Holding/Reasoning or Conditions of Settlement

Olmstead v. L.C.
US Supreme Court
Filed 1995; Supreme Ct Order 1999

Plaintiffs were two adult women with IDD and psychiatric disabilities living in an institutional setting in Georgia. Treatment professionals concluded that plaintiffs could live safely in a community-based setting, but no such setting was available to plaintiffs and so they remained institutionalized.
Whether the state violated Title II of the ADA when it failed to provide plaintiffs with community-based placement once treatment professionals determined that such placements were appropriate. Under Title II of the ADA, States are required to place persons with mental disabilities in community settings rather than in institutions when the State’s treatment professionals have determined that community placement is appropriate, the transfer from institutional care to a less restrictive setting is not opposed by the affected individual, and the placement can be reasonably accommodated, taking into account the resources available to the State and the needs of others with mental disabilities.

The State’s responsibility, once it provides community-based treatment to qualified persons with disabilities, is not boundless. The reasonable-modifications regulation speaks of “reasonable modifications” to avoid discrimination, and allows States to resist modifications that entail a “fundamenta[l] alter[ation]” of the States’ services and programs…. The ADA is not reasonably read to impel States to phase out institutions, placing patients in need of close care at risk….Some individuals…may need institutional care from time to time to stabilize acute psychiatric symptoms. For others, no placement outside the institution may ever be appropriate.

If, for example, the State were to demonstrate that it had a comprehensive, effectively working plan for placing qualified persons with mental disabilities in less restrictive settings, and a waiting list that moved at a reasonable pace not controlled by the State’s endeavors to keep its institutions fully populated, the reasonable-modifications standard would be met.
Townsend v. Quasim
9th Circuit
Filed 2000; Trial Order 2001; Appeal Order 2003

Class action lawsuit brought by Levi Townsend. Mr. Townsend was income-eligible for Medicaid services as “categorically needy.” He was receiving long term care services in the community on a Home and Community Bases Services COPES waiver. In 1999, Mr. Townsend’s income increased and he was no longer “categorically needy,” but still qualified for Medicaid services as “medically needy.” COPES was not available for “medically needy” Medicaid clients and Mr. Townsend was informed that he would have to move to a nursing facility in order to continue accessing long term care services.
Is denying community-based long term care to “medically needy” individuals a violation of the ADA by
(1) discriminating on the basis of disability; and
(2) contravening Olmstead v. L.C., 527 U.S. 581, 119 S.Ct. 2176, 144 L.Ed.2d 540 (1999), and the ADA’s “integration regulation,” which require that public entities administer services “in the most integrated setting appropriate to the needs of qualified individuals with disabilities.” 28 C.F.R. § 35.130(d).

D.WA granted summary judgment to the Defendants.

Plaintiffs appealed grant of summary judgment on claim that denial of community-based long term care to “medically needy” violates ADA principles expressed in Olmstead. Did not appeal summary judgment on claim of discrimination based on disability.
The denial of community-based long term care services to “medically needy” individuals violates the ADA. The issue in this case is the location where long-term care services are provided. By only providing the services in nursing facilities, DSHS is violating the ADA principles expressed in Olmstead by failing to provide long-term care services to “medically needy” individuals in integrated settings, unless providing services in integrated settings would be a “fundamental alteration” of the State’s provision of services to “medically needy” individuals.

Reversed and remanded to determine if providing community-based long term care services to “medically needy” beneficiaries constituted a “fundamental alteration.”
Arc of Washington v. Braddock
9th Circuit
Filed 2003; Dismissed 2005

WA operated ICFs for individuals with IDD and provided a community-based alternative through the Home and Community Based Services (HCBS) waiver program. WA limited this HCBS waiver program to 9,977 individuals. There were not enough HCBS waivers for all individuals who preferred HCBS causing individuals to wait for open slots.

The Arc of WA brought lawsuit claiming that the HCBS cap violated the ADA.
Does a state violate the ADA when it limits the number of people that can participate in a Medicaid waiver program providing people with disabilities with alternatives to institutionalization?
W. DA granted summary judgment for defendants. Plaintiffs appealed.
Existence of a cap on HCBS waiver program funding does not violate ADA.

“We do not hold that the forced expansion of a state’s Medicaid waiver program can never be a reasonable modification required by the ADA. What we do hold is that, in this case, Washington has demonstrated it has a ‘comprehensive, effectively working plan,’ Olmstead, 527 U.S. at 605, and that its commitment to deinstitutionalization is ‘genuine, comprehensive and reasonable,’ Sanchez, 416 F.3d at 1067. Washington’s HCBS program (1) is sizable, with a cap that has increased substantially over the past two decades (2) is full; (3) is available to all Medicaid-eligible disabled persons as slots become available, based only on their mental-health needs and position on the waiting list; (4) has already significantly reduced the size of the state’s institutionalized populations; and (5) has experienced budget growth in line with, or exceeding, other state agencies. Under such circumstances, forcing the state to apply for an increase in its Medicaid waiver program cap constitutes a fundamental alternation, and is not required by the ADA.”
Boyle v. Dreyfus
Filed 2001; Settled 2006, 2010; Dismissed 2014

Class action lawsuit by Medicaid recipients on HCBS waivers administered by DDD. Class members were receiving HCBS services, but did not have service plans that met all of their assessed needs. DDD did not inform waiver participants of all the available services on HCBS waiver, provide information on how to obtain services, provide re-assessments for unmet needs, or provide adequate notice or a fair hearing when services were changed or denied.
Does failure to provide adequate notice and a fair hearing when services are denied or changed violate the due process requirements of the 14th amendment of the US Constitution?

Does failure to inform plaintiffs of all available services on HCBS waiver and failure to provide covered waiver services for all unmet needs violate federal Medicaid requirements of Social Security Act?
Settlement agreement required DDA to create and implement policies and procedures covering the following:

– Annual CARE assessment
– Ability to change Waiver placement
– Restructuring employment service resource allocation
– Oversight of newly created CIBSS services
– Administrative appeals process
– Written response to requests for services
– Choice of service provider
– Statewide availability of waiver services
– Quality Assurance oversight for waiver services
Rust v. Western State Hospital
Filed 2000; Settled/Order 2001; Dismissed 2010?

Class action lawsuit brought by patients at Western State Hospital who were involuntarily committed for competency evaluation or restoration under RCW 10.77. Patients were not receiving minimally adequate treatment(medical, dental, psychiatric) and were at serious risk of abuse and neglect.
Does WSH’s failure to provide minimally adequate treatment, discharge planning, protection from abuse and neglect, and treatment in the most integrated setting appropriate to patients involuntarily committed for competency evaluation and restoration violate US Constitution (1st and 14th amendments) and ADA? Court found that inadequate access to medical, dental and psychiatric care; inadequate discharge planning; and inadequate protection from abuse and neglect were violations of US Constitution and ADA. Court issued an order requiring WSH to provide class members with (1) constitutionally minimally adequate protection from harm and adequate and timely dental and medical care; (2) freedom from unnecessary restraint; (3) adequate discharge planning; (4) privacy; and, (5) services, care, and treatment in the most integrated setting.

Order and partial settlement agreement included individualized treatment for patients with IDD. Patients with IDD who are committed to WSH for competency evaluation and restoration under RCW 10.77 shall be provided with habilitative mental health treatment, including positive behavior supports.
Allen v. Western State Hospital
Filed 1999; Settled 2001, 2007; Dismissed 2009?

Marr v. Eastern State Hospital
Filed 2002; Settled 2002, 2008, 2010; Dismissed 2012

Pair of class action lawsuits brought by individuals with developmental disabilities who were admitted on involuntary treatment orders to WSH or ESH (Washington’s public psychiatric hospitals) or recently discharged from ESH or WSH. Class members were not receiving minimally adequate habilitation, vocational support, or behavior services at WSH and ESH from staff qualified to work with people with IDD. This resulted in a lack of adequate treatment and unnecessary seclusion, restraint, and other abuses of patients with IDD. Additionally, it was alleged that the lack of sufficient community-based habilitation services caused class members to be admitted to WSH/ESH and caused delays in discharge. Plaintiffs filed lawsuit in order to enforce constitutional rights to receive individualized habilitation, vocational, and other support services in the most integrated setting appropriate.
Does WSH/ESH’s failure to provide minimally adequate treatment, minimally adequate discharge planning, protection from abuse and neglect, and treatment in the most integrated setting appropriate to patients with IDD who were involuntarily admitted to WSH or ESH violate the US Constitution (1st and 14th amendments), the ADA, the Rehabilitation Act and the Social Security Act? Settlement Agreements:

Recognition of the need for specialized habilitation services for people with IDD with co-occurring mental illness admitted to WSH or WSH.

Creation of Habilitative Mental Health (HMH) wards that provide individualized habilitative mental health care, vocation programs, and positive behavior support.

Requirement for Intensive Case Management, crisis response and respite, and access to heightened interdisciplinary person-centered services planning and oversight of plan implementation for DDA clients with co-occurring mental illness – one of the goals of this service is to mitigate risk of psychiatric institutionalization.
Samantha A. v DSHS
WA Supreme Court
Filed 2007; Court Order 2011; Dismissed 2011

Samantha A challenged WAC that reduced financial assistance for in-home services for children based on the child’s age and whether they lived with a parent. Samantha A was eligible for 24-hour institutional care but chose to receive services at home through HCBS waiver program. 2005 rule change established automatic reductions in child’s care hours by categorizing a need as “met” based solely on the child’s age and by reducing hours if child lived with a legal parent. Under this new rule, Samantha’s hours were cut from 90/month to 39/month. This reduction was made despite the fact that Samantha was eligible for 24-hour institutional care.
Did the WAC mandating automatic reduction in hours based on a child’s age or whether they lived with their legal parent violate Medicaid comparability requirements?

WA Superior court ruled for Samantha A.

Defendant appealed to D. WA, case transferred to WA Supreme Court.
Affirmed. The WAC is invalid against Federal Medicaid comparability requirements.

On its face, the rule treats similarly situated individuals differently because children with comparable disabilities are treated differently based not upon need, but upon whom the child lives with.

The rule makes changes based on presumptions, not on the individual needs of the child with disabilities.
MR v. Dreyfus
9th Circuit
Filed 2010; Appeal upholding order 2012

Class action. Plaintiffs brought case on behalf of Medicaid beneficiaries in WA state who were eligible for ICF or NF care but chose to receive in-home personal care services on a HCBS waiver. Governor of WA issued executive order directing across-the-board reductions in all state agency expenditures – in response, DSHS promulgated a regulation that would reduce base personal care hours by an average of 10% per beneficiary per month. Plaintiffs filed PI motion to prevent the cut in base personal care hours.
Does the proposed reduction in personal care hours violate the ADA by substantially increasing the likelihood that individuals will be institutionalized in order to receive adequate care?

W.D.WA denied motion for preliminary injunction. Plaintiffs appealed.
Court granted preliminary injunction preventing the State from making the cuts to in-home personal care hours.

Plaintiffs established sufficient likelihood that the cuts would cause irreparable injury. Cuts are related to care for mental and physical health. Reduction of these services will exacerbate health difficulties putting plaintiffs at serious risk of institutionalization.

Legal standard under the integration mandate of the ADA only requires plaintiffs to show serious risk of institutionalization, not the inevitability of institutionalization.

Court approved a settlement.
CF v. Lashway
Filed 2016; Settled 2018; Dismissed 2018

Plaintiffs were all adults with IDD who were institutionalized, or at serious risk of institutionalization, at the time of filing. All wanted to receive habilitation services in a community-based setting, not in an institutional setting. Alleged that DSHS’s and HCA’s failure to establish an effective system of providing community-based support caused them to lose their community-based services and be unnecessarily institutionalized, or at serious risk of institutionalization.
Whether Defendants violate the requirements under the ADA, the Rehabilitation Act, and the Medicaid Act by failing to have an adequate system in place to (1) provide Plaintiffs and the proposed class with services in the most integrated, least restrictive community-based setting; (2) provide, with reasonable promptness, home and community-based services to Plaintiffs and the proposed class necessary to ensure their health and welfare; and (3) provide adequate notice and due process to Plaintiffs and the proposed class of their eligibility for Medicaid services, including provision of services in the least restrictive setting, and their right to appeal any such determinations through an administrative fair hearing.

Class certification denied.
Settled in 2018.

Named plaintiffs received specific relief.
Murinko v. Strange
W. D. WA
Filed 2019; Settled 2020; Ongoing Ct Jx

Shawn Murinko, an adult with IDD, had been unnecessarily hospitalized and unable to return home for 6 months at the time of filing because DSHS could not provide individualized community-based services to enable him to return home safely. Murinko had no desire to receive services in an institutional setting and alleged that DSHS’s failure to provide him with needed services caused him to be at serious risk of institutionalization.
Whether DSHS’s failure to provide plaintiff with individualized community-based supports violates the requirements under the ADA, the Rehabilitation Act, and the Medicaid Act by failing to (1) provide Plaintiff community-based services that he needs in order to avoid segregation in an institution; (2) provide, with reasonable promptness, home and community-based services to Plaintiff to ensure his health and welfare; and (3) provide a meaningful choice of providers, including a choice between institutional and community-based services. Plaintiff received specific relief.

Systemic relief:

Settlement agreement – DRW will monitor DDA’s implementation until it satisfies certain standards for compliance for individuals seeking HCBS services.

DDA must implement Critical Case Protocol (DDA Policy 4.24) for Supported Living providers/clients. Critical Case Protocol requires individualized service planning to prevent gaps and disruptions in services, which put individuals at risk of unnecessary institutionalization. Critical Case Protocol must be implemented by supported living providers at least 60 days before giving notice that services will be terminated. Protocol requires DDA to add services that are available on a client’s waiver when additional services are necessary to prevent disruption or gaps in services.

DDA must revise and implement policy governing referrals to supported living providers and supported living provider initiated termination of services (DDA Policy 4.02). Updated policy provides for enhanced information about and communication with supported living providers and requires the development of individualized transition or interim services for client’s assessed residential support needs.