## Facts

- David Jenkins, Venetta Gasper, and Tommye Myers were Medicaid-eligible, functionally disabled adults receiving state-funded in-home personal care services.
- They required assistance with basic daily activities (e.g., bathing, dressing, meal preparation, shopping, and housekeeping).
- Each recipient lived with the person who served as their paid personal care worker.
- DSHS used an assessment tool to determine authorized service hours, then applied a regulation reducing hours by 15% for recipients living with their paid caregivers.
- The recipients challenged the regulation as inconsistent with federal Medicaid requirements and constitutional protections.

## Issues

1. Whether a state Medicaid regulation reducing personal care service hours by 15% solely because the recipient lives with the paid caregiver violates the federal Medicaid comparability requirement, 42 U.S.C. § 1396a(a)(10)(B).
2. Whether the regulation violates Medicaid free-choice-of-provider protections, the ADA, and state and federal constitutional provisions (equal protection, due process, and state privileges and immunities).

## Decision

- The Washington Supreme Court held the “shared living rule” (WAC 388-106-0130(3)(b)) invalid because it violates the federal Medicaid comparability requirement.
- The court concluded the rule created two subclasses of otherwise similarly situated categorically needy recipients receiving the same covered service, but with unequal hours based solely on living arrangement.
- The court found it unnecessary to decide the remaining statutory and constitutional challenges.
- The court affirmed the invalidation of the rule while limiting the basis for relief to the comparability analysis (affirmed in part and reversed in part as to the lower courts’ reasoning).

## Legal Principles

- Federal Medicaid comparability requires that covered medical assistance for eligible individuals not be less in amount, duration, or scope than assistance provided to other eligible individuals within the same coverage category.
- A state may not reduce benefits within a covered service category for a subset of categorically needy recipients based on a factor unrelated to assessed need (such as living with a paid caregiver), where similarly situated recipients receive the full assessed benefit.
- Cost-containment objectives do not justify noncomparable reductions that single out an otherwise eligible subgroup within the same benefit category.

## Conclusion

The court invalidated Washington’s regulation reducing authorized personal care hours by 15% for Medicaid recipients who live with their paid caregivers, holding that the living-arrangement-based reduction provided noncomparable benefits prohibited by federal Medicaid law.


Jenkins v. Wash. State Dep’t of Soc. & Health Servs., 160 Wash. 2d 287, 157 P.3d 388 (2007)