M.R. v. Dreyfus
697 F.3d 706
9th Cir.2011Background
- Washington's Medicaid program covers personal care services (in-home) for about 45,000 disabled individuals under CARE assessments determining monthly hours.
- In 2010, due to a budget deficit, Washington adopted across-the-board reductions to CARE hourly hours, with an average cut of about 10% and allowance for an Exception to the Rule (ETR) process for increases.
- The grant of CARE hours is flexible; it is not a guaranteed minimum and can be adjusted based on resources and assessments; Washington continued to allow ETR upward adjustments.
- Plaintiffs–14 in-home care recipients, advocates, and a union–sued, arguing the cuts violated the ADA and Rehabilitation Act by increasing risk of institutionalization and discrimination against home-based disabled individuals.
- The district court denied a preliminary injunction; the panel majority granted a narrow injunction for named plaintiffs; the case discusses whether the injunction should extend more broadly and on what grounds.
- This dissent argues the panel majority misapplies Olmstead and the ADA integration mandate, relies on improper fact-finding, and would create a sweeping prohibition on budget-related service reductions.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the district court abused its discretion denying relief on irreparable harm | M.R. argues reductions threaten irreparable harm via increased institutionalization risk. | DSHS asserts harms are speculative and not irreparable; reductions are budget-driven and evenly applied. | District court abuse disputed; majority found irreparable harm likely; dissent would limit to named plaintiffs |
| Whether the ADA integration mandate requires preserving a specific level of home-based services | OLMSTEAD requires community-based placement when feasible, and reductions risk institutionalization for ADA purposes. | ADA requires nondiscrimination but not a guaranteed level of services; resources may justify reductions. | Majority embraced broader interpretation; dissent cautions against treating budget cuts as impermissible discrimination |
| Whether DOJ's statement of interest should control or be accorded deference under Auer | DOJ interpretation supports preserving community-based care; should be given deference. | DOJ statement is not a regulation or agency action; not entitled to controlling deference. | DOJ view treated as persuasive but not controlling; deference criticized by dissent |
| Whether a fundamental alteration defense applies to preserve pre-regulation levels | Preserving pre-regulation hours would be necessary to avoid constitutionally altering the program. | Costs and resource allocations could justify alterations; maintaining status quo may be a fundamental change. | Majority considered the defense, but not definitively resolved; serious questions remained |
| Whether the district court applied the correct standard of review and properly assessed individualized harms | District court undervalued individualized harms; relied on generalized reasoning. | District court properly weighed evidence; standard of review deferential to factual findings. | Disagreement as to factual assessment; appellate standard acknowledged by dissent |
Key Cases Cited
- Olmstead v. L.C. ex rel. Zimring, 527 U.S. 581 (Supreme Court 1999) (integration mandate requires community-based treatment when feasible and reasonably accommodated)
- Townsend v. Quasim, 328 F.3d 511 (9th Cir. 2003) (limits Olmstead controls to location of services; cautions against expansive duties)
- Rodriguez v. City of New York, 197 F.3d 611 (2d Cir. 1999) (distinguishes discrimination challenges from substantive service adequacy claims under ADA)
- Anderson v. City of Bessemer City, 470 U.S. 564 (Supreme Court 1985) (standard for reviewing evidentiary findings; two permissible views cannot be clearly erroneous)
- United States v. Hinkson, 585 F.3d 1247 (9th Cir. 2009) (en banc standard: findings overturned only if illogical, implausible, or unsupported)
- Beltran v. Myers, 677 F.3d 1317 (9th Cir. 2011) (public medical benefits can support irreparable harm showings in social welfare cases)
- Indep. Living Ctr. of So. Cal. v. Maxwell-Jolly, 572 F.3d 644 (9th Cir. 2009) (irreparable harm can arise from denial of medical benefits; supports injunctions)