On August 18, 2009, three individuals receiving adult day health care services in California filed a class action lawsuit against the California Department of Health Care Services and its Director to enjoin the Department from making cuts to the Adult Day Health Care (ADHC) services program. Represented by Disability Rights California, AARP Foundation Litigation, and the National Senior Citizens Law Center, the plaintiffs filed their suit in the U.S. District Court for the Northern District of California, and alleged numerous causes of action: violation of the 14th amendment due process clause of the U.S. Constitution; violation of the American Disabilities Act; violations of the Medicaid Act; and violation of California Government Code sections 11135 and 11139.
The plaintiffs alleged that cuts or significant changes to the ADHC program would place elderly persons and adults with disabilities at great risk of permanent institutionalization. The proposed cuts would reduce ADHC services from 5 days a week to only 3, leaving a gap in service provision for elderly and disabled people otherwise unable to care for themselves. The plaintiffs sought injunctive relief for a class of individuals defined as "all recipients of Medi-Cal in California who receive ADHC services, whose benefits would be limited, cut or terminated" under the proposed legislation.
Less than a week after they filed the case, under the impression that the reduction in ADHC services would take effect on August 27, 2009, plaintiffs sought an emergency Temporary Restraining Order. Once the plaintiffs learned that the reduction would not take place until the week of September 7, 2009, they substituted a Motion for Preliminary Injunction.
On September 10, 2009, District Court (Judge Saundra Brown Armstrong) issued a preliminary injunction enjoining the California Department of Health Care Services from reducing, terminating, or modifying the ADHC program until an appropriate alternative could be provided to prevent institutionalization of individuals in the plaintiffs' class.
On February 24, 2010, the District Court issued a second preliminary injunction preventing the defendants from "implementing new, more restrictive eligibility requirements for ADHC services."
On August 10, 2010, the District Court granted the plaintiffs' motion for class certification. The court certified the class as "All Medi-Cal beneficiaries in the State of California for whom Adult Day Health Care benefits will be reduced, suspended, denied or terminated under the provisions of ABx4 5."
On December 14, 2011, the District Court approved the motion for preliminary approval of a settlement agreement. The settlement agreement "which preserves ADHC-like services for people who are at risk of institutionalization, in a new program called Community-Based Adult Services (CBAS). Similar to ADHC, CBAS will offer center-based skilled health and nursing care, therapies, transportation and other services, to eligible low income seniors and people with disabilities. Under the settlement, the planned December 1, 2011 ADHC elimination date will be moved to February 29, 2012 to ensure a seamless transition for eligible ADHC participants to the CBAS program." On January 25, 2012, the District Court entered the stipulated judgment pursuant to the settlement agreement reached by the parties.
On Sept. 15, 2012, the plaintiffs filed a motion to enforce the judgment and for the appointment of a special master. The district court referred the motion to Magistrate Judge Jacqueline Scott Corley, who issued an opinion and order denying the motion on Nov. 20, 2012.
In their motion, the plaintiffs alleged that the state failed to take necessary steps to prevent managed care opt-outs; that it subjected some class members to long-delayed hearing decisions; that it subjected class members to illegal Quality Assurance reviews in determining CBAS eligibility; and it had not acted to support access to CBAS and prevent loss of CBAS services due to center closures. But Judge Corley determined that the state had not violated any aspect of the settlement agreement.
On March 8, 2013, Judge Armstrong accepted Magistrate Judge Corley's report and recommendation. He ordered that the plaintiffs' motion be denied.
Justin Benson - 03/29/2012
Andrew Junker - 11/10/2014
compress summary
