Opinion ID: 2052163
Heading Depth: 2
Heading Rank: 3

Heading: Whether the Reduction of PCA Services Violates the ADA

Text: [¶ 27] Suzman contends that the reduction of his PCA hours constitutes discrimination on the basis of his disability in violation of the ADA. Although the Commissioner established Suzman's need of daytime PCA hours at seventy-four, the Commissioner reduced the number of hours to sixty-three and one-half. Suzman argued to the hearing officer that the reduction of his PCA hours violates the ADA, but the hearing officer and the Commissioner declined to address the claim. [14] [¶ 28] Suzman chose to present his ADA claim at the administrative level. We have held that, pursuant to the doctrine of exhaustion of administrative remedies, claims should be made before an administrative agency so that the agency will have the opportunity to resolve the claim. See New England Whitewater Ctr., Inc. v. Dep't of Inland Fisheries & Wildlife, 550 A.2d 56, 59-60 (Me.1988). Whether a Title II ADA claimant is required to exhaust administrative remedies is not at issue here because of Suzman's choice to present the claim at the administrative level. The hearing officer declined to issue findings of fact or legal conclusions on the claim although evidence and argument had been presented. [¶ 29] Instead of remanding the case to the Commissioner to make factual findings and legal conclusions on the ADA claim, the Superior Court itself made findings and conclusions based on the administrative record. It was appropriate for the court to review the record as it pertained to the ADA claim in order to determine if Suzman actually stated a claim. If, as a matter of law, Suzman did not state an ADA claim, there would be no sense in remanding the claim to the Commissioner to consider it. It was not appropriate, however, for the court to supplant the Commissioner's fact-finding authority. We do not review the Superior Court's findings. We will remand the ADA claim to the Commissioner for factual findings and legal conclusions unless we determine that Suzman has failed to state an ADA claim. [¶ 30] DHHS does not dispute that Suzman is a qualified individual with a disability under the ADA, 42 U.S.C.A. § 12131(2), or that DHHS is a public entity as defined in the ADA, 42 U.S.C.A. § 12131(1)(A), (B) (West Supp.2005). Nor does it dispute that it has determined that community-based placement is appropriate for Suzman's needs. See Olmstead, 527 U.S. at 587, 119 S.Ct. 2176. The appropriateness of community-based placement is apparent from the fact that Suzman has been taking part in the community-based waiver program successfully for several years and that the Commissioner's decision under appeal determines that he continues to be eligible for community-based placement. Suzman obviously does not oppose community-based treatment; he has brought this action to assert his right to it. [¶ 31] DHHS argues that Suzman's ADA claim is not viable because he has not alleged or shown that he will be institutionalized if he is not afforded all of the PCA hours that the Commissioner has determined he needs. This contention lacks merit. As a person eligible for the waiver program, Suzman by definition is in need of institutionalization. 42 U.S.C.A. § 1396n(c)(1) (providing that the secretary may issue waivers permitting a state to offer home and community-based services only to individuals who need them in order to avoid institutionalization); see also Fisher v. Okla. Health Care Auth., 335 F.3d 1175, 1181-82 (10th Cir.2003) (concluding that Olmstead does not require that a claimant be currently institutionalized in order to enforce the integration requirement). By determining his need level at seventy-four hours, the Commissioner found that seventy-four is the number of PCA daytime hours that allows Suzman to function outside of an institution. [¶ 32] DHHS also argues that by not presenting evidence as to actual expenses of the Medicaid program, Suzman failed to meet his burden of proving an ADA violation. DHHS misunderstands the burden upon an ADA claimant. As an ADA claimant, Suzman is required to show that he is a qualified individual who was discriminated against, in the receipt of services, by reason of his disability. Townsend, 328 F.3d at 516. There is little doubt that he meets this burden. Under Olmstead he has to show that DHHS has found that community-based services are appropriate for him and that he desires such services. Olmstead, 527 U.S. at 587, 119 S.Ct. 2176. DHHS already provides community-based services, and Suzman has requested a relatively modest modification of a state policy that has the effect of reducing the amount of services that he has been found to need. It is DHHS that has the burden to demonstrate that the requested modification is not reasonable because it would fundamentally alter the Medicaid program. Townsend, 328 F.3d at 517. [¶ 33] Bare assertions that a fundamental alteration will occur, or that the waiver program will be placed in jeopardy, are not sufficient to meet the burden of proving fundamental alteration in the absence of supporting evidence indicating that the program will in fact be jeopardized. See, e.g., id. at 520 (questioning whether the asserted additional costs would, in fact, compel cutbacks in services to other benefits recipients); Fisher, 335 F.3d at 1182-83 (noting that the fact that [a state] has a fiscal problem, by itself, does not lead to an automatic conclusion that [the provision of integrated treatment] will result in a fundamental alteration). [¶ 34] DHHS also argues that because CMS approved the waiver program proposal, which included the 90% rule, the rule is consistent with the ADA. However, the fact that the federal government found the waiver program proposal acceptable does not render the program immune from an ADA challenge, nor does it compel the conclusion that a fundamental alteration will result from a reasonable modification to it. [¶ 35] We will not speculate as to what evidence DHHS would present to prove fundamental alteration. Olmstead and the post- Olmstead cases, such as Townsend, describe what may be required to prove fundamental alteration. The cases acknowledge that the total picture is relevant and that the complete range of services and available resources must be considered. See, e.g., Olmstead, 527 U.S. at 597, 119 S.Ct. 2176. We have previously recognized when discussing Olmstead that DHHS must administer its services with an even hand. Bates v. Dep't of Behavioral & Developmental Servs., 2004 ME 154, ¶ 59, 863 A.2d 890, 905. [¶ 36] DHHS may be discriminating against Suzman if it is failing to provide, in a community-based setting, services that are available under an existing program, and if it cannot show that provision of those services in a community-based setting will result in a fundamental alteration. Suzman's claim that the reduction of his PCA hours is a violation of the ADA appears viable. Whether DHHS will be able to demonstrate a fundamental alteration will depend upon the evidence it presents.