## Facts

- Michela Leocata, an elderly woman with advanced dementia, lived in an assisted living facility (ALF) providing residential dementia care but not skilled nursing services.
- She paid privately for ALF care, but her assets were depleting and she anticipated inability to continue paying.
- Under Connecticut’s Medicaid program, payment was available for Medicaid-participating nursing facilities (NFs), not for ALF residency and services.
- Leocata alleged that once impoverished she would be forced to relocate to an NF to obtain Medicaid coverage, despite not needing the full level of NF medical services.
- Through her conservator, she sued the state Medicaid commissioner and the federal HHS secretary seeking declaratory and injunctive relief requiring funding for ALF-based care, plus fees and costs.
- Defendants moved to dismiss for lack of standing and failure to state a claim; plaintiff sought a preliminary injunction pending litigation.

## Issues

1. Whether the alleged future transfer to a nursing facility, contingent on asset depletion and Medicaid eligibility, presented an injury sufficient for Article III standing and ripeness.
2. Whether the Medicaid Act provisions cited by plaintiff created individually enforceable rights under 42 U.S.C. § 1983 to receive Medicaid-funded services in an assisted living setting.
3. Whether Title II of the ADA, as interpreted in *Olmstead v. L.C.*, required the state or federal government to fund assisted living services rather than limiting coverage to nursing facilities.
4. Whether limiting Medicaid coverage to nursing facilities violated due process or equal protection.
5. Whether plaintiff satisfied the requirements for a preliminary injunction, including likelihood of success on the merits.

## Decision

- The court granted the defendants’ motions to dismiss and entered judgment for defendants.
- The court denied the plaintiff’s motion for a preliminary injunction.
- The court concluded the asserted statutory and constitutional theories did not state a viable claim for compelled Medicaid funding of ALF care.

## Legal Principles

- Medicaid Act provisions are enforceable under § 1983 only when they unambiguously confer individual rights; broad programmatic directives and standards generally do not.
- Title II of the ADA and *Olmstead* address discriminatory administration of existing public services and do not require a state to create or fund new benefit categories not otherwise provided by Medicaid.
- There is no constitutional entitlement to publicly funded medical care in a particular setting; service-coverage classifications in social welfare programs ordinarily receive rational-basis review.
- A request for preliminary injunctive relief fails where the plaintiff cannot show likely success on the merits of the underlying statutory or constitutional claims.

## Conclusion

The court dismissed a challenge to Connecticut’s Medicaid coverage limitations that sought funding for assisted living services, holding that neither Medicaid enforceable via § 1983, nor the ADA/*Olmstead*, nor due process or equal protection required the government to expand Medicaid to cover assisted living facility care, and it therefore denied preliminary injunctive relief.


Leocata ex rel. Gilbride v. Wilson-Coker, 343 F. Supp. 2d 144 (D. Conn. 2004)