811 F.3d 1230
10th Cir.2016Background
- Ms. Leslie Taylor is a Colorado Medicaid recipient who needs paid attendants for in-home care and for travel to medical appointments because she cannot drive.
- Colorado pays attendants under a Consumer Directed Attendant Support Services program, but that program's regulation excludes payment for attendants’ driving time.
- Colorado’s Non-Emergent Medical Transportation (NEMT) program, administered county-by-county, provides either a county-accessible van (in Ms. Taylor’s county only for recipients 60+) or a per-mile reimbursement for others; at the time of the claims Ms. Taylor did not qualify for the van.
- Plaintiffs (Ms. Taylor, two attendants, and a disability nonprofit) sued under Title II of the ADA and §504 of the Rehabilitation Act, alleging the refusal to pay attendants for driving discriminated on the basis of disability.
- The district court dismissed the claims and denied reconsideration; the Tenth Circuit affirmed, concluding the state provided the same benefits to similarly situated recipients and had no statutory duty to create the requested driver-pay benefit.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether declining to pay attendants for driving is discriminatory under ADA/Rehab Act | Taylor: agency had discretion and should have exercised it to pay attendants’ driving time; refusal is disability discrimination | Colorado: discretion to set Medicaid benefits; declining to pay is lawful and not discriminatory because benefit applies equally to all similarly situated recipients | No discrimination; states have discretion and equal treatment defeats claim |
| Whether per-mile reimbursement that undercompensates is a discriminatory "cap" | Taylor: per-mile reimbursement inadequately compensates disabled recipients and thus discriminates | Colorado: an across-the-board reimbursement limit is not discriminatory merely because it disproportionately burdens some disabled individuals | No; inadequacy does not make a generally applicable cap discriminatory |
| Whether failing to provide a compensated driver while others get driver subsidies discriminates | Taylor: she needs a driver and some recipients elsewhere get subsidized drivers | Colorado: relevant comparison is recipients in same county; in Ms. Taylor’s county no one gets driver pay under NEMT | No; Ms. Taylor is treated the same as similarly situated county residents |
| Whether agency had duty under 28 C.F.R. §35.130(b)(7) to modify program to accommodate Taylor | Taylor: regulation required modification to avoid discrimination | Colorado: modification required only if necessary to avoid discrimination and only if others already receive such benefit; requested driver pay was not available to anyone | No duty to create a new benefit; modification not required when accommodation would create a benefit unavailable to nondisabled recipients |
Key Cases Cited
- Alexander v. Choate, 469 U.S. 287 (states have substantial discretion in Medicaid benefit scope)
- Gorsuch, Ltd., B.C. v. Wells Fargo Nat’l Bank Ass’n, 771 F.3d 1230 (equal treatment to all similarly situated recipients defeats discrimination claim)
- Patton v. TIC United Corp., 77 F.3d 1235 (a limitation that applies to all is not discriminatory merely because it falls disproportionately on the disabled)
- Boatman v. Hammons, 164 F.3d 286 (differences in county expenditures do not violate uniform operation requirement)
- Wis. Cmty. Servs., Inc. v. City of Milwaukee, 465 F.3d 737 (ADA accommodation required only when necessary to avoid discrimination)
- Cohon ex rel. Bass v. N.M. Dep’t of Health, 646 F.3d 717 (apply same standards to ADA Title II and Rehabilitation Act discrimination claims)