Smith v. Watanabe

Opinion

CLAUDIA CENTER – 158255 SILVIA YEE – 222737 ERIN NEFF – 326579 Disability Rights Education & Defense Fund 3075 Adeline Street, Suite 210 Berkeley, CA 94703 Telephone: (510) 644-2555 Email: ccenter@dredf.org syee@dredf.org eneff@dredf.org ERNEST GALVAN – 196065 MAYA E. CAMPBELL – 345180 Rosen Bien Galvan & Grunfeld LLP 101 Mission Street, Sixth Floor San Francisco, California 94105-1738 Telephone: (415) 433-6830 Facsimile: (415) 433-7104 Email: egalvan@rbgg.com mcampbell@rbgg.com Attorneys for Plaintiffs UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF CALIFORNIA, OAKLAND DIVISION RUSSELL RAWLINGS, JESSICA LEHMAN, Case No.: 4:21-cv-07872-HSG AND CALIFORNIA FOUNDATION FOR CALIFORNIA NONPROFIT JOINT STIPULATION OF DISMISSAL Judge: Hon. Haywood S. Gilliam, Jr. Plaintiffs, Action Filed: October 7, 2021 v. Trial Date: February 2, 2026 SERVICES AGENCY AND CALIFORNIA CARE, Defendants. The parties have reached a settlement of this matter which is attached as Exhibit A. The settlement includes commitments by Defendant Department of Managed Health Care (DMHC) at paragraphs 9, 10, and 11, and an agreed-upon process for resolving Plaintiffs’ claim for attorneys’ fees and costs at paragraph 12. Pursuant to Federal Rule of Civil Procedure 41(a)(1)(A)(ii), and as stated in paragraph 13, the parties stipulate and agree to dismiss this action with prejudice with retained jurisdiction for enforcement of the settlement agreement pursuant to Kokkonen v. Guardian Life Ins. Co. of America, 511 U.S. 375 (1994). Plaintiffs may seek to enforce the settlement agreement or move to reopen the action in the event that the new benchmark plan is not allowed by the federal government or passed by the legislature, or if the wheelchair benefit of the new benchmark plan is vetoed in whole or in part by the Governor. Respectfully submitted, Dated: September 9, 2025 DISABILITY RIGHTS EDUCATION AND DEFENSE FUND /s/ Claudia Center, DISABILITY RIGHTS EDUCATION AND DEFENSE FUND DISABILITY RIGHTS EDUCATION AND DEFENSE FUND /s/ Ernest Galvan, ROSEN BIEN GALVAN & Attorneys for Plaintiffs Dated: September 9, 2025 ROB BONTA Attorney General of California JULIE T. TRINH Supervising Deputy Attorney General /s/ Dane Barca, Deputy Attorney General Attorney for Defendants \ ECF ATTESTATION In accordance with Civil Local Rule 5-1(4)(3), I, Alexandra Cline, attest that I have obtained concurrence in the filing of this document from all other signatories listed here. > Dated: September 9, 2025 By: / Le (ox Alexandta Cline 1] 2] 4750989.1] JOINT STIPULATION OF DISMISSAL AND ORDER

ORDER The terms and conditions of the parties’ August 29, 2025, Settlement Agreement are incorporated by reference into this Order. The Court retains jurisdiction to enforce the terms of the Settlement Agreement pursuant to Kokkonen vy. Guardian Life Ins. Co., 511 U.S. 375 (1994) and in accordance with paragraph 13 of the Settlement Agreement. Subject to the foregoing, the Clerk of Court is directed to dismiss this matter. All dates g deadlines are hereby vacated. 1] Dated: 9/9/2025 Hon. Haywood S. Gilliam, Jr. UNITED STATES DISTRICT JUDGE 2] 4750989.1] JOINT STIPULATION OF DISMISSAL AND ORDER

EXHIBIT A CLAUDIA CENTER – 158255 SILVIA YEE – 222737 ERIN NEFF – 326579 DISABILITY RIGHTS EDUCATION AND DEFENSE FUND 3075 Adeline Street, Suite 210 Berkeley, California 94703 Telephone: (510) 644-2555 Email: ccenter@dredf.org syee@dredf.org eneff@dredf.org ERNEST GALVAN – 196065 MAYA E. CAMPBELL – 345180 ROSEN BIEN GALVAN & GRUNFELD LLP 101 Mission Street, Sixth Floor San Francisco, California 94105-1738 Telephone: (415) 433-6830 Facsimile: (415) 433-7104 Email: egalvan@rbgg.com mcampbell@rbgg.com Attorneys for Plaintiffs RUSSELL RAWLINGS, JESSICA Case No. 4:21-cv-07872-HSG LEHMAN, and CALIFORNIA FOUNDATION FOR INDEPENDENT LIVING CENTERS, a California nonprofit Judge: Hon. Haywood S. Gilliam, Jr. corporation, Plaintiffs, Action Filed: October 7, 2021 Trial Date: February 2, 2026 v. SERVICES AGENCY and CALIFORNIA DEPARTMENT OF MANAGED Defendants. 1. WHEREAS, the California Department of Managed Health Care (DMHC) is a state government entity that licenses and regulates health care service plans in the State of California, and is responsible for implementing and enforcing the Essential Health Benefits (EHB) provisions of the federal Affordable Care Act (“ACA”). 2. WHEREAS, the Plaintiffs sued DMHC and its parent agency, the California Health and Human Services Agency (CalHHS), alleging that these state entities violated Section 1557 of the ACA by implementing California’s EHB plan in a manner that excludes Durable Medical Equipment (DME) coverage for wheelchairs. 3. WHEREAS, DMHC and CalHHS contend that they are obligated by a state statute that established California’s EHB benchmark and that does not include wheelchairs. 4. WHEREAS, the United States District Court for the Northern District of California ruled that Plaintiffs had adequately alleged that the exclusion of wheelchairs resulted in a denial of “meaningful access to a benefit (i.e. wheelchair coverage) needed to address a condition that is a proxy for their mobility disability.” Smith v. Cal. Dep't of Managed Health Care, No. 21-CV-07872-HSG, 2023 WL 8125337, at *9 (N.D. Cal. Nov. 22, 2023). 5. WHEREAS, Plaintiffs have served, but DMHC has not responded to, discovery requests. 6. WHEREAS, DMHC on May 7, 2025, requested that the Centers for Medicare & Medicaid Services, a federal agency in the United States Department of Health and Human Services, approve a new EHB plan for the State of California that includes “[m]obility devices, including but not limited to, walkers and manual and power wheelchairs, and scooters.” 7. WHEREAS, the California Senate on May 27, 2025, passed Senate Bill 62, and the California Assembly on May 29, 2025, passed Assembly Bill 224, which are identical bills to add wheelchairs to the EHB starting January 1, 2027. forth in this Agreement, the Parties desire to fully and finally resolve this matter on the following terms and conditions. 9. DMHC commits to use best efforts to secure a wheelchair benefit in a new California EHB benchmark plan with the following characteristics: the benefit will cover medically necessary wheelchairs; it will not include a dollar limitation on medically necessary wheelchairs; cost-sharing will be counted toward deductible and maximum out- of-pocket amounts in the plan; and it will not include a “home use” or “in the home” rule. 10. DMHC agrees to require health plans subject to Health and Safety Code § 1367.005 to describe the wheelchair benefit under the new benchmark plan in their applicable Evidence of Coverage language. All such health plans must describe the benefit in the Evidence of Coverage for each health plan product available to the enrollees in those products. 11. DMHC agrees to provide reasonable discovery responses to Plaintiffs’ pending Requests for Production 14 and 20, as modified through meet and confer. Plaintiffs will not include any time related to this term in any request for fees and costs. 12. The parties agree to negotiate attorneys’ fees and costs. Plaintiffs are the prevailing parties in this action for the purposes of being entitled to attorneys’ fees and costs. Should the parties be unable to reach an agreement on the amount of attorneys’ fees and costs, Plaintiffs may file a motion for attorneys’ fees and costs. Defendants will not contest Plaintiffs’ entitlement to fees up to $400,000.00. Plaintiffs will not seek fees and costs under this agreement until the following events occur: a new benchmark plan including the above-described wheelchair benefit is passed by the legislature; said wheelchair benefit is not vetoed in whole or in part by the Governor; and is approved by CMS. If these events do not occur, this agreement is without prejudice to Plaintiffs’ right to seek attorneys’ fees and costs in the ordinary course of the litigation. 13. The Parties will stipulate to a dismissal with prejudice with retained 1 Guardian Life Ins. Co. of America, 511 U.S. 375 (1994). Plaintiffs may seek to enforce the settlement agreement or move to reopen the action in the event that the new benchmark 3 plan is not allowed by the federal government or passed by the legislature, or if the wheelchair benefit of the new benchmark plan is vetoed in whole or in part by the 5 Governor. 7 DATED: August 29 , 2025 Respectfully submitted, 8 DISABILITY RIGHTS EDUCATION AND 9 DEFENSE FUND; ROSEN BIEN GALVAN & GRUNFELD LLP

By: C4 wh dtr Claudia Center, DISABILITY RIGHTS EDUCATION AND DEFENSE FUND py. 2bb— Ernest Galvan, ROSEN BIEN GALVAN & Attorneys for Plaintiffs /DATED: August 28, 2025 Respectfully submitted, Attorney General of California JULIE T. TRINH Supervising Deputy Attorney General f od an By: Done C O = Dane Barca, Deputy Attorney General Attorneys for Defendants