Ninth Circuit on Medicaid Waiver Caps and ADA Title II

Yesterday, the Ninth Circuit issued its opinion in The Arc of Washington State v. Braddock. In an opinion by Judge Fernandez, the court held that the integration mandate of Title II of the ADA could not be invoked to require a state to expand its Medicaid Home and Community-Based Waiver program beyond the number of slots approved in the state's Medicaid plan. The court argued that the Medicaid Act expressly contemplates that states might impose caps on the number of people eligible to participate in waiver programs, and that the statute's implementing regulations require states to adhere to the caps that appear in their state plans. Although ADA Title II's integration mandate sometimes requires states to create new community placements for people with disabilities, the court held that in this context the specific provisions of the Medicaid Act and its implementing regulations took precedence over the general terms of Title II.

That reasoning, it seems to me, can only go so far. Because the Medicaid Act permits states to impose a cap on waiver slots, it might make sense to say that the simple fact that the state has imposed such a cap cannot in and of itself violate the ADA, lest the two statutes come into conflict. But states have pretty broad discretion in deciding where to set the cap. I don't think there would be any conflict with the Medicaid Act in saying that the ADA requires the state to seek a waiver with a higher cap. From the way the opinion is written, it looks like the plaintiffs challenged the mere existence of a cap rather than the size of the cap (or at least that's how the court was reading the complaint). That means that the case does not stand as precedent against an ADA claim that seeks an increase in the size of a state's Home and Community-Based Waiver cap.