Michael Beckem v. Indiana Family and Social Ser
823 F.3d 902
7th Cir.2016Background
- Indiana operated three Medicaid home- and community-based waivers: Aged & Disabled (A&D, uncapped), Community Integration & Habilitation (CIH, uncapped, more selective), and Family Supports (FS, capped at $16,545/year). State agencies assign services via case managers and also provide Medicaid "prior-authorization" home-health services that must be delivered in the home.
- In 2011 Indiana tightened A&D eligibility, excluding many developmentally disabled persons unless they met both "skilled medical need" and substantial functional limitations; many formerly on A&D were moved to the capped FS waiver in 2013.
- Plaintiffs (developmentally disabled individuals and guardians) allege the move drastically reduced community time (from ~40 hours/week to ~10–12 hours/week), produced dangerous supervision gaps, and put them at serious risk of institutionalization; some later obtained CIH or A&D slots but several remained on FS.
- District court denied class certification and granted summary judgment to the State, finding the ADA integration mandate inapplicable; plaintiffs appealed.
- Seventh Circuit reversed summary judgment on individual integration-mandate claims (finding genuine factual disputes whether the policy caused segregation or serious risk of institutionalization) but affirmed denial of class certification as the proposed class definition was vague.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Does the ADA "integration mandate" cover community-dwelling individuals segregated in their homes or at serious risk of institutionalization? | Integration mandate applies beyond institutions to settings that prevent interaction with non-disabled persons; plaintiffs are segregated at home and/or at serious risk of institutionalization. | Mandate applies only to persons literally institutionalized; community-dwelling individuals are outside its scope. | Mandate covers segregation in the home and persons at serious risk of institutionalization; DOJ guidance and Olmstead support broad application. |
| Were plaintiffs’ claims ripe and within Olmstead’s scope (risk-of-institutionalization theory)? | Yes — plaintiffs provided evidence of supervision gaps and CIH unavailability, creating a genuine risk of institutionalization. | State contended hypothetical availability of CIH or other safeguards made claims unripe/insufficient. | Claims are ripe; factual disputes about adequacy of CIH and causation preclude summary judgment. |
| Would providing more community-based waiver services fundamentally alter Indiana’s programs (Olmstead third prong)? | Plaintiffs seek reallocation of existing service types (waiver vs prior-authorized in-home services), not creation of new programs; modest reallocation won’t fundamentally alter programs. | Changing eligibility or reallocating resources would be a fundamental alteration and thus unreasonable. | State failed to show fundamental alteration; plaintiffs’ requested redistribution is reasonable and factual record does not support a defense. |
| Was the proposed class certifiable under Rule 23? | Plaintiffs proposed a class of persons terminated from A&D by the 2011 policy who require more services than FS provides and are not enrolled in CIH. | State argued class fails commonality, typicality, and other 23 requirements. | Denial of class certification affirmed: the class definition is impermissibly vague (unclear meaning of "require"). |
Key Cases Cited
- Olmstead v. L.C., 527 U.S. 581 (1999) (ADA integration mandate prohibits unjustified institutional isolation; test balancing appropriateness, non-opposition, and reasonable accommodation considering resources)
- Amundson ex rel. Amundson v. Wisconsin Dep’t of Health Servs., 721 F.3d 871 (7th Cir. 2013) (ripeness and risk-of-institutionalization analysis under Olmstead)
- Radaszewski ex rel. Radaszewski v. Maram, 383 F.3d 599 (7th Cir. 2004) (state may violate Title II by denying existing benefits that enable community integration)
- Fisher v. Oklahoma Health Care Auth., 335 F.3d 1175 (10th Cir. 2003) (integration-mandate scope and rejection of requirement that plaintiffs be institutionalized before relief)
- Pashby v. Delia, 709 F.3d 307 (4th Cir. 2013) ("setting" in integration mandate not limited to institutionalized persons)
- Omega Healthcare Inv’rs, Inc. v. Res-Care, Inc., 475 F.3d 853 (7th Cir. 2007) (Olmstead stands for proposition about appropriateness of community-based placement)