Wolf Prado-Steiman v. Jeb Bush

221 F.3d 1266
Court of Appeals for the Eleventh Circuit·Decided August 11, 2000·No. 99-11034·Published·Cited by 1 cases

Opinion

[PUBLISH]

IN THE UNITED STATES COURT OF APPEALS

FOR THE ELEVENTH CIRCUIT FILED ________________________ U.S. COURT OF APPEALS ELEVENTH CIRCUIT

AUGUST 11, 2000

No. 99-11034

THOMAS K. KAHN

________________________ CLERK

D. C. Docket No. 98-06496-CV-WDF

WOLF PRADO-STEIMAN, by and through his mother and next friend Laura Prado, M.C., by and through his mother and next friend, et al., Plaintiffs-Appellees,

versus

JEB BUSH, in his official capacity as Governor and Chief Executive of the State of Florida, KATHLEEN KEARNEY, in her official capacity as Secretary, Department of Children and Families, et al., Defendants-Appellants.

Appeal from the United States District Court for the Southern District of Florida

(August 11, 2000)

Before EDMONDSON and MARCUS, Circuit Judges, and STROM*, District Judge. MARCUS, Circuit Judge:

*

Honorable Lyle E. Strom, U.S. District Judge for the District of Nebraska, sitting by designation.

This is an interlocutory appeal from a class certification order. It also marks our first opportunity to explicate the circumstances in which a court of appeals should exercise its discretion to accept such an appeal under Federal Rule of Civil Procedure 23(f).

Defendants, Governor Jeb Bush and other named state officials, appeal the district court’s order certifying a broad class of developmentally-disabled persons eligible for Florida’s Home and Community Based Waiver Program, which provides Medicaid-related services in home- and community-based settings to individuals who meet certain level-of-care requirements. All parties agree that some kind of class or classes should be certified, but Defendants contend that the single class certified by the district court was too broad. Defendants specifically assert that Plaintiffs have not demonstrated that the claims of the named class representatives possess the requisite typicality with the claims of the class at large as required by Fed. R. Civ. P. 23(a). We agree and vacate the class certification order. On remand, the district court must ensure that at least one of the named class representatives possesses the requisite individual or associational standing to bring each of the class’s legal claims.

I.

A.

The named plaintiffs are individuals with developmental disabilities who meet the level-of-care requirements of an intermediate care facility for individuals with developmental disabilities (“ICF/DD”) under the Medicaid Act, Title XIX of the Social Security Act, 42 U.S.C. § 1396, et seq.1 Medicaid is a cooperative federal-state program through which the federal government furnishes financial assistance to the states so that the states may provide necessary medical, rehabilitation, and other services to low-income persons. At present, the federal government pays for about 55% of the cost of Medicaid services in Florida. State participation in Medicaid is voluntary, but participating states must comply with

1 Under the ICF/DD program:

Each client must receive a continuous active treatment program, which includes aggressive, consistent implementation of a program of specialized and generic training, treatment, health services and related services . . ., that is directed toward –

(i) The acquisition of the behaviors necessary for the client to function with as much self determination and independence as possible; and

(ii) The prevention or deceleration of regression or loss of current optimal functional status.

42 C.F.R. § 483.440(a)(1)(i)-(ii) (1996). The ICF/DD program is restricted to individuals with sufficiently severe mental retardation and related conditions. It is not designed for “generally independent clients who are able to function with little supervision or in the absence of a continuous active treatment program.” 42 C.F.R. § 483.440(a)(2) (1996).

certain requirements imposed by the Act as well as regulations promulgated by the Secretary of Health and Human Services (“Secretary”). Those provisions allow state Medicaid plans to apply a “medical necessity” test to all applicants to ensure that applicants receive medical services in order of need. However, state plans are required to provide “an opportunity for a fair hearing before the State agency to any individual whose claim for medical assistance under the plan is denied or is not acted upon with reasonable promptness.” 42 U.S.C. § 1396(a)(3); see also 42 C.F.R. § 431.200, et seq.

Under the Home and Community Based Services Waiver Act, Title XIX of the Social Security Act, 42 U.S.C. § 1396n(c), Congress has authorized certain persons with developmental disabilities to receive Medicaid services in a community setting rather than in an institutional facility. The Act empowers the Secretary to grant a waiver to a state under which approved costs of home- and community-based services are reimbursed for eligible individuals who otherwise would require care in an ICF/DD facility, but who instead elect to remain in their homes. 42 U.S.C. § 1396n(c). To qualify for a waiver, a state must develop alternative regulatory schemes aimed at lowering the cost of medical assistance

while still maintaining the same level of care.2 Florida has chosen to participate in the Medicaid Home and Community Based Waiver Program.3 B.

On May 13, 1998, two of the named plaintiffs, Wolf Prado-Steiman and Marlon Christie, filed a class action lawsuit alleging that various Florida state officials in their official capacity, including the Governor and the Secretary of the Department of Children and Families, have acted unlawfully in their governance of Florida’s Home and Community Based Medicaid Waiver Program. Plaintiffs allege violations of the American with Disabilities Act, 42 U.S.C. § 12101, et seq.; Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 794; Title XIX of the Social Security Act, 42 U.S.C. §§ 1396a, et seq., 1396n, et seq., and 42 C.F.R. § 431.200; the Due Process Clause; and 42 U.S.C. § 1983. Specifically, Plaintiffs contend that, contrary to federal law, state officials routinely deny or provide without reasonable promptness critical “Home and Community Based Waiver”

2 Although the Waiver Act excuses states from satisfying all of the Medicaid Act’s requirements, see 42 U.S.C. § 1396n(c)(3), it does not authorize the Secretary to waive any sections of the Medicaid Act governing the health, safety, or welfare of Medicaid recipients. Moreover, the Secretary may not grant a waiver unless a state provides assurances that its waiver plan includes “necessary safeguards” to protect the health and welfare of individuals provided services under the waiver. 42 U.S.C. § 1396n(c)(2)(A).

3 Florida’s Home and Community Based Waiver Program is outlined in detail at Fla. Admin.

Code § 59G-8.200. The specific provisions of this Program are not at issue in this appeal.

(“HCBW”) services for Medicaid-eligible, developmentally-disabled persons based on funding concerns rather than medical necessity concerns.4 Plaintiffs assert that as a result of this policy many developmentally-disabled persons who desire HCBW services have been forced to reside in institutional facilities in order to receive Medicaid services. Plaintiffs also allege that Defendants systematically deny Medicaid-eligible, developmentally-disabled persons who apply for HCBW services the procedural due process protections required by the Medicaid Act, including notice of their right to appeal adverse decisions and to continue receiving benefits pending appeal, as well as the opportunity for a fair hearing if their claims are denied or not acted upon with reasonable promptness.5 Plaintiffs seek, among other things, declaratory and

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Wolf Prado-Steiman v. Jeb Bush, 221 F.3d 1266 (11th Cir. 2000).

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