## Facts

- Developmentally disabled Medicaid beneficiaries in West Virginia were eligible for institutional-level services under the state’s Intermediate Care Facility for individuals with developmental disabilities (ICF/DD) program.
- West Virginia also operated a Medicaid Home and Community-Based Services (HCBS) waiver program intended to provide ICF/DD-level services in community settings as an alternative to institutional placement.
- Plaintiffs applied for waiver services and were placed on a waiting list for approximately one to eight years.
- While waiting, plaintiffs received some state services, but alleged those services were insufficient to meet ICF/DD-level needs and to prevent unnecessary institutionalization.
- Plaintiffs alleged the state’s administration of waiver services forced them to remain in restrictive settings or go without adequate supports, contrary to federal Medicaid requirements and Title II of the ADA.
- Plaintiffs sued the state agency head in her official capacity for declaratory and injunctive relief under 42 U.S.C. § 1983, the Medicaid Act, the ADA, and due process.
- Plaintiffs sought class relief and moved for a preliminary injunction to compel provision of ICF/DD-equivalent community services; defendants moved to dismiss.

## Issues

1. Whether the complaint alleged enforceable federal rights under the Medicaid Act that may be pursued under 42 U.S.C. § 1983.
2. Whether extended waiting lists and failure to provide ICF/DD-level community services likely violated Medicaid’s reasonable promptness and related requirements.
3. Whether the alleged service structure and waiting list likely violated Title II of the ADA by risking unnecessary institutionalization and failing to provide services in the most integrated setting appropriate.
4. Whether plaintiffs satisfied the requirements for preliminary injunctive relief (likelihood of success, irreparable harm, balance of hardships, and public interest).

## Decision

- The court denied defendants’ motion to dismiss.
- The court held plaintiffs sufficiently stated claims under Medicaid enforceable via § 1983, as well as under the ADA and due process.
- The court granted plaintiffs’ motion for a preliminary injunction in part.
- The court found plaintiffs showed serious, direct, and ongoing harm associated with the state’s failure to furnish adequate community-based services.
- The court ordered interim relief aimed at requiring provision of ICF/DD-level (or equivalent) services for at least some waiver-eligible individuals, while tailoring relief in light of asserted state cost and capacity limits.

## Legal Principles

- Medicaid’s “reasonable promptness” obligation for furnishing medical assistance to eligible individuals can create individual entitlements enforceable through § 1983.
- A state administering an HCBS waiver must provide waiver services in a manner consistent with federal Medicaid requirements governing adequacy and timeliness for eligible beneficiaries.
- Title II of the ADA requires public entities to administer services in the most integrated setting appropriate and prohibits practices that risk unnecessary institutionalization when community services are appropriate.
- Providing limited substitute services (e.g., short-term respite) may be inadequate where assessed needs require more comprehensive habilitation supports to avoid institutional placement.
- In preliminary-injunction analysis, substantial evidence of ongoing harm to disabled beneficiaries from delayed or inadequate services can support injunctive relief despite asserted fiscal or administrative burdens.

## Conclusion

The court allowed Medicaid beneficiaries’ claims to proceed and issued partial preliminary injunctive relief after finding a substantial likelihood that prolonged waiver waiting lists and inadequate community services violated enforceable Medicaid promptness obligations and the ADA’s integration requirement, causing ongoing harm warranting interim court-ordered measures.


Benjamin H. v. Ohl, No. 3:99-0338, 1999 U.S. Dist. LEXIS 22469 (S.D.W. Va. July 15, 1999)