Friday, December 16, 2011

Breaking: Ninth Circuit Orders Washington State Budget Cuts to Personal Care Services Enjoined

This is big news for a Friday afternoon.  Today, in M.R. v. Dreyfus, the Ninth Circuit ordered that Washington State's cuts to in-home personal care services provided under its Medicaid program be enjoined as potentially violating the ADA and Olmstead.  The panel's opinion, written by Judge William Fletcher, began as follows:
Plaintiffs, Washington State Medicaid beneficiaries with severe mental and physical disabilities, appeal the district court’s denial of their motion for a preliminary injunction. Plaintiffs seek to enjoin the operation of a regulation promulgated by Washington’s Department of Social and Health Services (“DSHS”) that reduces the amount of in-home “personal care services” available under the state’s Medicaid plan. The United States Department of Justice has filed a “statement of interest” in the district court supporting Plaintiffs’ request for an injunction.  
“Personal care services” provide assistance in performing basic life activities — such as eating, bathing, dressing, moving from place to place, and using the toilet — that Plaintiffs, because of their disabilities, cannot perform by themselves. To comply with Governor Christine Gregoire’s executive order that directed an across-the-board reduction in all state agency expenditures, DSHS promulgated a regulation that cut the base hours of covered in-home personal care services by an average of 10 percent per beneficiary per month.  
Plaintiffs argue principally that the regulation violates the antidiscrimination provisions of the Americans with Disabilities Act, 42 U.S.C. § 12132, and the Rehabilitation Act, 29 U.S.C. § 794(a), because the reduction in hours will substantially increase the risk that they will be institutionalized in order to receive care adequate to maintain their mental and physical health. The district court denied preliminary relief.  
We reverse. We conclude that Plaintiffs have demonstrated a likelihood of irreparable injury because they have shown that reduced access to personal care services will place them at serious risk of institutionalization. We further conclude that Plaintiffs have raised serious questions going to the merits of their Rehabilitation Act/ADA claims, that the balance of hardships tips sharply in their favor, and that a preliminary injunction will serve the public interest. See Alliance for the Wild Rockies v. Cottrell, 632 F.3d 1127, 1131-32 (9th Cir. 2011). We therefore remand for entry of a preliminary injunction.
The panel's opinion contains an especially strong discussion of the application of Olmstead to cases in which a state's decisions put individuals at risk of institutionalization.  Judge Rawlinson dissented.

I should disclose that I was at DOJ supervising disability rights work when the statement of interest to which the panel refers was filed, so I'm obviously pleased by this result.

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