On April 30, 1998, developmentally disabled individuals eligible for Medicaid benefits filed a lawsuit under 42 U.S.C. § 1983, the Social Security Act, the Medicaid Act, the Americans with Disabilities Act, and the Due Process Clause of the Constitution, against West Virginia's Secretary of Health and Human Resources in the United States District Court for the Southern District of West Virginia. Plaintiffs, represented by public interest attorneys, asked the court for declaratory and injunctive relief, and class certification. Specifically, Plaintiffs claimed that Defendants were violating federal law, resulting in Plaintiffs not receiving prompt benefits.
On July 15, 1999, the Court (Judge Robert C. Chambers) denied Defendants' motion to dismiss and granted, in part, Plaintiffs' motion for a preliminary injunction. Benjamin H. v. Ohl, 1999 WL 34783552 (S.D. W.V. Jul. 15, 1999). The Court found that Plaintiffs were suffering serious, direct, and ongoing harm because of Defendants' violations of the ADA.
On October 8, 1999, the Court granted Plaintiffs' motion for class certification. The class consisted of: all current and future West Virginia residents with developmental disabilities who are Medicaid beneficiaries and who are eligible for the level of services funded under the Intermediate Care Facility and/or the Developmentally Disabled Home and Community Based Waiver services.
The Court issued an order regarding Count IV (Opportunity to Apply) and Count VI (Medicaid and Due Process Notice and Hearing Rights) on March 7, 2000. The issues raised by those counts were settled. The compromise required Defendants to make an eligibility determination about individuals applying for waiver services within 90 days; all person were to have 90 days to request a hearing.
On March 15, 2000, the Court issued another order detailing partial settlement reached between the parties. In part: Defendants were required to develop capacity within the behavioral health services delivery system to ensure adequate service provision; individuals eligible for ICF-level care were to be afforded a legal representative; any individual could apply for Home and Community Based waiver services; and, Defendant would seek to expand its waiver slots.
On August 9, 2000, the Court granted Defendants' motion for summary judgment as to Count VIII, relating to the reimbursement rate for residential habilitation and respite care services. The Court found that Plaintiffs failed to prove that the reimbursement rate did not allow for adequate access.
On October 17, 2002, after a compromise between the parties, the Court ordered Defendants to pay approximately $125,000 in attorneys' fees and costs.
On March 6, 2009, the Court denied Defendant Secretary of West Virginia Department of Health and Human Service's motion for relief from prior orders. Benjamin H. v. Walker, 2009 WL 590160 (S.D. W.V. Mar. 6, 2009). Defendant had sought relief from class certification and the settlement claims, but the Court found that there were no extraordinary circumstances to warrant relief from the orders.
On April 8, 2009, the Court ordered Defendants to: develop a single eligibility process for all Medicaid programs that are utilized by waiver eligible applicants; expand its eligibility criteria to include services to children; file a Medicaid state plan amendment to include the provision of personal care services in the home or community; make annual budget requests to at least maintain current appropriations; and meet with Plaintiffs on a quarterly basis to assess the adequacy and efficiency of the waiver program.
Haley Waller - 05/19/2011
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