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No. 07-6163 UN ITED STA TES C OU RT OF AP P EA LS F O R T H E S IX T H C IR C U IT L AKERSKO B ROWN; KATI E BLACKBU RN; MATTHEW MCGOWAN; SHAL YN KI KER, as class represe ntatives; DI SABI L I TY L AW AND ADVOCACY CENTER OF TENNESSEE, Pla int if fs -A pp e lle e s,

v. TENN ESSE E D EPA RTM EN T O F F I NANCE AN D A DM I

NI STR A T I ON ; M. D. GO ET Z , JR., in his official c apac i t y

as Commissi oner of

the Depa rtment of F inance and Administration, De fe nd ants -A

pp e lla nts

. ON APPEALFROM THE UN I TE D ST AT ES D I STR I CT C O U R T F O R

T H E M ID D LE DI STRI CT OF TEN

NESSEE

/ B e fo re : MA RTI

N, RO GE RS, a

nd SUT TO N, Cir c uit

Judg e s. BOYCE F . MARTIN, JR., C ircuit Judge. Th e Te nn e sse e De pa rtme nt o f F ina

nc e a pp e a ls the district court’s d en i al o f i t s motion t o vacate a se ttlement betwee n the par ties in a suit for Medica id benef

its. Tennessee argues that the a g ree d order ap p ro v i n g the settlement should be treated as a

consent de cre e and vacated under Fe dera l Rule of Civil Procedur e 60(b) (5) be cause an in te r v e n in g d e c is io no f

th is Co u rt, W

est side Mothers v. O lszewski , 454 F.3d 532 ( 6th Cir. 2006) (“ W estside Mothers II ” ), e lim inate d the le g a l bas is fo r the se ttl e me nt an d thus ma de it i ne qu ita bleNo. 07-6163

Brown, et al. v. Tenn. Dept. of Fin. Pag e 2

Medica id is a fede ral “ g rant-in- aid” pr og ram that he lps states pay for he alth service s for 1 the ne ed y . Gra

nt-in-aid prog rams ar e contr actua l in nature—that is, states that ac cept f eder al Medica id funding must develop a state Medica id pla n that complies with the terms and c onditions upon which the f

ed er al funds wer e off

ere d. State plans must include cer tain service s, and may include other s if the state c hooses, but the servic es off ere d must meet th e re quirements of the Me dic a id A c t un le ss a

wa ive r o f c e rt a in r e qu ir e me nts is a pp ro ve d b y

the F e de ra l Ce nte r f

or Me dic a id Service s in the Depa

rtment of Hea lth a

nd Human Service s (CMS) under 42 U.S.C. § 1396n. The provi s io n s a t is s u e in th is c a s e ar is e w it h in th e “ h o me an d c o mm u n it y - b a s e d s e r

v ic e s ” wa iver. Enrollment in this waiver prog ram is ca pped at the numbe r of slots proposed by the state a

nd a pp ro ve d by CMS. 42 C.F .R. § 4 41 .3 03 (f )( 6) ; se e ge ne ra lly

State Medica id Direc tors L etter N o. 01- 006 (Jan. 10, 2001), av ail ab le at http:// www.c ms.hhs.gov/smdl/downloads/smd011001a.pdf. to enforc e prospe ctively

. We REVERSE in part and REMAND for f urther pr ocee dings c onsistent with this opi nion. I. This appea l stems from the s ettlement of a § 1983 sui t broug ht by a cla ss of mentally

disabled Tenne ssee r esidents. I n the under ly ing suit, the class members alleg ed they wer e elig ible for se rvice s

un de r t he Me dic a id A c t e ith e r in an I nte rm e diate Ca re F a c ili ty fo r t he Me nta lly

Re tard e d ( I CF /MR )

or in a hos t or g ro up ho me thr ou g h Te nn e sse e ’s “ ho me and c omm un ity ba se d s e rv ic e s” Me dic a id waiver prog ram (HC BS ), but had bee n denied the oppor tunity to apply for wa iver ser

vices, ha d 1 their applications denied, or had be en dete rmined to be eligible for service s but wer e put on a wa iting list. I n so doing, the plaintiffs argued that Te nnessee violated Medica id law in five wa y s: (1) by failing to provide medica l assistance in “ adequate amount, duration, and scope” in violation of 42 U.S.C. § 1396a(a) (10); (2) by failing to pr ovide elig ible defe ndants a choice betwee n I CF/MR and HB CS w a ive r s e rv ic e s i n vio latio n o f 4 2 U .S. C. § 13 96 n( c )( 2) ; ( 3) by fa ili ngto i nf

or m e lig ibl e individuals of the appli cation proc ess with rea sonable promptness in violation of 42 U.S.C. § 13 96 a (a )( 8) ; ( 4) by

fa ili ngto s e rv e ind ivi du a ls with re a so na ble pr omp tne ss in vio latio n of 4 2 U .S. C.No. 07-6163

Brown v. TennesseeDepartme nt of Finance Pag e 3 § 1396a(a )(8) ; and (5) b y fa i l i ng to provide written notice s and an oppor tunity to be hea rd whe n service s are denied in violation o f 4 2 U. S

. C

. § 1396a(a )(3) and the due proce ss clause of the F ourt e e nth

Am e ndme nt. Fol lo w in g th e d is tr ic t c o u rt’ s d e n ia l o f c r o s s - mo ti o n s f o r s u mm ar

y ju d g me n t, th e parties neg otiated a se ttlement that was later approve d by

the district court in an a g ree d order it issued J une 15 , 2 00 4. Un de r thi s se ttl e me nt, Te nn e sse e a g re e d th a t it wo uld ov e rh a ul i ts a dmi nis tr a tiv e sy ste m, expand funding and prog rams for the mentally disabled, and develop pr og ram infr astructur e with the g oal of incr easingprog ram e nrollment and substantially reduc ing or eliminating the w aiting list for waiver service s. J .A. 103. The ag ree ment presc ribed Te nnessee ’s objectives f or the fir st two y ear s of the a g re e me nt, and pr ov ide d th a t it s g oa ls f or y e ars thr e e thr ou g h f

ive wo uld be ne g oti a te d w ith in two y ear s. J .A. 106-07, 112-13. The ag ree ment would then expire at the e nd of the fif th y ear , on Dec ember

31, 2009. J .A. 121 After the initial two y ear

period, the pa

rties disag ree d as to whethe r Tenne ssee ha d met the g oals set for the first two y ear s and they wer e unable to rea ch an a g ree ment as to g oals for y ear s three throug h five. The mag istrate judg e super vising the case thus decla red an impasse and r efe rre d the matter ba ck to the district court (a s provided in the settlement). T ennesse e then moved to va cate the

a g re e d o rd e r a

pp ro vin g the se ttl e me nt a nd dis mis s the su it b a se d u po n a n in te rv e nin g Sixth C ir c uit decision, W

estside Mothers v . Olszewski , 454 F.3d 532 ( 6th Cir. 2006) (“ W estside Mothers II ” ). In W estside Mothers II

, this Court rejected a

suit alleg ing that Michiga n had violated the Me dicaid Ac t by fa ili ng to e ns ur e the pr ov isi on of dia g no sti c se rv ic e s to e lig ibl e c hil dr e n b e c a us e Me dic a id i s a

re imb ur se me nt sc he me , no t a sc he me fo r s tate -p ro vid e d me dic a l se rv ic e s. 45 4 F .3 d at 53 9- 41 ; c f.No. 07-6163

Brown v. TennesseeDepartme nt of Finance Pag e 4 42 U.S.C. § 1396d(a) ( “T h e t er m ‘m ed ical assistanc e’ me ans pay ment of par

t or all of the c ost of [co ve re d] c are and se rv ic e s. ” )

. I n it s mo tio n, Te nn e sse e argue d th a t th e se ttl e me nt w a s in te nd e d to

re me dy its a lle g e d n on c omp lia

nc e wi th t he Me dic a id s tatut e by

fa ili ng to e ns ur e e lig ibl e ind ivi du a ls ha d a c c e ss t o w a ive r s e rv ic e s, bu t th a t W estside Mothers II

ha d s inc e e sta

bli sh e d th a t no su c h d

uty exis ts. This, Tennessee argued, constituted a c hang e in c ircumstance s that entitled it to relief from prospec tive enfor ceme nt of the ag ree ment under the Supreme Court’s de cision in Rufo v. Inm ates of Suf fol k Cou nty J ail , 50 2 U. S. 36 7 (1 99 2) , w hic h h e ld t hat it is i ne qu ita

ble un de r R

ule 60 (b )( 5) to enfor ce a consent de cre e whe n the violation it int ends to reme dy has c ea s ed t o be illeg al due to a chang e in law. See J .A. at 049, 052-053. The district court denie d this mot ion, and Tenne ssee now

a pp e a ls. II. A. Me dic a id r e qu ir e s p ar

t i c i p a tin g state s to pr ov ide “ me dic a l a ssi sta nc e ” to e lig ibl e ind ivi du a ls, 42 U.S.C. § 1396a(a) , and that it b e provide d with “re asonable promptness.” 42 U.S.C. § 1396a(a )(8) . But what “medica l assistance” means in this context has b ee n t h e subj ect of disag ree ment in the fede ral c ourts. The district cour ts that init ially

addre ssed this issue took the view that “medica l assistance” means “ medi ca l s er v i ce s ,” and he ld that states had a duty to ensure that elig ible individuals rece ived medica l s er v ices with “r easona ble promptness.” See, e .g. , Sobky v

. Smoley , 855 F. Supp. 1123, 1147 (E.D. Ca l. 19 9 4 ) (“ § 1396a(a )(8) require s ‘Medica l assistance under the plan’ to be fu rn i s h ed wi t h rea sonable promptness, a nd this can only

mean medic al service s.”).No. 07-6163

Brown v. TennesseeDepartme nt of Finance Pag e 5 The initial courts of a ppeals to addr ess this issue followed suit without m uch discussion. See Doe v . Chiles , 1 3 6 F. 3 d 7 0 9 , 7 1 5 n . 1 3 (1 1 t h C i r. 1 9 9 8 ) ( fo l l o wi n g Sobky ); Bryson v. Shum way , 308 F. 3 d 7 9 , 8 9 (1 s tC i r. 2 0 0 2 ) ( fo l l o wi n g Doe ). B ut in Bruggeman v . Blagojevich , 3 24 F .3 d 9 06 (7 th Cir. 2003) , the Seventh Circuit of fer ed an alternative interpre tation. Observingt h at “m edical

a ssi sta nc e ” is d e fi ne d in

the statut e a s “ fi na

nc ia l a ssi sta

nc e ,” Judg e Pos ne r s ug g e ste d th a t th e state ha s n o d uty to e ns ur e that ind ivi du a ls r e c e ive se rv ic e s, bu t on ly to p ro vid e re imb ur se me nt f or the ir costs. Id. a t 910. Th is dis tin c tio n, he no te d, “ wa s mi sse d in Bryson v. Shum way and Doe v . Chiles .” Id. I n W

estside Mothers II

, this Court followed J udg e P osner’ s dicta in Bruggeman and re jected a suit by a class of Medica id-elig ible children who argued that Michig an wa s violating fe dera l law by failing to provide or a

rra ng e for the provision of ce rtain scr eening , diag nostic, and treatment service s. 454 F.3d at 540. Observingthat the Medica id Act def ined “ m ed i ca l assistance ” as “pay ment of part or all of t he cost of .

. . car e and se rvice s,” 42 U.S.C. § 1396d(a), w e conc luded: “The most reasona

ble interpre tation of § 1396a(a )(8) is that all eligible individuals should have the opportunity

to apply for medic al assistance , i.e., financ ial assistance, an d that such medica l assistance , i.e. financ ial assistance , shall be provided to the individual with reasonable promptness.” Id. at 540. Thus, we he ld that plaintiffs had fa iled to state a c laim under either sec tion 1396a(a) (8) beca use they soug ht to compel the state to ar rang e for the provision of such services or provide them itself. Id. Most rece ntly , in Mandy R. v . Owens , 4 64 F.3 d 11 39 (1 0th Cir . 2 00 6) , th e Te nth

Cir c uit applied our r easoningin W estside Mothers II

to a su it b ro ug ht b y

a cla ss o f e lig ibl e ind ivi du a lsNo. 07-6163

Brown v. TennesseeDepartme nt of Finance Pag e 6 seekingservice s under a Home and Communi ty -B ased Services waiver pr og ram (the same prog ram as her e). Explaining that “m ed i cal assistance” is defined a s “financ ial assistance ,” the Mandy R. court he ld that the state’s duty was l i m i t ed t o “pay [i ng ] promptl y and eve nhandedly

for medic al service s when pre sented with the bill.” Id. a t 11 43

. Thus , th e c la ss m e mbe rs fa ile d to state a c la im beca use they wer e on a w aiting list for se rvice s, not pay ment. Id. at 1143. We believe that the T enth C i rc u i t ’s application of W estside Mothers II in Mandy R.

acc urate ly

states the law of

our circuit on a st ate’ s obligations to provide “medical assistance” unde r the Medica id statute and applies w ith equal forc e to this case: a bsent more, a

waiting list for waiver service s does not violate federa l law because the s tate’s duty is to pay for services, not ensure they

are provided. B. Fe dera l Rule of Civil Procedur e 60(b) (5) a uth o ri z es a c ourt to g rant re lief fr om final judgme nt if “applying it prospe ctively is no longe r equitable .” Whet h er p ro s p ective enforc ement is n o lo ng e r e qu ita

ble un de r R

ule 60 (b )( 5) is a

fa c t- int e ns ive in qu ir y

wi thi n th e br oa d e qu ita

ble power s of a district cour

t. Accor dingly , we r eview a d i s t ri ct co u rt’s denia l of a motion for re lief from judg ment under F eder al Rule of Civil P roce dure 60( b)(5) for a buse of discr etion. Ford Motor Co. v. Mustangs Unlimited, Inc ., 487 F.3d 465, 468 ( 6th Cir. 2007). Under this standard, we def er to the district court’s ring side view of the proce eding s, including its understanding of the unde rlying complaint and the mea

ning a nd purpose of

the settlement, and w e will aff irm absent “a definite a

nd firm conviction that the t ri al co u rt committed a clea r er ror of judgme nt.” Davis v. J

ellico Cmty. Hosp. Inc. , 912 F.2d 129, 132- 33 (6th Cir. 1990) (c itations omi tted).No. 07-6163

Brown v. TennesseeDepartme nt of Finance Pag e 7 I n Ru

fo v . I nm ate s o f Su ffo lk Cou nty J ail , 502 U.S. 367 (1992), the Supre me Court explained that under Rule 60( b)(5) , “A pa rty seekingmodification of a c ons en t d ec re e may meet its initi al burden by showing a signific ant chang e either in f actua l c onditions or in law,” id. at 384, and that conseque ntly , “modification of a consent decre e may be warra nted when the s tatutory or dec isional law has c hang ed to make le g al what the de cre e is desig ned to pre vent.” Id. a t 38 8; see also Agostini v. Fe lton 521 U.S. 203, 238 (1997) (“It is true that the trial court has discretion, but the exerc ise of discretion ca

nnot be per

mitted to st and if we find it r ests upon a leg al principle that c an no long er be sustained.” ). The Ru

fo rule flows f

rom the insight that a

consent de cre e desig ned to re medy violations of fede ral lawis not a private contra ct; it is a judi cial decre e enforcing rig hts created by fe de ra l la w thr ou g h me ans a g re e d u po n b y the pa rt ie s. So i f a

c ha ng e in l aw e lim inate s th e ri g hts

and du tie s th e c on se nt d e c re e is de sig ne d to enf or c e , the n it sh ou ld not

be e nf or c e d s imp ly

be c a us e the par ties ag ree d to it. See B iodiversity v. Cables , 357 F.3d 1152, 1169- 70 (10th Cir. 2004). The district cour

t in this case misapplied Ru fo , as it den i ed T en n es s ee’ s motion on t he g r o u n d s t h a ti t s o b l i g a t i o n s u n d e r t h e s e t t l e m e n tw e r e c o n t r a c tu a l an d t h u s u n a f f e c t e d b y W estside Mothers II: I n s e ttl ingthe un de rl y ing lit ig a tio n, De fe nd ants wi lli ng ly a c c e pte d a c on tr a c tua l duty to e ns ur e the pr ov isi on

of me dic a l se rv ic e s to pe rs on s on the DM RS wa iti nglis t to help ac complish the parties’ “ overr iding c ommon in t er es t” in “assur ing that Tenne ssee’ s citiz ens with mental retardation are provided re asonable opportunities to gr ow and develop, exercise independe nce, and lead full and productive lives in a safe environment.” Neit h er Ru fo , Sweeton , W

estside Mothers II

, nor Mandy R. re qu ir e s th e Court

to r e lie ve the de fe nd ants of the so le mn o bli g a tio ns the y vo lun tari ly assumed under

the Ag ree ment.No. 07-6163

Brown v. TennesseeDepartme nt of Finance Pag e 8

The dist rict court reta ined j urisdiction over the settlement ag ree ment “for all purposes” and 2 it is thus the functional equivalent of a c onsent dec ree . See Vanguards of Cleveland v . Cleveland , 23 F.3d 1013, 1018 (6th Cir. 1994) (obser ving that an ag ree d order

“plac es the pre stige of the c ourt behind the ag ree ment rea ched by the parties” and that the prospec tive provisions of such oper ate a s an injunction). J.A. a t 05 5- 05 6. As e xpla ine d a bo ve , th e fa c t that Ten nes see sett le d th is c a se is b e sid e the po int

. What matters under Rufo is n ot t hat T e nn e sse e a g re e d to take the a c tio ns sp e c if ie d in the se ttl e me nt, but what those actions wer e intended to r emedy : if the settlement was premised on the unde rstanding that th e Me dic a id statut e imp os e d upo n Te nn e sse e a du ty to en sure the pr ov isi on of me dic a l se rv ic e s, then Rufo counsels that we vaca te t he agr eed or der be cause W estside Mothers II

established that no such duty exis ts. So the r emaining question is whether Te nnessee has ca rried its burde n of proof

. 2 C. Th e re c an b e little d ou

bt t hat W estside Mothers II

repr esents an importa

nt chang e in law. Prior to W

estside Mothers II

, it wa s an open question in our circ uit whe ther a state’s duty to provide “medica l ass i s t an ce ” re quired it to ensure that all elig ible individuals rece ived servic es, and the weig ht of authority

in other circ uits favore d such an inter pretation. After W

estside Mothers II

and Mandy R. , it

is c le ar t hat no su c h d

uty e xists . B ut, e ve n a c kn ow le dg ingthe si gnif ica nce of thi s chang e in law, we are not c onvinced that the dramatic relief Tenne ssee seeks—f or us to vacate the settlement in its entirety

—is appropriate at this juncture. First, the pa

rties cha rac terize t h e u n d er l ying litig ation and g oals of the se ttlement in very differ ent way s, and it is not clear f rom the spar se re cord w hether W estside Mothers II

c omp le te ly

un de rm ine d th e se ttl e me nt. Te nn e sse e argue s th a t th e se ttl e me nt w a s in tende d to e lim inate its waiting list for Medica id service s based upon a perc eived statutory

duty to ensure that service s wereNo. 07-6163

Brown v. TennesseeDepartme nt of Finance Pag e 9 provided to all elig i b le individuals. Pl aintiffs, howe ver, disavow this chara cter ization of the underlying litig ation. I nstead, they contend t h at t h ey

wer e see king inf

ormation about the wa iver prog ram, a cce ss to it, and enrollment in a vailable slots (at least up to the statutory cap) so that they could obtain Medica id funds. The re cord doe s not conclusively show which party ’s descr iption of the under ly ing litig ation is corre ct. Plaintiffs’ complaint is pleaded g ener ally and could plausibly

be re ad to support either theory

. We have no rec ord of the s ettlement di scussions betwee n the parties or t heir pre -settlement argumen t s t o the district court. The district court’s initial order was brie f and de nied summary judgme nt on all five of plaintiffs’ claims. And Tenne ssee’ s duties unde r the settlement ag ree ment

a re no t c le ar l y i n t e n d e d t o r e m e dy o n e t h e o r y b u t n o t t h e o t h e r . A s a r e s u l t , w e c an n o t sa y wi th

cer tainty that W estside Mothers II ha d th e e ff e c t T e nne sse e c on te nd s o r w arr ants the re lie f i t r e qu e sts

. I n our view, it is difficult t o deter mine whether

this consent decr ee w as under mined to a deg ree sufficie nt to just ify

relief when the ba sis and meaning of the decr ee are not clear and the district cour

t h a s y e tt o i n t e r

p r e ti t

. A s a

r e s u l t , w e h e s i t a t e t o v a c a t e t h e d e c r e e i ni t s e n t i r e t y a tt h i s s t a g e . If plaintiffs’ ac count of the unde rlying litig ation is as revisionist as Tenne ssee c laims, then Tennesse e is e nti tle d to fu ll re lie f fr om pr os pe c tiv e e nf or c e me nt. B ut the dis tr ic t c ourt wi ll h a ve to a dd

re ss t his matter on re mand. Second, the settlement is about t o expire—its five y ear term runs out at t he end of this y ear , and Te nnessee ’s duties under it will then ce ase. So, g iven that only part of the settlement is in clear conflict with W

estside Mothers II

, and that Te nnessee ’s obligations will soon end, we do not believe that equity

nece ssarily

require s that we va cate the dec ree in its entirety now.No. 07-6163

Brown v. TennesseeDepartme nt of Finance Pag e 10

Tenne ssee a

rg ues in the alter

native that we should vacate t he settl ement based upon its own 3 terms, but the basis for this appea l is the di strict court’s denial of Tennessee’ s motion to vacate the ag ree d order

under Rule 60( b)(5) , so Tennesse e is not “def end[i n g] an [ ] action for noncompliance ”and this provision does not apply here

. Th ir d, Te nn e sse e may

be a ble to o bta in r e lie f f

ro m e nf or c e me nt o f t

he se ttl e me nt d

ur ingits fi na l ni ne mon ths e ve n if

we do no t f

ull y g ra nt i t he re . T e nn e sse e ha s tw o s a fe ty va lve s ava ila

ble to i t un de r t

he se ttl e me nt i tse lf

. F ir st, the a g re e me nt p ro vid e s th a t T e nn e sse e ’s du ty to e nr oll additional individuals int o the waive r prog ram is conditioned on both the ava ilability of a w aiver

slot and fundingfor that slot. J .A. 109. Second, a nd more sig ni fi ca n t l y , s ection IX.B .5.d of the settlement ag ree ment provides that if the parties return to c ourt to liti g ate c laims of non-complianc e, “[a]fter two y ear s following the approva l of this Agr eeme nt, defe ndants may defe nd any

action for non-complianc e on the g rounds that defendants are in compliance with the fe dera l laws that are the basis of the unde rlying a ction which is the subject of this Ag ree ment.” J .A. at 117-18. Te nnessee 3 is c ur re ntl y de fe nd ing a pe nd ing e nf or c e me nt a c tio n o n th is v e ry g ro un d. I f t

he dis tr ic t c ourt

a c c e pts Tenne ssee’ s view of the c ase on r emand, Te nnessee will avoid all of its obligations under the settlement any

way . Be cause the district court ha s y et t o rule on this motion or otherwise interpr et the pr ov isi on s o f t

he se ttl e me nt, we fe e l it

is pr e matur e to va c a te the se ttl e me nt in its e nti re ty a t th is time. These thing s considere d, we do not believe the district court a bused i ts discretion in re fusing t o v a c a t e t h e s e t t l e m e n ti ni t s e n t i r e t y . B u t i td i d m i s a p p l y Ru fo , a nd it d id a bu se its dis c re tio n in

re fu sin g to m od if

y the a g re e me nt a t a ll. At thi s tim e , we wi ll mod if y the de c re e in tw o w ay s. F ir st,

we vacate Tenne ssee’ s commitment to deve lop “provider network c apac ity ,” J.A. 112, which doesNo. 07-6163

Brown v. TennesseeDepartme nt of Finance Pag e 11

We a c kn ow le dg e tha t e nr oll me nt i n th e wa ive r p ro g ra m is c a pp e d at th e nu mb er of sl ots 4 proposed by

the state a

nd approved b y C MS, and we do not take the plaintiffs to contend that Tenne ssee has a unlimit ed duty to enroll elig ible individuals in i ts HCBS waiver . To the extent that is p la int if fs ’ p os iti on , w e re

je c t it no w. We e xpre ss no op ini on a s to wh e the r T e nn e sse e ha s a du ty to enroll elig ible individuals up to t he wa iver-e nro l l m en t cap or whether such a duty

was contemplated by

the settlement ag ree ment at issue in this case. not appea

r to reme dy

any violation of fede ral lawafte r W es t s i de Mot hers II

. Second, any

c omm itm e nt T e nn e sse e argua bl y mad e to e lim inate the wa iti nglis t f or se rv ic e s is lik e wi se unenfor cea

ble af ter W estside Mothers II

. Absent more, a

waiting list for waiver

service s is not inc on sis te nt w ithTe nn e se e ’s du ty to pr ov ide “ me dic a l a ssi sta nc e ” to i nd ivi du a ls e lig ibl e fo r i ts HCBS waive r with “re asonable promptness.” 4 On re mand, the district court should consider the ag ree d order in light of its knowledg e of th e h is to r y o f th is c a s e an d o u r d is cussion of W es t side Mothers II

and Mandy R. to determine

w h e th e r an d to w h a t e xte n t th e s e tt le me n t s h o u ld b e e n f o r c e d d u r in g it s f

in a l n in e mo n th s of exis tence

. I V. F or the fo re g oin g re a so ns , w e REV ERS E i n p art and REM AN D f

or fu rt he r p ro c e e din g s.