Document: 469 U.S. 287 105 S.Ct. 712 83 L.Ed.2d 661 ALEXANDER, Governor of Tennessee, et al.v.CHOATE al. No. 83-727. Argued Oct. 1, 1984. Decided Jan. 9, 1985. Syllabus Faced with Medicaid costs beyond its budget, Tennessee proposed to reduce from 20 14 the number annual inpatient hospital days that state would pay hospitals on behalf a recipient. Before reduction took effect, respondent recipients brought class action in Federal District Court for declaratory and injunctive relief. Respondents alleged 14-day limitation have disproportionate effect handicapped hence was discriminatory violation § 504 Rehabilitation Act 1973—which provides no otherwise qualified person shall, solely by reason his handicap, be subjected discrimination under any program receiving federal financial assistance—and implementing regulations, moreover coverage disadvantage disproportionately 504. The dismissed complaint ground not type intended proscribe. Appeals held had established prima facie case violation, because both affect handicapped. Held: Assuming or regulations reach some claims disparate-impact discrimination, Tennessee's is among them. Pp. 292-309. (a) neutral face, rest motive, does deny meaningful access exclude them particular package services has chosen provide. State made same benefit equally accessible nonhandicapped persons, required assure "adequate health care" providing more than non-handicapped. Nothing Act's legislative history supports conclusion requires States view certain illnesses, i.e., those particularly affecting handicapped, as important others worthy cure through government subsidization. Section require alter definition it will simply meet reality greater medical needs. While seeks evenhanded treatment opportunity individuals participate programs assistance, guarantee equal results provision Medicaid. 306-309. (b) In addition, obligated modify abandoning reliance durational limitations coverage. redefine program, nothing suggests Congress desired make major inroads States' longstanding discretion choose proper mix amount, scope, covered Moreover, grantees broad-based distributive decision always way most favorable, least disadvantageous, To do so impose virtually unworkable requirement administrators. 715 F.2d 1036 (CA6 1983), reversed. W.J. Michael Cody, Memphis, Tenn., petitioners. Paul M. Bator, Cambridge, Mass., United amicus curiae, special leave Court. G. Gordon Bonnyman, Jr., Nashville, respondents. Justice MARSHALL delivered opinion 1 1980, reducing care program. question presented whether upon this cognizable 1973 regulations. We hold not. 2 * 1980-1981 projected Medicaid1 $42 million State's budget $388 million, directors decided institute variety cost-saving measures. Among these changes per fiscal year new measures respondents, recipients, relief which they alleged, inter alia, handicapped.2 Statistical evidence, petitioners dispute, indicated 1979-1980 year, 27.4% all users who received care, while only 7.8% care. 3 Based respondents asserted violate 1973, 87 Stat. 394, amended, 29 U.S.C. 794, provides: 4 "No individual . excluded participation in, denied benefits of, activity assistance ." 794. 5 Respondents' position twofold. First, argued change discriminatory.3 second, major, thrust respondents' attack directed at use covered, acknowledged that, given needs such likely disproportionately. noted, however, law coverage, 10 restrictions.4 therefore suggested follow other away covered. Instead, could limit per-stay basis, vary depending recipient's illness (for example, fixing an appendectomy); period each then set level keep whole within budget.5 refusal adopt plan said result imposition gratuitous thus constitute 6 A divided panel Sixth Circuit indeed violation. Jennings v. Alexander, (1983). majority apparently concluded grantee disparately affects states cause Because rule affected found been out, remanded6 give rebuttal. According majority, remand either demonstrate unavailability alternative plans achieve legitimate goals less impact offer "a substantial justification adoption impact." Id., 1045. granted certiorari consider issue 465 1021, 104 1271, 79 677 (1984), we now reverse. II 7 first parties urge proof animus establish also reaches recipient funding discriminates against rather design. argues purposeful As support position, relies heavily our recent Guardians Assn. Civil Service Comm'n New York City, 463 582, 103 3221, 77 866 8 Guardians, confronted Title VI Rights 1964, 42 2000d seq., prohibits racial ethnic minorities aid, intentional discrimination.7 No commanded Members offered widely varying interpretations VI. Nonetheless, two-pronged holding nature proscribed emerged case. itself directly reached instances discrimination.8 Second, actions having unjustifiable disparate redressed agency designed implement purposes VI.9 essence, then, delegated agencies instance complex determination what sorts impacts constituted sufficiently significant social problems, were readily enough remediable, warrant altering practices produced impacts. 9 therefore, petitioners' blanket proposition proscribes Indeed, extent relevant interpretation 504, part rely, actionable challenged case.10 there are reasons pause before too quickly extending even prong Cf. Consolidated Rail Corp. Darrone, 624, 632-633, n. 13, 1248, 1253-1254, 568 (1984) (recognizing distinctions between 504).11 Discrimination perceived often product, invidious animus, but thoughtlessness indifference—of benign neglect.12 Thus, Representative Vanik, introducing predecessor House,13 described one country's "shameful oversights," caused live society "shunted aside, hidden, ignored." 117 Cong.Rec. 45974 (1971). Similarly, Senator Humphrey, introduced companion measure Senate, "we can longer tolerate invisibility America 118 525-526 (1972). And Cranston, Acting Chairman Subcommittee drafted 504,14 response "previous societal neglect." 119 5880, 5883 (1973). See 526 (1972) (statement cosponsor Sen. Percy) (describing legislation leading national commitment eliminate "glaring neglect" handicapped).15 commentators plight similarly primarily apathetic attitudes affirmative animus.16 11 much conduct sought passing difficult if impossible construed proscribe fueled intent. For elimination architectural barriers central aims Act, see, e.g., S.Rep. 93-318, p. (1973), U.S.Code Cong. & Admin.News pp. 2076, 2080, yet clearly erected aim intent excluding Williams, chairman Labor Public Welfare Committee reported out victims "[d]iscrimination public transportation" simplest forms educational rehabilitation need 3320 again proposal later became listed, section prohibit, "transportation barriers," "discriminatory job qualification procedures," denial "special assistance" children. 525-526. These statements ring hollow resulting rectify harms discriminated well design.17 12 At time, urged respondents—that interpret handicapped—is troubling. typically situated nonhandicapped, essence funds evaluate every might touch interests alternatives achieving objectives severe formalization policing process lead wholly unwieldy administrative adjudicative burden. Note, Employment Against Handicapped Act: An Essay Legal Evasiveness, 97 Harv.L.Rev. 997, 1008 problems pure model context employment handicapped). Had National Environmental Policy Act18 requiring preparation "Handicapped Impact Statements" taken expect indication purpose statute history. Yet suggest Congress' purpose. just embrace discrimination. 13 Any must responsive two powerful countervailing considerations—the statutory desire manageable bounds. Given legitimacy tension them, decline parties' invitation decide today overshadows eclipse it. reject boundless notion showings cases assume without deciding On assumption, determine complain sort recognize. III actionable, starting point Southeastern Community College Davis, 442 397, 99 2361, 60 980 (1979), previous attempt define scope 504.19 Davis involved plaintiff hearing disability admission college trained registered nurse, capable safely performing nurse full-time personal supervision. stated circumstances, "refusal existing become unreasonable discriminatory. Identification where accommodate disabled amounts [is] responsibility HEW." Id.,, 413, S.Ct., 2370. admit appeared unlikely she modifications HEW required, id., 409, 2368, further sought—full-time, supervision whenever attended patients clinical courses—would compromised essential college's nursing 413-414, 2370-2371. Such "fundamental alteration program" far reasonable required. 410, 2369. struck balance rights integrated into preserving integrity their programs: "fundamental" "substantial" may "reasonable" ones. Compare ibid. 412-413, 2370.20 15 provided offers. itself, course, cannot defined effectively denies entitled; access, accommodations grantee's made.21 case, argue rule, limitation, Tennessee. examine arguments turn. 16 services. invoke criteria exclusionary handicapped; reduction, distinguish whose reduced basis test, judgment, trait meeting having. "meaningful access" coverage; record unable meaningfully receive rule.22 identical effective fully available use, classes subject limitation. Jefferson Hackney, 406 535, 92 1724, 32 285 17 prolonged means provide services, single suggestion unsound. base, amorphous objective care." But precisely tailored her That general assuring necessary remains offered—not 18 makes clear. gives duration long "the best recipients." 1396a(a)(19). serve 95% eligible Medicaid, lower courts "best interests" standard. unchallenged conclusion23 indicates free, matter 19 being conclude find conclusion. Doe Colautti, 592 704 (CA3 1979) (State covered-private-inpatient-psychiatric though sets physical illnesses). assistance. (1979). not, assuming equality constructed. Ibid. Regulations promulgated Department Health Human Services (HHS) pursuant conclusion.24 "provide (as 84.4(b)) others." 45 CFR 84.52(a)(3) (1984). prohibit adopting "criteria methods administration defeating substantially impairing accomplishment respect handicapped." 84.4(b)(4)(ii) (1984).25 21 read isolation, healthy reveal HHS contemplate imposing requirement. 84.4(b)(2) referred quoted above, clear 22 "[f]or part, aids, benefits, effective, produce achievement afford persons obtain result, gain benefit, 23 This regulation, indicating adjustments contemplated,26 users. seeking distinct entitled respond asserting reinstate 20-day B 24 turn next contention, contention whole. inclusion violates challenge discriminate (1) falls (2) harm avoided choice budgetary constraints disadvantaging Viewed light, current inflict 25 Whatever merits conception seek. enacting subsequent amendments,27 did focus several substantive areas—employment,28 education,29 access30—in considered refusals high.31 pre- post-1973 discussion see Beal Doe, 432 438, 444, 2366, 2370, 53 464 (1977). And, generally, already stated, supra, 298-299, NEPA-like grantees.32 26 minimal, pursue course suggest, "gratuitous" contrary, when taking across-the-board analysis prepared. Presumably, broken down handicap—the here, significantly harmful blind, minimally, subclasses recipients; various groups determine, balance, similar accorded protected regulation 27 It should obvious regime Davis. doing immediate IV 28 benefit—14 nonhandicapped. Assuming, reason, erred judgment below accordingly ordered. XIX Social Security 1965, 343, 1396 seq. joint state-federal Government approves needy subsidizes portion obligations agreed assume. Once voluntarily chooses comply requirements applicable Harris McRae, 448 297, 301, 100 2671, 2680, 65 784 (1980). array Although many changes, settlement Thus none causes claim original amended complaints. additional legal theories Since Court's decision, minor ways materially issues certiorari. evidence provided, 16.9% compared 4.2% met. 1980 average ceiling 37.6 days. Six reimbursable admission, spell illness, period. App. Brief Amicus Curiae. 518 F.Supp. 877, 883, (MD Tenn.1981). diagnosis-related reimbursement supported committee Legislature, recommended plan. System Health, Report Special Joint Ninety-Third General Assembly 24, seems mischaracterized total visits annum days." 1036, 1044 1983). Rule Procedure 12(b)(6) included "not proscribe." F.Supp., 881. 601 2000d, race, color, origin, assistance." premise modeled VI, evolution regulatory judicial ascertaining agree basic premise. 93-1297, 39 (1974) 1974, 6373, 6390-91 ("Section patterned after almost to, antidiscrimination language 2000d-1 (relating origin) 901 Education Amendments 1972, 1683 sex)"). infra, 295-297, facile assimilation resisted. U.S., 607-608, 3235-3236 (opinion POWELL, J., BURGER, C.J., REHNQUIST, joined); 612, 3237 O'CONNOR, J.); 634, 3249 STEVENS, BRENNAN BLACKMUN, JJ., joined). 584, 3223 (WHITE, announcing Court); 623, 15, 3244, MARSHALL, Lau Nichols, 414 563, 569, 94 786, 789, (Stewart, concurring). 304-306, fact action. addition concerned, considerations counsel hesitation reading pari materia effect/intent issue. seven Justices, outcome settled University California Regents Bakke, 438 265, 98 2733, 57 750 (1978), 607, 3235 641, 12, 3253, (STEVENS, joined dissenting). five Justices Bakke wrote 590-591 590, 11, 3226-3227 3226, 616-618, 3240-3241 (MARSHALL, dissenting), controlled stare decisis. felt force constraint, unclear 626, 3245 (O'CONNOR, concurring judgment) ("Were construing prior Court, redress discrimination") (citation omitted). factors peculiar locked construction seem direct applicability time enacted nearly decade experience accumulated operation nondiscrimination provisions Titles VII. By enforcement incorporating standard Presidential task Department, Cabinet about 40 adopted standards interpreted bar impact. 629-630, 3247 provoked controversy Congress, 1966 House Representatives rejected amendment limited 630-631, 3247-3248. used aware intent/impact consistently refusing expressly thought approved Rutherford, 544, 554, 2470, 2476, 61 68 (1979); Cannon Chicago, 441 677, 698-699, 1946, 1958-1959, 560 sure, well-cataloged exist. See, Commission Rights, Accommodating Spectrum Individual Abilities, Ch. (1983); Wegner, Antidiscrimination Model Reconsidered: Ensuring Equal Opportunity Without Respect Handicap Under 69 Cornell L.Rev. 401, 403, ultimately passed principle codified initially Vanik House. H.R. 14033, 92d Cong., 2d Sess., 9712 (1972); 12154, 1st 45945 Senate Senators Humphrey Percy. S. 3044, underlying bills reshaped inserted vocational-rehabilitation pending. bill carried forward 6145 (1973) Humphrey); 32310 (same); 7114 Rep. Vanik). lack debate devoted R. Cappalli, Grants Cooperative Agencies 20:03 (1982), Congressman crafted primary signpost road toward interpreting 30680 Randolph describing origins 504). Percy version 1973. Abilities Handicapped: Meaning 55 N.Y.U.L.Rev. 881, 883 All Courts addressed Mexico Retarded Citizens Mexico, 678 847, 854 (CA10 1982); Pushkin Colorado, 658 1372, 1384-1385 1981); Dopico Goldschmidt, 687 644, 652-653 (CA2 NAACP Wilmington Medical Center, 657 1322, 1331 1981) (en banc); Majors Housing Authority County DeKalb, Georgia, 652 454, 457-458 (CA5 Jones Illinois Dept. Services, 689 724 (CA7 Stutts Freeman, 694 666 (CA11 1983); Georgia McDaniel, 716 1565, 1578-1580 vacated consideration light Smith Robinson, 468 992, 3457, 82 746 (1984); 1213, 3581, 880 cf. Joyner Lowry Dumpson, 770, 775-776, 1983) (rejecting "adverse impact" theory grounds challenging parents state-subsidized residential child-care children transfer temporary custody State, reserving test actions). 900.704(b)(3) (OPM) 15b.4(b)(4)(DOA) 4.121(b)(4) (NRC) 1040.63(b)(4) (DOE) 1251.103(b)(5) (NASA) 8b.4(b)(4) (DOC) 1307.4(b)(3) (TVA) 142.4(b)(4) (DOS) 217.4(b)(4) (AID/IDCA) §§ 41.51(b)(3), 42.503(b)(3) (DOJ) 32.4(b)(4)(DOL) 31 51.52(b)(1)(vi), 51.55(b)(1)(viii) (Dept. Treas. (OST)) 56.8(a)(6) (DOD) 34 104.4(b)(4) Ed.) 38 18.404(b)(4) (VA) 49 Fed.Reg. 1656 (EPA) (to pt. 7); 41 101-8.303(d) (GSA) 43 17.203(b)(4) (DOI) 84.4(b)(4) 605.4(b)(4) (NSF) 1151.17(c) (NEA) 1170.12(c) (NEH) 1232.4(b)(3) (ACTION) 27.7(b)(4) (DOT) unaware facial validity 4321 "otherwise qualified" becomes relevant. However, "discrimination" sides coin; ultimate "affirmative-action obligation funds." 411, 2369-2370. Our term "affirmative action" severely criticized failing appreciate difference accommodation; former refer remedial policy past latter relates obstacles 885-886 (1980); Rehabilitating After Southeastern, 80 Colum.L.Rev. 171, 185-186 1982) ("Use phrase 'affirmative action' unfortunate, making talk kind efforts importing connotations term."). Regardless aptness words "changes," "adjustments," "modifications" "substantial," 10, 2369, 2369-2370, alteration[s] .," accommodations. states: "Antidiscrimination obviously emptied meaning 'collapsed' one's benefit." Curiae 29, 36. oral argument, shows, sometimes Tr. Oral Arg. 14-15 (referring ). consistent times access. 84.12(a) (requiring employer "reasonable accommodation known mental limitations" individual); 84.22 84.23 buildings accessible, building alterations "to maximum feasible," facilities eventually operated inside is, "when viewed entirety," accessible); 84.44(a) regular academic secondary education institutions, length permitted completion degree requirements, substitution specific courses adaptation manner conducted). contain illnesses uniquely associated occurring frequency treated, fewer days' apply conditions takes regardless hospitalization. unchallenged, express limits Act. Charleston Memorial Hospital Conrad, 693 324, 329-330 (CA4 (upholding 12-day-a-year coverage); Virginia Kenley, 427 781 (ED Va.1977) 21-day limitation). previously recognized source guidance Corporation (holding 1978 codify enforcing 504); 2370 ("Identification continues HEW"); generally 1974 clarified charged administering leeway explore areas posed devise 40-41, 56 (1974). rely 84.52(a)(2) (stating "[a]fford persons"); 84.4(b)(1)(iii) (prohibiting service others"); 84.4(b)(1)(ii) afforded others"). interpretive accompanying "[T]he 'equally effective,' paragraph (b)(2), encompass concept equivalent, opposed identical, acknowledge order corresponding met, different necessary." CFR, 84, A, ¶ passed, returned amendments Pub.L. 93-516, 88 1617. substitute expression enactment, contemporaneous elaborations norm shed enacted. Andrus Shell Oil Co., 446 657, 666-671, 1932, 1938-1941, 64 593 Seatrain Shipbuilding 444 572, 596, 800, 813, 63 36 V 1978, mechanisms 1964. 95-602, 2982, 505(a)(2), 794a (1982). relied 1253-1254. "The goal increase employment." 633, 1254, 13. 701(11) (1976 ed.). (1971) Vanik); 5882-5883 Cranston); 3320-3322 Williams). 30 ed.); (1973); 50 (1974), 6400. training, training involve concerning benefits. never programs. arguendo, (1983), broad terms permit choose, options, option worded rules, specificity themselves agrees

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