Reduction of personal care benefits. Claims against state agencies and officials for restitution of benefits and payments that were reduced under a shared living rule were dismissed. Claims that the shared living rule violated the comparability requirements of Soc. Sec. Act §1902(a)(10)(B) had previously been dismissed as moot (see ¶302,434) after the rule was repealed. The application of the shared living rule did not violate either the Americans with Disabilities Act (ADA) or Section 504 of the Rehabilitation Act of 1974 because the reduction of recipients' benefits was based upon their sharing living quarters with their care providers, not their disabilities. The integration requirements of the ADA were not violated because the agencies' actions did not result in institutionalization; all recipients continued to live in the community. The state agency and officials were entitled to judgment as a matter of law.
The application of a shared living rule, under which recipients with live-in caregivers were presumed to need 15 percent fewer hours of service than those with live-out caregivers, did not violate the Takings Clause of the United States Constitution because the recipients did not establish that any of their needs were unmet or that anyone was institutionalized due to the reduction in services. The providers' contracts with the Medicaid agency stated that they would be paid only for the hours authorized by the agency, and the agency had wide discretion in authorization of services. Therefore, the providers did not establish any violation either of the Takings Clause or of the Contracts Clause. Awards of restitution or money damages are not available against the agency or against individuals in their official capacity because of the Eleventh Amendment bar to suits against the states. The state officials sued in their individual capacities are immune from suit for violations of the Due Process and Equal Protection Clauses because a reasonable official could have believed that the shared living rule was consistent with constitutional requirements. It was unnecessary to decide any issues under state law, including collateral estoppel, or whether the agency was bound by state court rulings invalidating the shared living rule. The state agency and officials were entitled to judgment as a matter of law.
Pfaff v. Washington Department of Social and Health Services, W.D. Wash., Dec. 8, 2008.
For more information on this and related topics, consult the CCH® Medicare and Medicaid Guide.
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