This appeal arises from a class action challenging the failure of the City of New York and other appellants (collectively “New York”) to provide certain personal-care services to Medicaid recipients. Judge Scheindlin held that New York’s failure to include safety-monitoring services along with other personal care services violated: (i) the Medicaid Act, 42 U.S.C. § 1396 et seq.; (ii) certain regulations promulgated under the Act, 42 C.F.R. §§ 440.230(b), (c); 420.240(b); (iii) Section 504 of the Rehabilitation Act, 29 U.S.C. § 794; and (iv) the Americans with Disabilities Act (“ADA”), 42 U.S.C. §§ 12101 et seq. The district court entered a permanent injunction requiring that New York provide safety monitoring. We reverse.
BACKGROUND
The federal Medicaid program provides medical assistance to certain financially needy individuals. Medicaid is funded and run jointly by the federal and state governments. State participation in the program is optional. However, if a state chooses to participate, it must formulate a plan that includes certain mandatory forms of medical assistance. See 42 U.S.C. § 1396a(a)(10)(A). The Medicaid Act defines “ ‘[m]edieal assistance’ ” as “payment of part on all of the cost of the [enumerated] care and services.” Id. § 1396d(a). States are also given the option of providing additional types of coverage. See id. §§ 1396a(a)(10)(A), 1396d(a) (listing 27 different categories of medical assistance, 7 of which are mandated by § 1396a(a)(10)(A)). Once the federal government approves a state Medicaid plan, it then subsidizes a significant portion of the cost of the coverage — including optional services that the state has agreed to provide. See 42 U.S.C. § 1396; Alexander v. Choate,
New York has enacted a Medicaid program, see N.Y. Soc. Serv. Law § 363, that is administered by local social services districts within the parameters of federal and state regulation. See id. § 62(1). As part of its program, New York has opted to include personal-care services, which are not federally required. See 42 U.S.C. §§ 1396a(a)(10)(A), 1396d(a)(24); N.Y. Soc. Serv. Law § 365-a(2)(e).
New York has enumerated three types of personal-care services with a detailed list of the discrete tasks to be provided under each type. See id. § 505.14(a)(6). These services include tasks associated with numerous ADLs, including bathing, toileting, taking medication, assisting with
To determine which services it will provide, New York uses so-called task based assessment (“TBA”) programs. While the programs vary, they basically involve a medical request for home care from the patient’s physician, which is followed by an assessment by a social worker or a nurse. See Rodriguez v. Debuono,
This class action challenges New York’s failure to. include safety monitoring as an independent task in the TBA or as a provided service. Appellees are members of a class that are eligible to receive Medicaid and who suffer from mental disabilities — ■ such as Alzheimer’s disease — that cause them to require assistance with daily living tasks. They have received personal-care services but allege that, without the provision of safety monitoring as an independent service, the services provided are inadequate to meet their medical needs and to allow them to continue living in their homes. See Rodriguez,
Initially, the district court granted partial class certification and entered a preliminary injunction ordering New York to include safety monitoring as a separate task on their TBA forms. See Rodriguez,
On remand, the district court held that the TBA program violated the Medicaid Act, its regulations, the Rehabilitation Act, and the ADA. See Rodriguez v. DeBuono,
DISCUSSION
We may overturn an order granting a permanent injunction “if the district court relied upon a clearly erroneous finding of fact or incorrectly applied the law.” General Media Communications, Inc. v. Cohen,
a) Medicaid Act
Appellees first contend that the exclusion of safety monitoring from the TBA and the list of provided services violates 42 U.S.C. § 1396a(a)(10)(B). This provision states:
that the medical assistance made available to any individual described in sub-paragraph (A)—
(i) shall not be less in amount, duration, or scope than the medical assis-' tance made available to any other such individual, and
(ii) shall not be less in amount, duration, or scope than the medical assistance made available to individuals not described in subparagraph (A).
Subparagraph (A) lists the individuals to whom medical assistance must be provided, i.e., many types of needy individuals. See id. § 1396a(a)(10)(A).
We have previously elaborated upon the purpose and scope of this provision. When Congress passed the Medicaid Act in 1965, it sought to ensure that “the primary concern of the states in providing financial assistance should be those persons who lack sufficient income to meet their basic needs — termed the categorically needy.” Camacho v. Perales,
Appellees’ discrimination claim is entirely different from the types of discrimination described above. They do not contend that the medically needy receive coverage in New York not afforded to the categorically needy or that some distinction is drawn among the categorically needy. Instead, they claim that, because safety monitoring is “comparable” to the personal care services already provided by New York, the failure to provide such monitoring violates Section 1396a(a)(10)(B). See also Rodriguez,
However, Section 1396a(a)(10)(B) does not require a state to fund a benefit that it currently provides to no one. Its only proper application is in situations where the same benefit is funded for some recipients but not others. See, e.g., Blanchard v. Forrest,
We reject appellees’ further contention that because incidental safety monitoring is provided to those receiving other personal care services, it must be provided to appellees as well. Caregivers of course monitor safety while providing other personal-care services to patients. See Rodriguez,
Because New York’s program does not impermissibly discriminate under Section 1396a(a)(10)(B), New York may prevail simply by showing that the decision not to include safety monitoring as an optional benefit was reasonable. See 42 U.S.C. § 1396a(a)(17); Beal,
b) Jp2 C.F.R. § U0.230(b), (c)
Appellees next contend that appellants’ plan violated two regulations promulgated pursuant to the Medicaid Act, 42 C.F.R. § 440.230(b) & (c). Title 42 C.F.R. § 440.230 reads in relevant part as follows:
(b) Each service must be sufficient in amount, duration, and scope to reasonably achieve its purpose.
(c) The Medicaid agency may not arbitrarily deny or reduce the amount, duration, or scope of a required service under §§ 440.210 and 440.220 to an otherwise eligible recipient solely because of the diagnosis, type of illness, or condition.
Appellants contend that these regulations are not enforceable by private actions under Section 1983 but, even if they are, the regulations have not been violated. Assuming arguendo that a claim based upon these regulations is cognizable under Section 1983, cf. Concourse Rehabilitation & Nursing Ctr. Inc. v. Wing,
Title 42 C.F.R. § 440.230(b) looks to the purpose of the particular service provided. Appellees argue that the purpose of the personal care services is to enable recipients to reside in their homes, see Rodriguez,
The regulation looks to the purpose of “[e]ach service” provided, see 42 C.F.R. § 440.230(b), and where a state like New York provides numerous different services, each is to be examined independently.
Appellees’ claim under subsection (c) also suffers from a fatal problem. The regulation states that “[t]he Medicaid agency may not arbitrarily deny or reduce the amount, duration, or scope of a required service under §§ 440.210 and 440.220 to an otherwise eligible recipient solely because of the diagnosis, type of illness, or condition.” 42 C.F.R. § 440.230(c) (emphasis added). Personal care services are not a required service under Section 440.210 or Section 440.220.
c) ADA and Rehabilitation Act Claims
Because Section 504 of the Rehabilitation Act and the ADA impose identical requirements, we consider these claims in tandem. See Lincoln Cercpac v. Health & Hosps. Corp.,
Under the ADA,
no qualified individual with a disability shall, by reason of such disability, be ... denied the benefits of the services[ ][or] programs ... of a public entity, or be subjected to discrimination by any such entity.
42 U.S.C. § 12132; see also 29 U.S.C. § 794(a) (comparable requirement under the Rehabilitation Act). A “qualified individual with a disability” is defined as “an individual with a disability who ... meets the essential eligibility requirements for the receipt of services or the participation in programs or activities provided by a public entity.” 42 U.S.C. § 12131(2). There is no dispute that the appellees are disabled under the statute.
Appellees contend that they satisfy the eligibility requirements for personal care services but are effectively denied the services because of their disability. We disagree.
We begin by noting that New York provides identical services to mentally and physically disabled Medicaid recipients. Although the district court did state that “it is not clear that [certain] services are consistently provided to the mentally disabled, while comparable services are provided to the physically impaired,” Rodriguez,
Appellees again fail to focus on the particular services provided by appellants. See Alexander v. Choate,
Appellees place much reliance on the Supreme Court’s recent decision in Olm-
In Olmstead, the parties disputed only— and the Court addressed only — where Georgia should provide treatment, not whether it must provide it. See id. at 2183-84 (detailing state’s provision of treatment to mentally disabled patients in institutions). Georgia already had numerous state programs that provided community-based treatment that the Olmstead respondents were qualified to receive. See id. at 2183-84, 2188. The state contended that even though these services existed, it had a cost justification to keep certain mentally disabled individuals institutionalized.
The portion of the opinion most relevant to the instant dispute was the Court’s statement that it was explicitly not holding that “the ADA imposes on the States a standard of care for whatever medical services they render, or that the ADA requires States to provide a certain level of benefits to individuals with disabilities.” Id. at 2188 n. 14 (internal quotation marks omitted). Olmstead does not, therefore, stand for the proposition that states must provide disabled individuals with the opportunity to remain out of institutions. Instead, it holds only that “States must adhere to the ADA’s nondiscrimination requirement with regard to the services they in fact provide.” Id. (emphasis added).
Appellees want New York to provide a new benefit, while Olmstead reaffirms that the ADA does not mandate the provision of new benefits. Under the ADA, it is not our role to determine what Medicaid benefits New York must provide. See Cercpac,
We therefore reverse.
Notes
. N.Y. Soc. Serv. Law § 365-a(2)(e) states that medical assistance includes:
personal care services, including personal emergency response services, shared aide and an individual aide, furnished to an individual who is not [institutionalized], as determined to meet the recipient’s needs for assistance when cost effective and appropriate ... and when prescribed by a physician, in accordance with the recipient’s plan of treatment ... and furnished in the recipient's home or other location[.]
. Rodriguez also relies on 42 C.F.R. § 440.240. This provision states that:
Except as limited in § 440.250—
(a) The plan must provide that the services available to any categorically needy recipient under the plan are not less in amount, duration, and scope than those services available to a medically needy recipient; and
(b) The plan must provide that the services available to any individual in the following groups are equal in amount, duration, and scope for all recipients within the group:
(1) The categorically needy.
(2) A covered medically needy group.
This regulation does not differ from Section 1396a(a)(10)(B) in any respect relevant to this appeal, and our analysis is thus identical under the two provisions.
. Of course, a state could avoid such a requirement by simply ceasing to provide personal service coverage altogether as it is optional under the Medicaid Act.
. We note that courts construing this regulation have viewed as the relevant question the propriety of the manner in which a particular benefit was provided, not whether a new benefit was mandated. For example, in Charleston Memorial Hospital v. Conrad,
. Section 440.210 does require states to provide the home health services described in Section 440.70, but those required services do
. Because New York did not discriminate against appellees in violation of the ADA, we need not reach whether separately tasking safety monitoring is a "reasonable modification ]” required under the ADA by 28 C.F.R. § 35.130(b)(7).