48 F.4th 331
5th Cir.2022Background
- Barbara Harrison, a severely disabled Medicaid recipient with multiple medical needs, requires intensive care and sought 24/7 nursing in a community-based care center.
- Texas operates a Medicaid home- and community-based waiver with an approximate per-person cost cap of $170,000; Harrison’s proposed community plan cost ~ $330,000 annually.
- Harrison requested that the Texas Health and Human Services Commission (HHSC) use state general revenues to cover the excess; HHSC denied the request and approved only limited daily nursing hours.
- Administrative review did not resolve HHSC’s refusal to use general revenue; Harrison sued under the ADA, the Rehabilitation Act (Olmstead theory), and 42 U.S.C. § 1983 (due process), and sought a preliminary injunction ordering 24/7 nursing.
- The district court granted the preliminary injunction; the State appealed to the Fifth Circuit.
- The Fifth Circuit held it had jurisdiction under Ex parte Young, but vacated the preliminary injunction and remanded for additional factual findings.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Sovereign immunity / jurisdiction (Ex parte Young) | Harrison seeks prospective relief to stop ongoing federal-law violations (ADA/RA), so Ex parte Young permits suit against state official. | Eleventh Amendment bars suit for monetary or state-funded relief; sovereign immunity precludes federal-court relief. | Ex parte Young applies; suit seeking prospective relief is not barred by sovereign immunity. |
| Abstention (Burford) | Federal court should decide federal ADA/RA and due-process claims; no special state forum; federal adjudication appropriate. | District court should abstain to avoid disrupting complex state administrative allocation of funds. | Burford abstention not warranted; factors favor exercising federal jurisdiction. |
| Due process / property interest in general-revenue funding | Harrison has a protectable property interest in continued home-care funding and thus due-process rights to a hearing. | Texas law authorizes but does not mandate use of general revenue; no mandatory entitlement, so no property interest. | Harrison unlikely to have a property interest; due-process claim unlikely to succeed and cannot support the injunction. |
| ADA / Rehabilitation Act (Olmstead reasonable accommodation) | Forcing institutionalization because state won’t use general revenue is unlawful isolation; 24/7 community care is the most integrated setting and is reasonably accommodated here. | State resources, waiver cost cap, and Olmstead’s deference to resource constraints mean exceeding the federal-waiver cap may be unreasonable. | Plaintiff has not shown likelihood of success on Olmstead: the district court’s narrow marginal-cost comparison is insufficient given state-resource considerations; injunction vacated and case remanded for more findings. |
Key Cases Cited
- Ex parte Young, 209 U.S. 123 (U.S. 1908) (creates exception to sovereign immunity for prospective injunctive relief against state officials)
- Edelman v. Jordan, 415 U.S. 651 (U.S. 1974) (distinguishes permissible prospective relief from barred retrospective relief under Eleventh Amendment)
- Pennhurst State Sch. & Hosp. v. Halderman, 465 U.S. 89 (U.S. 1984) (federal courts cannot enjoin state-law violations; Ex parte Young requires a federal-law claim)
- Olmstead v. L.C. ex rel. Zimring, 527 U.S. 581 (U.S. 1999) (ADA integration mandate; institutionalization as discrimination unless placement is unjustified after accounting for state resources)
- Burford v. Sun Oil Co., 319 U.S. 315 (U.S. 1943) (abstention doctrine to avoid interference with complex state administrative schemes)
- Bd. of Regents v. Roth, 408 U.S. 564 (U.S. 1972) (property-interest analysis for entitlement to benefits)
- Goldberg v. Kelly, 397 U.S. 254 (U.S. 1970) (recognizes procedural due-process protections for statutorily mandated welfare benefits)
- Ridgely v. FEMA, 512 F.3d 727 (5th Cir. 2008) (no property interest where statute/regulation lacks mandatory entitlement language)