[DRAFT]{.underline}: Judicial Cases Involving State Obligations under
Medicaid and the ADA to Provide Residential Home and Community-Based
Services for Medicaid Beneficiaries[^1]

<table>
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<tr class="header">
<th>Case and Judicial Circuit</th>
<th>Resolution</th>
<th>Enforceable Right</th>
<th>Eleventh Amend. Sovereign Immunity</th>
<th>Entitlement Status of Waiver Services</th>
<th>Reasonable Promptness</th>
<th>Freedom of Choice</th>
<th><p>EPSDT /</p>
<p>Amount, Duration and Scope</p></th>
<th><p>Procedural Due</p>
<p>Process</p></th>
<th>Budgetary Defense</th>
</tr>
</thead>
<tbody>
<tr class="odd">
<td><p>Boulet v Celluci</p>
<p>2000WL 1030398</p>
<p>( MA, 1<sup>st</sup> Cir.)</p></td>
<td>For Plaintiffs<a href="#fn1" class="footnote-ref" id="fnref1"
role="doc-noteref"><sup>1</sup></a></td>
<td><a href="#fn2" class="footnote-ref" id="fnref2"
role="doc-noteref"><sup>2</sup></a></td>
<td><a href="#fn3" class="footnote-ref" id="fnref3"
role="doc-noteref"><sup>3</sup></a></td>
<td><a href="#fn4" class="footnote-ref" id="fnref4"
role="doc-noteref"><sup>4</sup></a></td>
<td><a href="#fn5" class="footnote-ref" id="fnref5"
role="doc-noteref"><sup>5</sup></a></td>
<td><a href="#fn6" class="footnote-ref" id="fnref6"
role="doc-noteref"><sup>6</sup></a></td>
<td></td>
<td></td>
<td><a href="#fn7" class="footnote-ref" id="fnref7"
role="doc-noteref"><sup>7</sup></a></td>
</tr>
<tr class="even">
<td><p>Cramer v Chiles</p>
<p>33 F. Supp. 2d 1342 (FL. 11<sup>th</sup> Cir., 1999)*<a href="#fn8"
class="footnote-ref" id="fnref8"
role="doc-noteref"><sup>8</sup></a></p></td>
<td>For Plaintiffs<a href="#fn9" class="footnote-ref" id="fnref9"
role="doc-noteref"><sup>9</sup></a></td>
<td><a href="#fn10" class="footnote-ref" id="fnref10"
role="doc-noteref"><sup>10</sup></a></td>
<td><a href="#fn11" class="footnote-ref" id="fnref11"
role="doc-noteref"><sup>11</sup></a></td>
<td></td>
<td><a href="#fn12" class="footnote-ref" id="fnref12"
role="doc-noteref"><sup>12</sup></a></td>
<td><a href="#fn13" class="footnote-ref" id="fnref13"
role="doc-noteref"><sup>13</sup></a></td>
<td></td>
<td><a href="#fn14" class="footnote-ref" id="fnref14"
role="doc-noteref"><sup>14</sup></a></td>
<td><a href="#fn15" class="footnote-ref" id="fnref15"
role="doc-noteref"><sup>15</sup></a></td>
</tr>
<tr class="odd">
<td><p>Doe v Chiles</p>
<p>136 F. 3d 709 (11<sup>th</sup> Cir, 1998)</p></td>
<td>For Plaintiffs<a href="#fn16" class="footnote-ref" id="fnref16"
role="doc-noteref"><sup>16</sup></a></td>
<td><a href="#fn17" class="footnote-ref" id="fnref17"
role="doc-noteref"><sup>17</sup></a></td>
<td><a href="#fn18" class="footnote-ref" id="fnref18"
role="doc-noteref"><sup>18</sup></a></td>
<td><a href="#fn19" class="footnote-ref" id="fnref19"
role="doc-noteref"><sup>19</sup></a></td>
<td><a href="#fn20" class="footnote-ref" id="fnref20"
role="doc-noteref"><sup>20</sup></a></td>
<td></td>
<td></td>
<td></td>
<td><a href="#fn21" class="footnote-ref" id="fnref21"
role="doc-noteref"><sup>21</sup></a></td>
</tr>
<tr class="even">
<td><p>Lewis v New Mexico Dept of Health</p>
<p>94 F. Supp. 2d 1217 (NM, 10<sup>th</sup> Cir, 2000) *<a href="#fn22"
class="footnote-ref" id="fnref22"
role="doc-noteref"><sup>22</sup></a></p></td>
<td>For Plaintiffs<a href="#fn23" class="footnote-ref" id="fnref23"
role="doc-noteref"><sup>23</sup></a></td>
<td><a href="#fn24" class="footnote-ref" id="fnref24"
role="doc-noteref"><sup>24</sup></a><a href="#fn25" class="footnote-ref"
id="fnref25" role="doc-noteref"><sup>25</sup></a></td>
<td><a href="#fn26" class="footnote-ref" id="fnref26"
role="doc-noteref"><sup>26</sup></a><a href="#fn27" class="footnote-ref"
id="fnref27" role="doc-noteref"><sup>27</sup></a></td>
<td></td>
<td><a href="#fn28" class="footnote-ref" id="fnref28"
role="doc-noteref"><sup>28</sup></a></td>
<td></td>
<td></td>
<td><a href="#fn29" class="footnote-ref" id="fnref29"
role="doc-noteref"><sup>29</sup></a></td>
<td></td>
</tr>
<tr class="odd">
<td><p>Benjamin v Ohl</p>
<p>(WV, 4<sup>th</sup> Cir., 1999)*<a href="#fn30" class="footnote-ref"
id="fnref30" role="doc-noteref"><sup>30</sup></a></p></td>
<td>For Plaintiffs<a href="#fn31" class="footnote-ref" id="fnref31"
role="doc-noteref"><sup>31</sup></a></td>
<td></td>
<td></td>
<td></td>
<td><a href="#fn32" class="footnote-ref" id="fnref32"
role="doc-noteref"><sup>32</sup></a></td>
<td><a href="#fn33" class="footnote-ref" id="fnref33"
role="doc-noteref"><sup>33</sup></a></td>
<td><a href="#fn34" class="footnote-ref" id="fnref34"
role="doc-noteref"><sup>34</sup></a></td>
<td><a href="#fn35" class="footnote-ref" id="fnref35"
role="doc-noteref"><sup>35</sup></a></td>
<td><a href="#fn36" class="footnote-ref" id="fnref36"
role="doc-noteref"><sup>36</sup></a></td>
</tr>
<tr class="even">
<td>King v Sullivan 776 F. Supp. 645 (RI, 1<sup>st</sup> Cir.,
1991)</td>
<td>For Defend-ants<a href="#fn37" class="footnote-ref" id="fnref37"
role="doc-noteref"><sup>37</sup></a></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><a href="#fn38" class="footnote-ref" id="fnref38"
role="doc-noteref"><sup>38</sup></a></td>
<td><a href="#fn39" class="footnote-ref" id="fnref39"
role="doc-noteref"><sup>39</sup></a></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><p>King v Fallon</p>
<p>801 F. Supp. 925</p>
<p>(RI, 1<sup>st</sup>. Cir., 1992)</p></td>
<td>For Defend-ants<a href="#fn40" class="footnote-ref" id="fnref40"
role="doc-noteref"><sup>40</sup></a></td>
<td></td>
<td></td>
<td></td>
<td><a href="#fn41" class="footnote-ref" id="fnref41"
role="doc-noteref"><sup>41</sup></a></td>
<td><a href="#fn42" class="footnote-ref" id="fnref42"
role="doc-noteref"><sup>42</sup></a></td>
<td><a href="#fn43" class="footnote-ref" id="fnref43"
role="doc-noteref"><sup>43</sup></a></td>
<td></td>
<td><a href="#fn44" class="footnote-ref" id="fnref44"
role="doc-noteref"><sup>44</sup></a></td>
</tr>
<tr class="even">
<td><p>McMillan v McCrimon</p>
<p>807 F. Supp. 475 (IL, 7<sup>th</sup> Cir., 1992)</p></td>
<td>For Plaintiffs<a href="#fn45" class="footnote-ref" id="fnref45"
role="doc-noteref"><sup>45</sup></a></td>
<td></td>
<td></td>
<td><a href="#fn46" class="footnote-ref" id="fnref46"
role="doc-noteref"><sup>46</sup></a></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><a href="#fn47" class="footnote-ref" id="fnref47"
role="doc-noteref"><sup>47</sup></a></td>
</tr>
<tr class="odd">
<td><p>Sobky v Smoley</p>
<p>855 F. Supp. 1123 (CA, 9<sup>th</sup> Cir., 1994)</p></td>
<td>For Plaintiffs<a href="#fn48" class="footnote-ref" id="fnref48"
role="doc-noteref"><sup>48</sup></a></td>
<td><a href="#fn49" class="footnote-ref" id="fnref49"
role="doc-noteref"><sup>49</sup></a></td>
<td></td>
<td><a href="#fn50" class="footnote-ref" id="fnref50"
role="doc-noteref"><sup>50</sup></a></td>
<td><a href="#fn51" class="footnote-ref" id="fnref51"
role="doc-noteref"><sup>51</sup></a></td>
<td></td>
<td></td>
<td><a href="#fn52" class="footnote-ref" id="fnref52"
role="doc-noteref"><sup>52</sup></a></td>
<td><a href="#fn53" class="footnote-ref" id="fnref53"
role="doc-noteref"><sup>53</sup></a></td>
</tr>
<tr class="even">
<td>Rodriguez v City of New York 197 F. 3d 611 (NY, 2d Cir., 1999)*</td>
<td>For Defend-ants<a href="#fn54" class="footnote-ref" id="fnref54"
role="doc-noteref"><sup>54</sup></a></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><a href="#fn55" class="footnote-ref" id="fnref55"
role="doc-noteref"><sup>55</sup></a></td>
<td></td>
<td><a href="#fn56" class="footnote-ref" id="fnref56"
role="doc-noteref"><sup>56</sup></a></td>
</tr>
</tbody>
</table>
<aside id="footnotes" class="footnotes footnotes-end-of-document"
role="doc-endnotes">
<hr />
<ol>
<li id="fn1"><p>Plaintiffs, adults with mental retardation and
developmental disabilities, who had spent years on waiting list, were
entitled to residential and community services under State plan within
90 days, to the extent available. State given leave to put forth
alternative schedule to reflect availability.<a href="#fnref1"
class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn2"><p>Court finds that statute meets standard for enforceable
right because Congress clearly intended to benefit the plaintiff class,
the right is not vague and is capable of measurement and enforceability,
and the obligation creates a binding mandate on the States that
participate in Medicaid.<a href="#fnref2" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn3"><p>Court rejects defendant’s sovereign immunity claim where
requested Medicaid relief is for prospective action under Federal law.
(Court also finds that unlike the Age Discrimination in Education Act,
which was the subject of <em>Kimel v Florida Board of Regents</em>, 120
U.S. 631 (2000), the ADA was a valid exercise of Congressional power to
abrogate State sovereign immunity because of its clear intent to
abrogate immunity, clear history of evidence of discrimination against
persons with disabilities, and an intention to create a statutory right
of action to remedy what also would be constitutional wrongs).<a
href="#fnref3" class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn4"><p>Court finds that reasonable promptness standard covers
waiver services enumerated in State plan. Court finds that waiver
services are part of the Medicaid entitlement once added to the State
plan and therefore that the same reasonable promptness standard applies
to these services as to any State plan services.<a href="#fnref4"
class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn5"><p>Court determines the reasonable promptness requirement
applies to actual provision of medical assistance services and not only
to determination of eligibility or furnishing evidence of coverage and
thus gives rise to an obligation to actually furnish services within a
reasonable time period, as determined by relevant evidence.<a
href="#fnref5" class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn6"><p>Federal home and community care regulations as well as
the statute require states that cover residential home and community
services under their State plans offer individuals who require ICF/MR
services feasible alternatives.<a href="#fnref6" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn7"><p>Rejected. Where State plan identifies residential
habilitation services in its plan for individuals meeting the
eligibility criteria and does not limit the residential settings to
individuals’ own homes or those of their parents, State has an
obligation to furnish the services it identifies (including residential
care), at least up to the cap that it may permissibly place on such
services, regardless of whether FFP may be available for the room and
board component of such services.<a href="#fnref7" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn8"><p>Decided before the Supreme Court decision in
<em>Olmstead</em>; court holds that the underfunding of the community
service program compels institutionalization and thus compels
institutionalization, thereby violating the ADA’s most integrated
setting requirement. Court finds that neither economics nor
administrative convenience can justify segregation.<a href="#fnref8"
class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn9"><p>Court finds that plaintiffs, children and adults with
developmental disabilities who were given the choice of large State
institutions or long waiting lists for community services and who desire
both institutional and community services, are entitled under Federal
Medicaid law to choose between institutional care and home and community
services covered under the State Medicaid plan. Court further finds that
the State cannot reduce its State plan below reasonable levels by
simultaneously cutting institutional services below reasonable levels
and failing to make sufficient community services available.<a
href="#fnref9" class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn10"><p>See FN 3.<a href="#fnref10" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn11"><p>See FN 4.<a href="#fnref11" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn12"><p>Court finds that while the State has the authority to
shift services into community setting, current funding levels are
inadequate to ensure that services will be furnished with reasonable
promptness, thus extending reasonable promptness requirement to both
eligibility determinations and the actual sufficiency of care.<a
href="#fnref12" class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn13"><p>Court finds that State’s failure to adequately support
either waiver or ICF services leaves individuals without any real
freedom of choice regarding the services they can receive and that the
State’s reduction of its institutional services and concomitant failure
to adequately fund community services violated the choice requirement.<a
href="#fnref13" class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn14"><p>Court finds that State’s termination of plaintiffs’
private ICF services without notice or hearing and its failure to
maintain services at adequate levels pending a hearing violated due
process requirements.<a href="#fnref14" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn15"><p>State budgetary defense cannot justify failure to fund
its Medicaid plan. Furthermore, the State’s failure to adequately fund
the plan with respect to the provision of home and community services
for persons with disabilities may constitute a violation of Title II of
the ADA because of its effects on the State’s most integrated setting
obligations.<a href="#fnref15" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn16"><p>Court finds that plaintiffs, children and adults with
mental retardation and developmental disabilities, have enforceable
right to ICF services covered under the state plan within 90 days of a
request for services.<a href="#fnref16" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn17"><p>See FN 3. Court finds that plaintiffs show a legal
right of the type that is enforceable under 42 U.S.C. §1983 in that the
Medicaid statute creates a binding obligation on the part of
participating States to furnish certain services rather than a mere
Congressional expectation or preference for the service. Court also
finds that the obligation to furnish a reasonable level of care is
neither vague nor amorphous given the structure of the statute and that
enforcement would not strain judicial competence. Court rejects
defendant’s argument that providers rather than individuals are the
intended beneficiaries of Medicaid coverage requirements.<a
href="#fnref17" class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn18"><p>See FN 4.<a href="#fnref18" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn19"><p>See FN 5.<a href="#fnref19" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn20"><p>See FN 6. Requirement extends to the service as well as
the eligibility determination. As a result, a 90-day service requirement
is reasonable for services that are enumerated in the plan and tailored
to solving the problem of long waits without telling the State how to do
so.<a href="#fnref20" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn21"><p>See FN 8. State cannot defend with budgetary
constraints where its Medicaid plan covers the service sought, although
the State retains the right to terminate certain services or its
Medicaid participation entirely.<a href="#fnref21" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn22"><p>Court finds that, consistent with <em>Olmstead</em>,
the failure to furnish community services covered under the State
Medicaid plan may violate the ADA most integrated setting requirement
and that such failure constitutes discrimination. Court also finds that
the issue of the cost of the care sought is a consideration in the
remedial phase, not a bar to the right to seek a remedy.<a
href="#fnref22" class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn23"><p>Plaintiffs, Medicaid beneficiaries who are elderly or
who have disabilities and the state’s Protection and Advocacy Agency,
are permitted to proceed with their claims against the State regarding
the State’s failure to provide them with the Medicaid home and community
based waiver services to which they allege that they are entitled.
Individual plaintiffs are residents of institutions who have been on
waiting lists for up to 7 years.<a href="#fnref23" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn24"><p>See FN 3.<a href="#fnref24" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn25"><p>Court also finds that unlike the Age Discrimination in
Education Act, which was the subject of <em>Kimel v Florida Board of
Regents</em>, 120 U.S. 631 (2000), the ADA was a valid exercise of
Congressional power to abrogate State sovereign immunity because of its
clear intent to abrogate immunity, clear history of evidence of
discrimination against persons with disabilities, and an intention to
create a statutory right of action to remedy what also would be
constitutional wrongs.<a href="#fnref25" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn26"><p>See FN 4.<a href="#fnref26" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn27"><p>Court also finds that despite the fact that the ADA
prohibits discrimination by “public entities,” the litigation has
properly been brought against individual officials and falls into the
prospective injunctive relief exception to the bar against damages
actions by individuals against States under the Eleventh Amendment.
Court further finds that the most integrated setting requirements of ADA
Title II are mandatory and not an exercise of official discretion.<a
href="#fnref27" class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn28"><p>See FN 5 and FN 6.<a href="#fnref28"
class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn29"><p>Court finds that plaintiffs have a constitutional
interest in procedural due process in the application for benefits,
regardless of whether they can claim substantive due process violations
for failure to actually furnish services.<a href="#fnref29"
class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn30"><p>While ADA claims were raised, they were not decided by
the Court.<a href="#fnref30" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn31"><p>Plaintiffs, children and adults with mental retardation
and developmental disabilities who are eligible for ICF/MR services but
prefer community services covered under the State plan, are entitled to
have an eligibility determination for such services within 90 days of
their application, and are entitled to procedural safeguards as part of
the application process, including the availability of applications, the
ability to apply in accessible locations, assistance in applying, and
procedural due process (i.e., a fair hearing) if an application is
denied or not acted upon in a timely fashion. Out of 1869 slots, State
had filled 1779 as of the time of the case, and evidence was presented
that local behavioral health centers were failing to allow people to
apply and that the State was placing limits on the applications that it
would permit. Court requires defendants to take affirmative steps to
ensure accessibility of services in the event that movement off the
waiting lists slows beyond 90 days.<a href="#fnref31"
class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn32"><p>See FN 6.<a href="#fnref32" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn33"><p>See FN 7.<a href="#fnref33" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn34"><p>Court also finds that where the State covers ICF/MR
services it either must furnish the services in an appropriate amount,
duration, and scope, or make alternative services available that meet
the depth and range of health care needs required of individuals who are
in need of ICF/MR services. Evidence presented that each child plaintiff
in the case was receiving some community care but less than the amount
required.<a href="#fnref34" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn35"><p>Court found that the State lacked application policies
and procedures and that the application centers actually discouraged
individuals from making an application because they thought that they
did not have sufficient money either to cover more eligible
beneficiaries or add services for persons whose level of care under the
waiver was inadequate.<a href="#fnref35" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn36"><p>See FN 8.<a href="#fnref36" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn37"><p>Pre-<em>Olmstead</em> decision. Court finds no
violation in State’s failure to fund sufficient small residential
placements for plaintiffs, persons in need of ICF/MR services for
persons with mental retardation and developmental disabilities.
Plaintiffs failed to show that small residential placements were
appropriate for them or that State failed to offer services.<a
href="#fnref37" class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn38"><p>Court finds that where plaintiffs fail to show that
small residential homes are furnishing services to private patients
while refusing to participate in Medicaid or alternatively that they are
unable to secure a placement appropriate to their needs, there can be no
violation of the freedom of choice statute as a matter of law.<a
href="#fnref38" class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn39"><p>Because defendant offered plaintiffs placement in a
large public ICF/MR, the fact that it did not have sufficient small
residential placements did not prevent its plan from being reasonable.<a
href="#fnref39" class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn40"><p>Pre-<em>Olmstead</em> case. Court rejects the claims of
plaintiffs, adults with mental and physical disabilities, that Rhode
Island is operating its program unlawfully because of its failure to
sufficiently fund private and small public ICF/MR residential services
in lieu of larger State facilities. Plaintiffs fail to show lack of
adequate services but instead argued the lack of services of particular
quality and type.<a href="#fnref40" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn41"><p>Where the argument turned on the lack of ICF/MR
services of a particular type (i.e., small residences) versus larger
institutions, State did not violate reasonable promptness requirement
because only large institutions were available.<a href="#fnref41"
class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn42"><p>Court finds that plaintiffs failed to show violation of
freedom of choice requirement simply because certain types of ICF
services listed in the State plan were not available. Court further
finds that freedom of choice applies only to “appropriate” services and
plaintiffs failed to show that they were not given the right to choose
among services appropriate to their individual needs.<a href="#fnref42"
class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn43"><p>See FN 39.<a href="#fnref43" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn44"><p>Because plaintiffs failed to show lack of any ICF/MR
services and instead focused on the lack of a particular type of service
(i.e., smaller residential facilities) the court did not address the
issue of the sufficiency of the State’s budget.<a href="#fnref44"
class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn45"><p>Pre-<em>Olmstead</em> decision. Court found that
plaintiffs, persons with severe physical and mental disabilities, had
right under Federal law to apply for home and community care waiver
services even where the State limits on funding for such services would
result in a waiting list. Court further finds that beneficiaries have a
right to services with reasonable promptness and that State claim to
limited resources is not a defense.<a href="#fnref45"
class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn46"><p>See FN 5.<a href="#fnref46" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn47"><p>While court did not specifically address the budgetary
defense, it found that the budget neutrality of the waiver services and
their restriction to persons who in the absence of waiver services would
need institutional services prevented the State from arguing that the
limits of its home care budget line item should justify its failure to
accept and process further applications.<a href="#fnref47"
class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn48"><p>Court finds that plaintiffs, beneficiaries in need of
methadone maintenance services, had an enforceable right to sufficient
level of services to be furnished with reasonable promptness. Certain
aspects of the legal adequacy of State administration of its program
through county operated treatment centers were either left undecided or
decided in defendant’s favor (procedural due process claims), although
court held that State could not systematically underfund the service and
then force beneficiaries onto lengthy county-maintained waiting lists.<a
href="#fnref48" class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn49"><p>See FN 3.<a href="#fnref49" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn50"><p>See FN 5.<a href="#fnref50" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn51"><p>See FN 6.<a href="#fnref51" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn52"><p>Plaintiffs’ claims regarding the State’s fair hearing
system for denials and terminations or reductions in methadone services
were rejected. Provider-administered hearing system is constitutionally
sufficient where State delegates aspects of the due process procedure
(i.e., notice) to providers and providers thus act as agents of the
State. Plaintiffs made no showing that providers failed to carry out
their duties or that State failed to monitor them.<a href="#fnref52"
class="footnote-back" role="doc-backlink">↩︎</a></p></li>
<li id="fn53"><p>Decision makes clear that it is because of the
reasonable promptness requirement of the statute that the budgetary
defense fails. The court holds that once a State adds services to its
State plan, they become subject to the reasonable promptness requirement
and the State cannot fail to provide adequate funding to meet this
obligation.<a href="#fnref53" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn54"><p>Court holds that the State’s failure to include safety
monitoring services as a separate personal care benefit and not merely
as an incident to other personal care services violated neither the
Medicaid statute nor the ADA in the case of persons whose mental
disabilities required safety monitoring only but no other personal care
services.<a href="#fnref54" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn55"><p>Court found that the State’s coverage of personal
services was reasonable despite absence of separate coverage for
freestanding safety monitoring services not furnished as an incident to
another personal care service. The court also found that the limitation
was acceptable despite the anti-discrimination provision of the Medicaid
coverage regulations because that provision applies only to required
services, and personal care is an optional service. Record explicitly
contained a letter from HCFA classifying safety monitoring alone as a
service that did not qualify as a personal care service. The court
further held that the ADA does not require a State to affirmatively
modify or expand its Medicaid plan to include previously uncovered
services or populations.<a href="#fnref55" class="footnote-back"
role="doc-backlink">↩︎</a></p></li>
<li id="fn56"><p>As long as a State reasonably covers the items and
services in its State plan and conforms with applicable Federal legal
requirements, it may legitimately decide not to cover certain optional
services without violating either the ADA or Federal Medicaid law.<a
href="#fnref56" class="footnote-back" role="doc-backlink">↩︎</a></p></li>
</ol>
</aside>

Legend: \* = ADA claims also raised

[^1]: **Endnotes**

    ^?^ Does not include cases challenging restrictions on eligibility
    criteria for home and community based services; plaintiffs
    represented in these cases meet eligibility standards for relevant
    services.