On April 30, 1999, 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, the plaintiffs claimed that the defendants were violating federal law, resulting in the plaintiffs not receiving prompt benefits.

On July 15, 1999, the court (Judge Robert C. Chambers) denied the defendants' motion to dismiss and granted, in part, the plaintiffs' motion for a preliminary injunction. Benjamin H. v. Ohl, 1999 WL 34783552 (S.D. W.V. Jul. 15, 1999). The Court found that the plaintiffs were suffering serious, direct, and ongoing harm because of the defendants' violations of the ADA.

On October 8, 1999, the court granted the 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 the 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: the 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, the defendant would seek to expand its waiver slots.

On August 9, 2000, the court granted the 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 the 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 the 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). The 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.

Subsequently, on March 16, 2009, the parties informed the court that they wished to negotiate a settlement in regards to the remaining matters pending before the court. After the parties presented terms to the court, issued an April 8, 2009, order. The court ordered the 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 the plaintiffs on a quarterly basis to assess the adequacy and efficiency of the waiver program. This order included certain prospective budget requests on part of the defendants as well, extending to December 2014. As part of this order, the court struck the case from its active docket.

There had been no further action in the case until July 23, 2018, when the parties filed a motion to re-open the case for the sole and limited purpose of entering a proposed agreed order, clarifying that a reservation of slots on the Intellectual/Developmental Disabilities waiver waitlist for certain particularly vulnerable, institutionalized populations would not violate the terms of the consent order. Shortly after, on July 25, 2018, the court approved this order.

The case has otherwise been closed.

Haley Waller - 05/19/2011
Carol Chen - 07/04/2020
Lily Sawyer-Kaplan - 02/15/2021


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