January 12, 2018, CMS notified the
    Governor’s office that the application had been approved. 
    Id. at 1.
    Two weeks later, Plaintiffs brought this nine-count suit seeking declaratory and
    injunctive relief on behalf of themselves and a “statewide proposed class . . . of all residents of
    Kentucky who are enrolled in the Kentucky Medicaid program on or after January 12, 2018.”
    Compl., ¶ 33. The Complaint alleges that Defendants violated the Constitution and the
    Administrative Procedures Act by both sending the January 11 letter to state Medicaid directors
    and by approving Kentucky HEALTH. See Compl., ¶¶ 339-408. Soon thereafter, Defendants
    4
    filed this Motion to Transfer, asking the Court to send the case to Kentucky, specifically the
    Frankfort Docket of the Central Division of the Eastern District of that state. See Mot. to
    Transfer at 2 n.2. On March 30, 2018, the Court granted Kentucky’s Motion for Intervention.
    See Minute Order.
    II.     Legal Standard
    Even if a plaintiff has brought its case in a proper venue, a district court may, “for the
    convenience of parties and witnesses, in the interests of justice . . . transfer [it] . . . to any other
    district or division where [the case] might have been brought.” 28 U.S.C. § 1404(a). The only
    textual limitation on the Court’s power to transfer a case under § 1404(a), then, is the
    requirement that the case “might have been brought” in the forum to which the defendant is
    seeking transfer. Van Dusen v. Barrack, 
    376 U.S. 612
    , 623 (1964). In other words, the transfer
    statute requires that venue be proper in the new forum.
    Once that threshold condition is met, district courts have “discretion … to adjudicate
    motions for transfer according to an ‘individualized, case-by-case consideration of convenience
    and fairness.’” Stewart Org., Inc. v. Ricoh Corp., 
    487 U.S. 22
    , 29 (1988) (quoting Van 
    Dusen, 376 U.S. at 622
    ); see also Pres. Soc’y of Charleston v. U.S. Army Corps of Eng’rs, 
    893 F. Supp. 2d
    49, 53 (D.D.C. 2012). This analysis “calls on the district court to weigh in the balance a
    number of case-specific factors,” which typically relate to the private interests of the parties and
    the public interest of justice. See Stewart 
    Org., 487 U.S. at 29-30
    .
    In evaluating motions to transfer venue, courts in this circuit are instructed to guard
    against “the danger that a plaintiff might manufacture venue in the District of Columbia . . . [b]y
    naming high government officials as defendants . . . .” Cameron v. Thornburgh, 
    983 F.2d 253
    ,
    256 (D.C. Cir. 1993). Still, to prevail, the movant must show that “considerations of
    5
    convenience and the interest of justice weigh in favor of transfer.” Sierra Club v. Flowers, 
    276 F. Supp. 2d 62
    , 65 (D.D.C. 2003); Trout Unlimited v. U.S. Dep’t of Agric., 
    944 F. Supp. 13
    , 16
    (D.D.C. 1996) (movant bears burden to show that transfer is proper).
    III.   Analysis
    A. Propriety of New Venue
    Before assessing the “case-specific factors,” Stewart 
    Org., 487 U.S. at 29
    , Defendants
    must show that this case might have been brought in the Eastern District of Kentucky. They
    easily clear this hurdle, as venue in a suit against the federal government will lie in any district in
    which a plaintiff resides. See 28 U.S.C. § 1391(e)(1)(C); Gardner v. Mabus, 
    49 F. Supp. 3d 44
    ,
    47 (D.D.C. 2014). Here, several Plaintiffs reside in the area served by the Frankfort Docket of
    the Eastern District of Kentucky. See Compl., ¶¶ 12, 14, 16-18, 20-24, 26; see also Mot. to
    Transfer at 9 n.3. Section 1404(a)’s threshold requirement is thus satisfied.
    B. Private- and Public-Interest Factors
    Defendants must next establish that the “particular circumstances” of the case “render
    [this] forum inappropriate.” Starnes v. McGuire, 
    512 F.2d 918
    , 925 (D.C. Cir. 1974). For this
    determination, the Court assesses a number of private- and public-interest factors. See Trout
    
    Unlimited, 944 F. Supp. at 16
    . The former factors include: (1) the plaintiff’s choice of forum;
    (2) the defendant’s choice of forum; (3) whether the claim arose elsewhere; (4) the convenience
    of the parties; (5) the convenience of the witnesses; and (6) the ease of access to sources of
    proof. 
    Id. The public
    interests relevant to this inquiry are: (1) the transferee’s familiarity with
    the governing laws; (2) the relative congestion of the calendars of the transferor and transferee
    courts; and (3) the local interest in having local controversies decided at home. 
    Id. 6 1.
    Private–Interest Factors
    In this APA case, the six private-interest factors collapse into three inquiries:
    (1) deference to each parties’ forum choice; (2) the link between the relevant fora and the claims;
    and (3) overall convenience. The Court addresses each in turn.
    a. Deference
    The Court first considers the parties’ choice of forum — namely, the amount of deference
    to afford each. “A plaintiff’s choice of forum is generally afforded ‘substantial deference,’ but
    that deference is not unyielding.” Gulf Restoration Net. v. Jewell, 
    87 F. Supp. 3d 303
    , 311
    (D.D.C. 2015) (quoting Greater Yellowstone Coal. v. Bosworth, 
    180 F. Supp. 2d 124
    , 128
    (D.D.C. 2001)). Defendants urge the Court to give “minimal deference” to Plaintiffs’ choice
    because the District is not the home forum for any of the class (including the named Plaintiffs)
    for whom certification is sought. See Mot. to Transfer at 15.
    While typically the named plaintiff’s choice of forum in a class action “is afforded little
    weight,” Eichenholtz v. Brennan, 
    677 F. Supp. 198
    , 202 (S.D.N.Y. 1988), the reasons for doing
    so are not applicable here. Courts that minimize such deference cite two rationales: (1) to guard
    against forum shopping, see In re Ferrero Litig., 
    768 F. Supp. 2d 1074
    , 1078 (S.D. Cal. 2011),
    and (2) when all class members do not hail from the same home forum, the one chosen by the
    named plaintiff may be inconvenient for others. See Blake Const. Co., Inc. v. Int’l Harvester
    Co., 
    521 F. Supp. 1268
    , 1272 (N.D. Ill. 1981); Jaramillo v. DineEquity, Inc., 
    664 F. Supp. 2d 908
    , 914 (N.D. Ill. 2009). Defendants do not allege that the Enrollees engaged in forum
    shopping in choosing this district, and, as discussed below, convenience to class members is
    largely irrelevant in this administrative case. The Court thus concludes that the potential of this
    case to become a class action does not affect the deference given to Plaintiffs’ choice of forum.
    7
    Similarly, the Government’s reliance on the principle that “less deference is given where,
    as here, Defendants seek transfer to the plaintiffs’ resident forum,” Preservation Soc’y, 893 F.
    Supp. 2d at 54 (internal quotation marks and citation omitted), has little bearing because, as
    discussed in detail below, the case has a strong nexus to the District. See Wilderness Soc’y v.
    Babbitt, 
    104 F. Supp. 2d 10
    , 13 (D.D.C. 2000) (relevant inquiry is “the nexus between plaintiffs’
    chosen forum — the District of Columbia — and the dispute”); see also Lou v. Belzberg, 
    834 F.2d 730
    , 739 (9th Cir. 1987). The Court thus finds that, because of the significant ties to the
    District, Plaintiffs’ choice is accorded “some deference.” See Gulf 
    Restoration, 87 F. Supp. 3d at 313
    (emphasis omitted); see also Wilderness 
    Soc’y, 104 F. Supp. 2d at 14-15
    (finding that
    plaintiff’s choice of forum was “entitled to substantial deference” in part because of agency
    secretary’s “involvement in the [agency’s] review” of project and policymakers’ residence in
    District); Lax v. Toyota Motor Corp., 
    65 F. Supp. 3d 772
    , 779 (N.D. Cal. 2014) (holding that
    “[e]ven though this is a class action, the plaintiffs’ choice of forum weighs against transfer”
    because of “legitimate and significant connection to [the] forum”).
    Such deference outweighs Defendants’ request to send this case to a particular court in
    Kentucky. Unlike the plaintiff, a defendant’s forum preference “is not ordinarily entitled to
    deference,” and to prevail, a defendant “must establish that the added convenience and justice of
    litigating in their chosen forum overcomes the . . . deference given to” the plaintiff’s. Tower
    Labs., Ltd. v. Lush Cosmetics Limited, 
    2018 WL 534323
    , at *4 (D.D.C. Jan. 24, 2018).
    “[C]oncerns about forum shopping” can also count against a defendant’s choice. Oceana v.
    Bureau of Ocean Energy Mgmt., 
    962 F. Supp. 2d 70
    , 78 (D.D.C. 2013).
    As explained below, Defendants have not carried their burden to show how Kentucky is a
    more convenient place for this APA case, and the Enrollees further accuse the Government of
    8
    “blatant . . . forum shopping,” Opp. at 1, by asking to transfer the case to a particular division.
    Kentucky has two federal districts, comprising ten different dockets, but the Government
    specifically asks this Court to transfer the case to Frankfort, which has only one judge.
    Defendants, understandably, balk at such a characterization and provide a legitimate reason for
    preferring the Frankfort Division: it is the state capitol and seat of government. See Reply at 9-
    10. Although the Court does find the Government’s request unduly restrictive, given that
    Plaintiffs are geographically dispersed throughout the state, see Compl., ¶¶ 12-26, and the
    underlying situs of the case expands beyond Frankfort County, it declines to assign such
    nefarious motives to the Government’s venue choice. This preference, however, does not
    overcome the requisite deference.
    b. Connection of Claims to Fora
    Deference thus established, the Court next moves to the crux of this Motion: where the
    claims arose and their connection to D.C. In APA cases, “courts generally focus on where the
    decisionmaking process occurred to determine where the claims arose.” Nat’l Ass’n of Home
    Builders v. EPA, 
    675 F. Supp. 2d 173
    , 179 (D.D.C. 2009). “An administrative claim is said to
    arise in this district if it was drafted, signed, and published in this district, and if the controversy
    ‘stems from the formulation of national policy on an issue of national significance.’” Oceana,
    Inc. v. Pritzker, 
    58 F. Supp. 3d 2
    , 6 (D.D.C. 2013) (quoting Greater Yellowstone Coalition v.
    Kempthorne, Nos. 07-2111, 07-2112, 
    2008 WL 1862298
    , at *5 (D.D.C. 2008)). Plaintiffs’ suit
    clearly fits that bill. They challenge the Secretary’s decision to (1) encourage Section 1115
    waivers with work-eligibility requirements and (2) approve Kentucky HEALTH. The
    “decisionmaking process” for both actions “occurred primarily within the District of Columbia
    and the decisionnmakers [a]re located” here. Home 
    Builders, 675 F. Supp. 2d at 179
    . The
    9
    Secretary’s “national policy” allowing states to condition Medicaid benefits on workforce
    participation is also “an issue of national significance.” 
    Oceana, 58 F. Supp. 3d at 6
    ; see AARP
    Amicus Brief at 2 n.1 (listing nine states that have requested similar waivers).
    The Government’s attempt to sidestep these facts, insisting that this is a “fundamentally
    local controversy,” Mot. to Transfer at 9, construes Plaintiffs’ claims too narrowly. The
    Enrollees challenge the approval of Kentucky HEALTH, which has an obvious connection to
    that state. But it mischaracterizes their case to assert that their “sole interest in this matter arises
    solely from their residency in the Commonwealth and their enrollment in Kentucky’s State
    Medicaid program.” 
    Id. at 13
    (emphasis added). In addition to mentioning Kentucky HEALTH,
    Plaintiffs argue that CMS’s letter to all state Medicaid Directors supporting and encouraging
    Section 1115 waivers with a work-eligibility requirement violated the APA. This is not a case
    where the agency only rubber-stamped a proposal from its local office. On the contrary, D.C.-
    based agency officials drafted, signed, and disseminated the letter to state Medicaid directors,
    and those same agencies worked with Kentucky to develop, and ultimately approve, Kentucky
    HEALTH.
    Defendants’ selective citation only buttresses this point. The Government quotes Kafack
    v. Primerica Life Ins. Co., 
    934 F. Supp. 3
    (D.D.C. 1996), arguing that “transfer is warranted
    because ‘material events that constitute the factual predicate for the plaintiff’s claims occurred’
    in the Eastern District of Kentucky.” Mot. to Transfer at 10 (quoting 
    Kafack, 934 F. Supp. at 6
    ).
    But the court in that case found it significant that “all of the material events . . . occurred” in the
    proposed forum. 
    Kafack, 934 F. Supp. at 6
    (emphasis added). Here, the Government concedes
    that the Government’s decision “was a product of yearlong discussions and negotiations with
    state officials[,] . . . and CMS worked with the Commonwealth to develop the terms and
    10
    conditions of the approval.” Mot. to Transfer at 11. Medicaid is a cooperative program between
    federal and state governments. A challenge to HHS’s decision to approve a state plan is thus
    almost always predicated on events that had their genesis in a state. To buy Defendants’
    argument would mean that Medicaid challenges only belong in courts of the relevant state. That
    simply is not so.
    Not only did the claims arise here, but they also have a strong nexus to D.C. Courts in
    this district have often found that federal-agency action that occurs here can provide “meaningful
    ties” to support retention of the case. See, e.g., Gulf 
    Restoration, 87 F. Supp. 3d at 312
    (D.C.
    had interest in District-based federal agencies’ decision to approve project in Alabama). “[T]he
    mere fact that a case concerns the application of a federal statute by a federal agency” is not, of
    course, enough to “provide a sufficient nexus to the District of Columbia to weigh against
    transfer.” Preservation Soc’y, 
    893 F. Supp. 2d
    at 55. But “ heavy,” “personal involvement” by
    District-based government officials, such as occurred here, provides a “link between this
    controversy and the District of Columbia,” even if the case “will have an impact on the
    residents” of another state. Wilderness Soc’y,104 F. Supp. 2d at 13-14.
    c. Convenience
    The three private-interest factors that specifically address convenience — viz., the
    convenience of the parties, the convenience of the witnesses, and ease of access to sources of
    proof — are neutral or tip only slightly in favor of sending the case to Kentucky. The
    Government cannot reasonably claim to be inconvenienced by litigating in this district; after all,
    this is its home forum. Defendants nevertheless argue that this factor should lean towards
    transfer because Kentucky would be a more convenient forum to decide whether to certify a
    class. While this could be a relevant point, the class that Plaintiffs seek to certify is “all residents
    11
    of Kentucky who are enrolled in the Kentucky Medicaid program on or after January 12, 2018.”
    Compl., ¶ 33. Defendants do not explain (and the Court does not see) how putative class
    members would need to be involved in the certifying of such a class in a way that might
    inconvenience them. In any event, at most this consideration tips only slightly towards transfer.
    And, because this is an APA case, the convenience of witnesses and the ease of access to
    sources of proof are “not likely to be relevant here.” 
    Oceana, 58 F. Supp. 3d at 5
    (citation
    omitted); see also Reply at 14 (stating that administrative record will be available in electronic
    form). The Government concedes that “judicial review of the merits will be limited to the
    administrative record and there will be no discovery or trial,” but argues that “discovery into
    standing or class discovery” would take place in Kentucky. See Mot. to Transfer at 16-17.
    Again, the Court cannot foresee how the proposed class would require discovery, but, even if it
    did, this would only be a feather on the scale in favor of transfer. See Southern Utah Wilderness
    Alliance v. Norton (Southern Utah II), 
    315 F. Supp. 2d 82
    , 88 (D.D.C. 2004) (finding
    convenience of witnesses irrelevant where parties agreed case would be decided solely based on
    administrative record); 
    Flowers, 276 F. Supp. 2d at 69
    (“[T]he location of witnesses is not a
    significant factor” in judicial review of agency action.).
    On balance, then, the private-interest factors tip in favor of keeping the case in D.C.
    2. Public–Interest Factors
    a. Judicial Economy
    Defendants agree that the first two public-interest factors — the transferee court’s
    familiarity with the governing law and the relative congestion of the courts’ calendars — are
    neutral with respect to transfer. See Mot. to Transfer at 17. Resolving this case will require
    statutory interpretation, a task any federal court is competent to undertake. See Flowers, 
    276 F. 12
    Supp. 2d at 70 n.6 (noting “the principle that the transferee federal court is competent to decide
    federal issues correctly”) (citation omitted). If anything, this Court has more experience with
    APA cases, which would weigh against transfer. See Tuttle v. Jewell, 
    952 F. Supp. 2d 203
    , 208
    (D.D.C. 2013) (finding relevant that D.C. “receives more APA claims than its western
    colleagues”). The caseload disparity between the two courts, moreover, is not great enough to
    have an effect on the transfer analysis. See Mot. to Transfer at 22 n.9 (noting pending cases per
    judge is 382 in Kentucky versus 263 in the District). Absent a showing that either court’s docket
    is “substantially more congested” than the other, this factor weighs neither for nor against
    transfer. Nat’l Ass’n of Home Builders v. EPA, 
    675 F. Supp. 2d 173
    , 178 (D.D.C. 2009); see
    also Preservation Soc’y, 
    893 F. Supp. 2d
    at 57 (finding that when “relative congestion . . .
    appears comparable,” judicial-economy factor not substantial enough to warrant transfer).
    b. Local Interest
    This brings the Court to the final and arguably “most important” of the public-interest
    factors: the local interest in having local controversies decided at home. Southern Utah
    Wilderness Alliance v. Norton, 
    845 F. Supp. 2d 231
    , 237 (D.D.C. 2002); Pres Soc’y, 893 F.
    Supp. 2d at 57. Because the Court finds that this a case of national, rather than local,
    significance, this factor tips sharply against transfer.
    Defendants first mention that their preferred forum is “experienced with the laws in the
    Commonwealth that may be relevant to the review of Plaintiffs’ claims,” Mot. to Transfer at 22,
    but a federal court need not wade into any particulars of state law to decide whether the
    Secretary can, under federal laws and regulations, permit certain state Medicaid proposals. See
    Wilderness 
    Soc’y, 104 F. Supp. 2d at 16
    (“no reason to transfer” case challenging agency
    decision to start oil and gas leasing because it would not involve state law).
    13
    The Government’s stronger argument is that “Kentucky has a substantial interest in the
    resolution of the claims of this lawsuit” because it is “the citizens of Kentucky who will directly
    feel the effects of” Kentucky HEALTH. See Mot. to Transfer at 17. The central question,
    however, is not “whether the people of [Kentucky] have an interest — even a strong one — in
    the outcome of this case. Instead, the Court must determine whether this is a ‘question[] of
    national policy or national significance.’” 
    Oceana, 58 F. Supp. 3d at 9
    (quoting Oceana v.
    Bureau of Ocean Energy Mgmt., 
    962 F. Supp. 2d 70
    , 77 (D.D.C. Aug. 23, 2013)) (emphasis
    added). While this suit has an undeniable connection to Kentucky and may affect the lives of
    many people there, it also carries national consequences, particularly in light of CMS’s invitation
    to other states to use Section 1115 waivers in a similar way. Indeed, Plaintiffs ask the Court to
    enjoin not only Kentucky HEALTH but also all “practices purportedly authorized by” the letter
    to state Medicaid Directors. See Compl. at 76. In other words, the Enrollees’ challenge to the
    Secretary’s use of Section 1115 waivers has “potential impacts” that will likely be felt “locally”
    in Kentucky, but also broadly across the nation. See Mot. to Transfer at 20; see also Preservation
    Soc’y, 
    893 F. Supp. 2d
    at 55 (noting that “a facial attack on the statutes and regulations at issue
    . . . might have the kind of national impact that would weigh against transfer” but declining to
    reach issue because plaintiffs only challenged decision made by local agency office) (emphasis
    omitted). Those effects are already spilling out past Kentucky, as several other states have
    similar waiver applications pending, and the Secretary recently approved Indiana’s work-
    eligibility Medicaid requirements. See Opp. at 13.
    Defendants’ reliance on cases where a local federal-agency office made a decision
    involving local resources that are located entirely in a proposed transferee district does not
    change the outcome. See Mot. to Transfer at 20-21 (citing cases); Preservation Soc’y, 
    893 F. 14
    Supp. 2d at 57 (finding challenge was local controversy because “a clear majority of the events
    took place within the District of South Carolina,” and “challenged action was taken by
    Charleston District of the [U.S. Army] Corps”) (internal quotation marks and citation omitted);
    Airport Working Grp. of Orange Cty., Inc. v. Dep’t of Defense, 
    226 F. Supp. 2d 228
    , 232
    (D.D.C. 2002) (granting motion to transfer case challenging “administrative decision that
    involves land situated only in Orange County and affects only the local citizenry there” when
    decision was prepared by agency staff “located in Orange Country [sic]”); Sierra Club, 276 F.
    Supp. 2d at 67, 71 (challenge to Everglades permitting was “controversy local to Florida” when
    federal officials in Washington did not play “active or significant role” in decision); Trout
    
    Unlimited, 944 F. Supp. at 19
    (transferring case challenging “decision made by a Forest Service
    official located in Colorado, which directly affects” water in that state). Here, the federal
    decisionmaking happened in the District by D.C.-based officials, and the waiver program affects
    all states. This factor thus tips in Plaintiffs’ favor.
    IV.     Conclusion
    In the end, both the private- and public-interest factors weigh against transfer. The Court
    will thus deny the Government’s Motion to Transfer the case to Kentucky. An Order consistent
    with this Opinion will issue this day.
    /s/ James E. Boasberg
    JAMES E. BOASBERG
    United States District Judge
    Date: April 10, 2018
    15