Several individuals with disabilities filed this lawsuit to challenge Oklahoma's proposed reduction in prescription drug coverage under its Home and Community Based Services Medicaid waiver. Each of the plaintiffs has a range of (largely physical) disabilities and would qualify for nursing home care, but is able to remain in the community due to services provided via the Medicaid waiver. When the Oklahoma Health Care Authority announced that it would cover a maximum of 5 prescription drugs for those not residing in institutions, but would not limit the prescription drugs available to those residing in institutions, the Plaintiffs filed a complaint on October 1, 2002, in the U.S. District Court for the Northern District of Oklahoma, claiming that this planned reduction violates the Americans with Disabilities Act (ADA) under the Supreme Court precedent Olmstead v. L.C. The Plaintiffs also claimed that the reduction in benefits violated the notice provision of the federal Medicaid Act and the Due Process Clause of the U.S. Constitution.
On November 1, 2002, the District Court (Judge James H. Payne) granted the state's motion for summary judgment. He found that this case was distinguishable from Olmstead because the Plaintiffs were not institutionalized, but were instead alleging a risk of institutionalization. Judge Payne held that the ADA would not apply to such a claim.
The Plaintiffs subsequently filed an appeal with the U.S. Court of Appeals for the Tenth Circuit. In a decision on July 15, 2003, the Court of Appeals (Judge Lucero) reversed the District Court. The Court found that it was not necessary for Plaintiffs to be currently institutionalized in order to bring a claim under the ADA's integration mandate, and nothing in the text of the ADA or in the Olmstead decision would suggest that institutionalization is a prerequisite.
On November 17, 2003, the District Court dismissed the case because the parties had entered into a settlement agreement. Under the settlement, HCBS Waiver participants can have up to 7 generic prescriptions with the option to request more through an authorization process.
Beth Kurtz - 03/31/2013
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