MCKENNA v. MAINE DEPARTMENT OF HEALTH AND HUMAN SERVICES

CourtDistrict Court, D. Maine
DecidedSeptember 27, 2024
Docket2:23-cv-00366
StatusUnknown

This text of MCKENNA v. MAINE DEPARTMENT OF HEALTH AND HUMAN SERVICES (MCKENNA v. MAINE DEPARTMENT OF HEALTH AND HUMAN SERVICES) is published on Counsel Stack Legal Research, covering District Court, D. Maine primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
MCKENNA v. MAINE DEPARTMENT OF HEALTH AND HUMAN SERVICES, (D. Me. 2024).

Opinion

UNITED STATES DISTRICT COURT DISTRICT OF MAINE

GAVEN MCKENNA and ) JARED MCKENNA, ) by and through their co-Guardians ) Steven and Catherine McKenna, ) ) Plaintiffs, ) ) v. ) Docket No. 2:23-cv-00366-NT ) MAINE DEPARTMENT OF HEALTH ) AND HUMAN SERVICES, ) ) Defendant. )

ORDER ON DEFENDANT’S MOTION TO DISMISS Before me is the Defendant’s Motion to Dismiss the Plaintiffs’ Complaint (ECF No. 8). For the reasons stated below, I GRANT the motion. FACTUAL BACKGROUND Gaven and Jared McKenna (the “Plaintiffs”) are adult brothers who live with their parents Steven (“Steve”)1 and Catherine (“Kerri”) McKenna (together, the “McKennas”) in Shapleigh, Maine. Compl. ¶¶ 1, 3, 11 (ECF No. 1). Gaven has been diagnosed with autism and moderate-to-severe intellectual disabilities. Compl. ¶ 9. He is nonverbal and incontinent of bowel and bladder. Compl. ¶ 9. Jared has been diagnosed with autism, moderate intellectual disabilities, and generalized anxiety disorder. Compl. ¶ 10. Gaven and Jared each require assistance with all activities of

1 I use first names in this Order, as the Plaintiffs and their parents share a last name. daily living and around-the-clock supervision to ensure their health and safety. Compl. ¶ 12. Gaven and Jared both qualify for “Shared Living Services,” which is a Medicaid

Home and Community-Based Service waiver program, administered by the Maine Department of Health & Human Services (“DHHS”) through MaineCare. Compl. ¶¶ 13–16. Shared Living Services are available to MaineCare members with intellectual disabilities or autism who are eligible for an institutional level of care, but instead choose to receive services in a community-based setting. Compl. ¶ 13. Steve and Kerri McKenna are each certified as a “Direct Support Professional” (“DSP”), meaning they can be reimbursed by DHHS for providing Shared Living

Services. Compl. ¶¶ 19, 25. Both Plaintiffs qualify for Shared Living Services at a level of service known as “Single Member Served,” which is when one DSP serves only one member. Compl. ¶¶ 16, 24. In August of 2018, DHHS approved Kerri as Jared’s DSP to provide Single Member Served level services in their family home. Compl. ¶ 21. The reimbursement rate for this level of service is $156 per diem. Compl. ¶ 25. In May of 2019, the family

applied for Gaven, like Jared, to receive care at home at the Single Member Served level, with Steve as Gaven’s DSP. Compl. ¶ 22. But in August of 2019, the Plaintiffs received notice that because they lived together, DHHS had approved them for a different service level: “Shared Living, two members served.” Compl. ¶ 23. At this level of service, one DSP serves two members simultaneously; in other words, it is a two-on-one rather than a one-on-one arrangement. Compl. ¶ 24. The reimbursement rate for Shared Living, two members served is $78.02 per diem. Compl. ¶ 25. Notwithstanding DHHS’s decision, Steve and Kerri continued to act as DSPs to their children at a Single Member Served level of care. Compl. ¶ 33. This meant the

McKennas received the same amount from DHHS to care for both Gaven and Jared as they had been receiving to care just for Jared. Compl. ¶¶ 21, 23, 25–26, 33. DHHS based its decision—that Gaven and Jared could not both receive Single Member Served level support in the same home—on the following regulation from the MaineCare Benefits Manual: Shared Living (Foster Care-adult) is a model in which services are provided to a member by a person who meets all of the requirements of a [DSP] with whom that member shares a home . . . . Only one member may receive services in any one Shared Living arrangement at the same time unless a relationship existed prior to the service arrangement and the arrangement is approved by DHHS. In such case, no more than two members may be served in any one Shared Living arrangement concurrently.

Compl. ¶¶ 27–28.2 DHHS reached this decision by interpreting the term “arrangement” to mean “home” rather than the service relationship between the member and DSP. Compl. ¶ 29. From this interpretation, DHHS determined that Gaven and Jared could not both receive Single Member Served care while living under the same roof. Compl. ¶¶ 30–31.

2 I have quoted this provision of the MaineCare Benefits Manual as it appears in the Plaintiffs’ Complaint. The Plaintiffs cite Chapter II, Section 21.02-28 of the MaineCare Benefits Manual as the source of this provision. I infer that the Plaintiffs meant, however, to cite Chapter II, Section 29.02- 25, because that is the section that contained the relevant “[o]nly one member may receive services in any one Share Living arrangement” language. See Me. Code R. 10-144, Ch. 101, ch. II § 29.02-25 (2019). I note that this section of the MaineCare Benefits Manual has since been renumbered, and the “[o]nly one member” language has been revised. See Me. Code R. 10-144, ch. II § 29.05-12 (2024). In 2020, Steve and Kerri challenged DHHS’s interpretation of this regulation by filing suit in the Maine Superior Court for York County under the Maine Administrative Procedures Act and Rule 80C of the Maine Rules of Civil Procedure

(“Rule 80C”). Compl. ¶ 34. The Superior Court agreed that DHHS’s interpretation of the regulation was “arbitrary, unreasonable, and inconsistent” with the policy of “maximizing community inclusion in a Shared Living family environment.” Compl. ¶ 35. The Superior Court ordered DHHS to approve both Gaven and Jared for services at the Single Member Served level within the same home, and DHHS has complied with that order. Compl. ¶¶ 35–36. Gaven and Jared continue to live together with their parents, as they have throughout this dispute. Compl. ¶ 11.

In September of 2023, Gaven and Jared filed suit in this Court seeking relief for the period when DHHS reimbursed them for care from one DSP at the Two Members Served rate (rather than from two DSPs at the Single Member Served rate). Compl. at 1–2, 11. Specifically, they assert that by denying services they were otherwise entitled to receive, DHHS discriminated against each of them based on their association with an individual with a disability, in violation of Title II of the Americans

with Disabilities Act (“ADA”), 42 U.S.C. § 12132 (Count I), and the Maine Human Rights Act (“MHRA”), 5 M.R.S. § 4592(6) (Count II). Compl. ¶¶ 37–44. DHHS has moved to dismiss their Complaint under Federal Rules of Civil Procedure 12(b)(1) and 12(b)(6). Def.’s Mot. to Dismiss (“Def.’s Mot.”) (ECF No. 8). LEGAL STANDARD Under Federal Rule of Civil Procedure 12(b), a party may move to dismiss a complaint for “lack of subject-matter jurisdiction” or “failure to state a claim upon which relief can be granted.” Fed. R. Civ. P. 12(b)(1), (6). In reviewing such motions,

I accept all well-pleaded facts as true and draw all reasonable inferences in the nonmoving party’s favor. Squeri v. Mount Ida Coll., 954 F.3d 56, 61 (1st Cir. 2020) (applying Rule 12(b)(6)); Aversa v. United States, 99 F.3d 1200, 1210 (1st Cir. 1996) (applying Rule 12(b)(1)); see Lyman v. Baker, 954 F.3d 351, 359–60 (1st Cir. 2020) (noting the First Circuit applies “the same basic principles” when reviewing dismissals under Rules 12(b)(1) and 12(b)(6)). “When faced with motions to dismiss

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Bluebook (online)
MCKENNA v. MAINE DEPARTMENT OF HEALTH AND HUMAN SERVICES, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mckenna-v-maine-department-of-health-and-human-services-med-2024.