M.R. v. Dreyfus
2011 U.S. App. LEXIS 24986
9th Cir.2011Background
- Medicaid program in Washington covers in-home personal care services; a 2010 executive order mandated across-the-board budget reductions leading DSHS to cut base hours by about 10% on average.
- Cut reduced hours for CARE-classified beneficiaries, with largest percentage cuts for the most disabled groups; some groups saw up to 17% reductions.
- Plaintiffs, 14 home-care beneficiaries and related advocates, allege ADA/ Rehabilitation Act violations and improper Medicaid regulation; seek preliminary injunction.
- DSHS provided notices of reduced hours in December 2010, stating changes were budget-driven and not subject to administrative hearings or appeals.
- District court denied preliminary injunction, applying a strict causation/medical-care distinction and finding no irreparable harm; Ninth Circuit reverses.
- Regulatory framework requires services to be 'medically necessary' and evaluated under CARE, with potential for Exceptions to Rule and appeals processes.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the regulation creates irreparable injury | M.R., C.B., K.S. show imminent institutionalization risk | DSHS asserts no imminent harm due to alternative care | Yes, irreparable injury likely shown |
| Whether ADA/Rehabilitation Act claims present serious questions on the merits | Regulation violates integration mandate by risking institutionalization | Budget reductions permissible if not causing discrimination | Serious questions shown; merits reviewed |
| Whether district court erred on causation and scope of harm evidence | Individualized evidence shows causation from hours cut | Medical deterioration independent of hours cuts; generalized harms relied on | District court erred by not adequately crediting individualized evidence |
| Whether a fundamental-alteration defense applies to preserving pre-regulation levels | Preserving current level of services is not a fundamental alteration | Maintaining pre-regulation care could fundamentally alter Medicaid program | Whether defense applies unresolved; serious questions shown; not dispositive |
Key Cases Cited
- Olmstead v. L.C. ex rel. Zimring, 527 U.S. 581 (U.S. 1999) (integration mandate; community-based treatment when reasonably accommodated)
- Winter v. Natural Resources Defense Council, Inc., 555 U.S. 7 (U.S. 2008) (preliminary injunction standard; four-factor test)
- Alliance for the Wild Rockies v. Cottrell, 632 F.3d 1127 (9th Cir. 2011) (likelihood of irreparable injury; public-interest considerations)
- Sanchez v. Johnson, 416 F.3d 1051 (9th Cir. 2005) (discussion of ADA/ Rehabilitation Act interpretation)
- Armsstrong v. Davis, 275 F.3d 849 (9th Cir. 2001) (scope of systemic injunctive relief; class considerations)
- Rodde v. Bonta, 357 F.3d 988 (9th Cir. 2004) (public-interest and balance of hardships in welfare cases)
- Brown v. Plata, 131 S. Ct. 1910 (U.S. 2011) (oversight of systemic health-care deficiencies; balance of harms)
- Olmstead, 527 U.S. 581, 527 U.S. 581 (U.S. 1999) (integration mandate; state's obligation to provide community-based treatment)
- Beltran v. Meyers, 677 F.2d 1317 (9th Cir. 1982) (early ADA/discrimination framework; injury from denial of care)