M.R. v. Dreyfus
2011 U.S. Dist. LEXIS 18819
W.D. Wash.2011Background
- This case challenges Washington DSHS's 2011 across-the-board reduction of in-home personal care service hours under CARE due to a budget shortfall.
- Plaintiffs are disabled/elderly receiving personal care services; they seek to enjoin the reductions.
- CARE-based hours are allocated by acuity with base hours then adjusted by factors; CARE does not reflect each individual's minimum need.
- The 2011 reductions followed 2009/2010 adjustments and Governor EO 10-04; DSHS claims budget constraints justify reductions.
- The court previously denied a TRO, Ninth Circuit stayed the emergency regulation, and the matter proceeds to a decision on preliminary injunction.
- DSHS provided extensive declarations showing potential offsetting steps and statewide resource allocation.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the 2011 hours reduction violates due process | Plaintiffs argue CARE is an individualized need assessment, so reductions threaten irreparable harm | State argues mass change without nonfactual dispute does not require due process | No likelihood of irreparable harm; mass change bars due process relief. |
| Whether CARE determines beneficiaries' actual minimum needs | CARE does not assess actual minimum needs; reduces below essential level | CARE allocates relative needs, not each individual's minimum, and allows ETR/reassessments | CARE does not measure individual minimum needs; no irreparable harm found. |
| ADA integration mandate violated by reducing hours | Reduction forces institutionalization or violates integration mandate | Factual record shows no discrimination; state remains integrated; care levels preserved | No likelihood of success on ADA claim; no irreparable harm established. |
| Whether the reduction constitutes a fundamental alteration of the Medicaid program | Reduction harms beneficiaries and alters program purpose | Modification necessary to preserve overall Medicaid system; not a fundamental alteration | Modification not a fundamental alteration given deinstitutionalization trend and budget constraints. |
| Whether federal approval was required for the 2011 change | State plan does not specify base hours or method; federal approval not required | No likelihood of success on federal approval claim. |
Key Cases Cited
- Winter v. Natural Resources Defense Council, Inc., 555 U.S. 7 (U.S. 2008) (preliminary injunction is an extraordinary remedy; sliding scale compatible with Winter)
- Jenkins v. Dep't of Soc. & Health Servs., 160 Wash.2d 287, 157 P.3d 388 (Wash. 2007) (CARE not necessarily requiring individualized needs assessments for comparability)
- Fisher v. Okla. Health Care Auth., 335 F.3d 1175 (10th Cir. 2003) (ADA integration mandate; no choice but institutional care)
- Townsend v. Quasim, 328 F.3d 511 (9th Cir. 2003) (Olmstead integration test framework (three-part))
- Brantley v. Maxwell-Jolly, 656 F. Supp. 2d 1161 (N.D. Cal. 2009) (serious risk of institutionalization not always required for ADA claim)
- Alexander v. Choate, 469 U.S. 287 (U.S. 1985) (Medicaid program is a bundle of services reflecting broad state discretion)
- Mayer v. Wing, 922 F. Supp. 902 (S.D.N.Y. 1996) (physician-based determinations differ from CARE model)