Emily Fitzmorris, et al. v. New Hampshire Department of Health and Human Services Commissioner Lori Weaver, et al.

2023 DNH 036
District Court, D. New Hampshire·Decided April 17, 2023·No. 21-cv-25-PB·Published·Cited by 5 cases

Opinion

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW HAMPSHIRE

Emily Fitzmorris, et al.

v. Case No. 21-cv-25-PB Opinion No. 2023 DNH 036

New Hampshire Department of Health and Human Services Commissioner Lori Weaver, et al.

MEMORANDUM AND ORDER

The plaintiffs in this putative class action are disabled individuals who are enrolled in New Hampshire’s Choices for Independence (CFI) waiver program, a Medicaid program administered by the New Hampshire Department of Health and Human Services (DHHS). The CFI waiver program provides home and community-based care services to adults who otherwise would be Medicaid-eligible for nursing home care. The plaintiffs claim that DHHS has failed to operate the CFI waiver program in a way that ensures participants receive all of their authorized services.

The plaintiffs filed a complaint against DHHS and its Commissioner, alleging that the defendants’ systemic failure to provide CFI waiver participants with their authorized services violates the Medicaid Act, the Americans with Disabilities Act, and the Rehabilitation Act. The plaintiffs now move for class certification.

I. BACKGROUND

A. The CFI Waiver Program “Medicaid is a cooperative federal-state program that provides medical care to needy individuals.” Douglas v. Indep. Living Ctr. of S. Cal., 565 U.S. 606, 610 (2012). States wishing to participate in the program must submit a “state Medicaid plan” that describes the services the state will provide and explains how it will administer the program. See 42 U.S.C. § 1396a. The U.S. Department of Health and Human Services must approve the plan before a state is eligible to receive federal funds. See Douglas, 565 U.S. at 610. States may apply for a “waiver” that exempts a state plan from certain requirements. See 42 U.S.C. § 1396n. Obtaining a waiver enables the state to establish a program to provide home and community-based services to persons who would otherwise require institutional care. See id. at § 1396n(c); see also 42 C.F.R. §§ 441.300 et seq.

New Hampshire established the CFI waiver program pursuant to such a waiver. See Doc. 91-1 at 1-2. The program provides home and community- based services to Medicaid-eligible adults who clinically qualify for nursing home services, but “prefer to be cared for at home or in other settings less acute than a nursing facility.” See N.H. Rev. Stat. Ann. §§ 151-E:1(II); 151- E:3(I)(a). DHHS is the state agency “responsible for CFI waiver operations, including waiver program monitoring.” Doc. 23-3 at 15.

DHHS implements the CFI waiver program through a network of eight private case management agencies that are licensed and regulated by the state. See Price v. Shibinette, 2021 DNH 179 at 5; Doc. 91-1 at 6. Once DHHS determines that an individual is eligible for the program, the participant is paired with a case management agency. N.H. Admin. R. He-E § 805.07. The case management agency, in turn, determines what services are necessary to meet the needs of the participant and then seeks DHHS authorization for those services. Id. at §§ 801.05; 801.06. When authorization is received, the case management agency is tasked with coordinating the participant’s waiver services, which are delivered by private service providers. See id. at § 805.05(c)-(d). Case management agencies are responsible for “[e]nsur[ing] that services . . . are being provided,” and must conduct a quarterly review of their participants’ records in order to “evaluate the delivery of services.” Id. at §§ 805.05(d)(2); 805.10(a). The agency must then “take any remedial action necessary to address deficiencies in service delivery” identified in the quarterly review. Id. at § 805.10(c). Nonetheless, case management agencies retain considerable discretion in determining how best to ensure that participants receive all their authorized services. See id. at §§ 805.05(d); 805.10(c). Notwithstanding the substantial involvement of private actors, the proper administration of the CFI program remains the ultimate responsibility of DHHS. See Price, 2021 DNH 179 at 27.

B. Statutory Requirements Like all state Medicaid plans, the CFI waiver program must comply with a number of federal statutes, including the Medicaid Act, the Americans with Disabilities Act, and the Rehabilitation Act. Under the Medicaid Act, all covered services must be furnished to eligible participants “with reasonable promptness.” See 42 U.S.C. § 1396a(a)(8); see also 42 U.S.C. § 1396d(a) (defining “medical assistance” to include “the care and services themselves”); Rosie D. v. Romney, 410 F. Supp.2d 18, 27 (D. Mass. 2006); Lewis v. N.M. Dep’t of Health, 275 F. Supp.2d 1319, 1344 (D.N.M. 2003). Whether a delay in the provision of services is “reasonable” requires consideration of several factors, including “[t]he urgency of an individual’s need, the health and welfare concerns of the individual, the nature of the services required, the potential need to increase the supply of providers, [and] the availability of similar or alternative services[.]” See Murphy ex rel. Murphy v. Minn. Dep’t of Human Servs., 260 F. Supp.3d 1084, 1107 (D. Minn. 2017) (quoting U.S. Dep’t of Health & Human Servs., Olmstead Update No. 4, HCFA Update at 6 (Jan. 10, 2001)) (alterations in original).

The CFI waiver program must also comply with Title II of the Americans with Disabilities Act (Title II), 42 U.S.C. §§ 12131 et seq., and

Section 504 of the Rehabilitation Act (Section 504), 29 U.S.C. §§ 794 et seq. 1 Both Title II and Section 504 prohibit discrimination on the basis of disability. 42 U.S.C. § 12132; 29 U.S.C. § 794. One form of prohibited discrimination is the “unjustified institutional isolation of persons with disabilities.” See Olmstead v. L.C. ex rel. Zimring, 527 U.S. 581, 600 (1999). Title II and Section 504 employ similar implementing regulations, two of which are relevant here: the integration mandate and the methods of administration regulation. 2 The integration mandate requires entities to “administer services, programs, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities.” See 28 C.F.R. § 35.130(d); see also 45 C.F.R. § 84.4(b)(2); 28 C.F.R. § 41.51(d). “The most integrated setting is defined as a setting that enables individuals with disabilities to interact with nondisabled persons to the fullest extent possible.” Parent/Professional

1 Title II applies to public entities, including state agencies, whereas Section 504 applies to programs that receive federal funds. See 42 U.S.C. § 12131; 29 U.S.C. § 794.

2 The parties’ briefing assumes that the relevant provisions of Title II and Section 504 are coextensive. Accordingly, I address the statutory provisions together. Cf. Theriault v. Flynn, 162 F.3d 46, 48 n.3 (1st Cir. 1998) (“Title II of the ADA was expressly modeled after Section 504 of the Rehabilitation Act, and is to be interpreted consistently with that provision.”).

Advocacy League v. City of Springfield, 934 F.3d 13, 18 (1st Cir. 2019) (hereinafter PPAL) (cleaned up). Pursuant to this regulation, entities must provide services in the community, rather than in institutional settings, if “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 [disabilities].” See Olmstead, 527 U.S. at 587.

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Emily Fitzmorris, et al. v. New Hampshire Department of Health and Human Services Commissioner Lori Weaver, et al., 2023 DNH 036 (D.N.H. 2023).

2023 DNH 036 (Emily Fitzmorris, et al. v. New Hampshire Department of Health and Human Services Commissioner Lori Weaver, et al.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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