Rekhter v. Dep't of Soc. & Health Servs.

Washington Supreme Court·Decided April 3, 2014·No. 86822-1·Published

Opinion

Fl LE IN CLERKS OFFICE This opinion was filed for record at ~'B '·qo a r)? on Ap c a 2-QI'-f

~~

........ COURT, STATEOFWMI.Gftll

-L:~ o3 2014 I ~~~ Ronaki R. carper.

Supreme Court Clerk

IN THE SUPREME COURT OF THE STATE OF WASHINGTON

LEY A REKHTER, an individual receiving Medicaid benefits ) under the Community Options Program Entry System (COPES), ) No. 86822-1 and ALEX ZIMMERMAN, an aggrieved live-in care provider ) for an individual in the COPES program, LISA R. FUCHSER, ) En Bane an individual receiving Medicaid benefits under the Medicaid ) Personal care (MPC) program, and JUDITH L. ALBERTS, a ) live-in care provider for an individual in the MPC program, and ) PAUL RACCI-IETA, a live-in care provider for an individual in ) the COPES program, and others similarly situated, )

)

Respondents/Cross-Appellants, )

)

v. )

)

STATE OF WASHINGTON, DEPARTMENT OF SOCIAL ) AND HEALTH SERVICES, a Washington State Agency, ) ROBIN ARNOLD-WILLIAMS -(individual and official ) capacities), Secretary ofDSHS, DENNIS BRADDOCK ) (individual and official capacities), former Secretary ofDSI-IS, ) KATHY LEITCH (individual and official capacities), Assistant ) Secretary for the Aging and Disability Services Administration, ) Jane and John Doe Nos. 1 thru 100, )

)

Appellants/Cross-Respondents. )

________________________________________) NATASHA PFAFF, by and through her guardians, Maureen ) and Donald Pfaff, individually and on behalf of all other ) similarly situated persons, )

)

Respondent/Cross-Appellant, )

)

v. )

)

ROBIN ARNOLD-WILLIAMS, in her official capacity as the ) Secretary ofWASHINGTON STATE DEPARTMENT OF ) SOCIAL AND HEALTH SERVICES, and the WASHINGTON ) STATE DEPARTMENT OF SOCIAL AND HEALTH ) SERVICES, )

)

Appellants/Cross-Respondents. )

_________________________________________)

Rekhter v. Dep 't of Soc. & Health Servs. No. 86822-1

SERVICE EMPLOYEES INTERNATIONAL UNION 775, on ) behalf of the individual providers it represents, and CINDY ) WEENS, individually and on behalf of all other similarly ) situated persons, )

)

Respondents/Cross-Appellants, )

)

v. )

)

ROBIN ARNOLD-WILLIAMS, in her official capacity as the ) Secretary of WASHINGTON STATE DEPARTMENT OF ) SOCIAL AND HEALTH SERVICES, and the WASHINGTON ) STATE DEPARTMENT OF SOCIAL AND HEALTH ) SERVICES, )

)

Appellants/Cross-Respondents. )

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _) Filed _A_PR_0_3_2_0_14_

OWENS, J. -- In this class action case, a jury found that the Department of Social and Health Services (DSHS) violated the implied duty of good faith and fair dealing in its contracts with individual providers who live with the DSHS clients for whom they provide care. The jury found that the providers incurred $57,123,794.50 in damages, and the judge awarded an additional $38,652,219.85 in interest. The DSHS clients who lived with their providers also filed a class action suit, but the judge did not allow them to recover any damages. We uphold the jury's verdict for the providers, the judge's decision to disallow the clients from recovering damages, and the dismissal of the providers' wage claims, because all comply with Washington law. However, we reverse the judge's award of prejudgment interest because the damages could not be determined with certainty.

Rekhter v. Dep 't ofSoc. & Health Servs. No. 86822-1

FACTS

DSHS provides public assistance for in-home care for certain individuals with disabilities, referred to herein as "clients." To provide this assistance, DSHS contracts with individual care providers to perform necessary services for clients. In their contracts with DSHS, the providers agree to assist with those personal care services and household tasks included in the client's "service plan." The providers also agree that DSHS will pay only for authorized services in the client's service plan and that their monthly payment will not exceed the amount authorized in the service plan. The contracts explicitly incorporate by reference the service plan of the particular client, but because the contracts are signed before the service plan is created, key terms such as tasks to be performed and authorized hours are left undefined until long after the contract is executed.

Beginning in 2003, DSHS implemented the Comprehensive Assessment and Reporting Evaluation (CARE) process to determine how many hours of paid assistance a client was eligible to receive. Part of the CARE process was the shared living rule, which automatically reduced assistance for in-home care by 15 percent for clients that live with their providers. The rationale for the shared living rule was that the providers would already be performing certain household tasks (shopping, laundry, housekeeping, meal preparation, and wood supply services) even if they were not providing in-home care for a person with a disability. The shared living rule

Rekhter v. Dep 't ofSoc. & Health Servs. No. 86822-1

created an irrebuttable presumption that clients living with their providers needed 15 percent less paid assistance, even if those clients did need assistance with those household tasks.

When DSHS reduced the authorized hours of support for a client pursuant to the shared living rule, it did not change or reduce the service plan's list of services the provider was required to perform. Indeed, even when a service plan specifically described a client's need for help with shopping or cooking as "[t]otal dependence" and instructed the caregiver to complete such tasks, DSHS still eliminated payment for such household tasks because the client lived with the provider. See Clerk's Papers (CP) at 3982-84. As a result, live-in providers were required by contract to perform necessary services without compensation. The structure of the agreements also resulted in DSHS requiring live-in providers to perform the same services as live- out providers for less compensation.

In 2004, three affected clients filed administrative appeals of determinations made pursuant to the shared living rule. The administrative law judges dismissed the appeals because they did not have authority to review the validity of agency rules. The three affected clients sought review in the courts, and in 2005, two trial courts held that the shared living rule was invalid under federal law. Those decisions were stayed pending a consolidated appeal, and in May 2007, this court affirmed the trial courts and found the rule violated federal law that required parity for individuals on

Rekhter v. Dep 't of Soc. & Health Servs. No. 86822-1

Medicaid. Jenkins v. Dep 't ofSoc. & Health Servs., 160 Wn.2d 287, 290-91, 157 P.3d 388 (2007). Throughout this process, DSHS continued to apply the shared living rule. DSHS ultimately repealed the shared living rule effective June 29, 2007, and began reassessing affected clients-a process that was not completed until June 2008.

Shortly after Jenkins, separate class action lawsuits were filed on behalf of clients and providers affected by the shared living rule between April 2003 and June 2008. The lawsuits were consolidated in 2009. Prior to trial, the trial judge granted summary judgment to DSHS on the providers' claims that DSHS (1) wrongfully withheld wages in violation ofRCW 49.52.050 and .070 and (2) failed to pay the providers for all hours worked, in violation of the Washington Minimum Wage Act (MWA), chapter 49.46 RCW.

At trial, the jury found that DSHS "breached an implied duty of good faith and fair dealing with the Providers as to [DSHS' s] performance of a specific term in the Individual Provider Contracts." CP at 2985. The jury found that the providers incurred $57,123,794.50 in damages. The trial judge ruled that prejudgment interest applied to the jury's verdict for the providers, which amounted to $3 8,652,219.85.

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