Disability Law Index - Public Entities: Managed Care (Medicare & Medicaid)

Case Law:

Fisher v. Oklahoma Health Care Authority, 335 F.3d 1175, (10th Cir. 2003).

  • State agency's decision to limit prescriptions for Medicaid recipients in the community was discriminatory when limit was not imposed on those in nursing homes. Forced people to go into nursing homes if they need to go over the limit
  • Institutionalization is a prerequisite to enforcement of the ADA's integration requirements.

Townsend v. Quasim, 328 F.3d 511 (9th Cir. 2003).

  • Refusal to offer community-based in-home nursing services to some disabled persons may violate the ADA unless state agency can demonstrate that extending eligibility to these persons would fundamentally alter its Medicaid programs.
  • Plaintiff's income had made him ineligible to receive his Medicaid services in the community. State agency told him to move to a nursing home to continue receiving his benefits.

Bruggeman v. Blagojevich, 324 F.3d 906 (7th Cir. 2003).

  • Parents of developmentally disabled adult children in Chicago sued Illinois to provide care facilities in their region. Most facilities are located in southern Illinois and there are low vacancy rates in the Chicago area. Parents did not want to send their children far away from home.
  • "The aim is to give the recipient a choice among available facilities, not to require the creation or authorization of new facilities."
  • There is a seeming paradox that a residential institution would be the least restrictive environment for the children. However, their parents may not be able to take care of their children making the home environment more restrictive to a child's opportunity to develop.

Rodriguez v. City of New York, 197 F.3d 611 (2nd Cir. 1999).

  • It is not the court's role to determine what Medicaid benefits New York must provide. Rather, it determines whether New York discriminates on the basis of a mental disability with regard to the benefits it does provide. Because New York does not "task" safety monitoring as a separate benefit for anyone, it does not violate the ADA by failing to provide this benefit to appellees.

Addis v. Whitburn, 153 F.3d 836 (7th Cir. 1998).

  • Wisconsin's policy forbidding disabled parent or caretaker from deducting from his or her income, for purposes of determining parent's eligibility for medicaid benefits, the portion of income allocated to dependent children in determining their own eligibility for benefits does violate the ADA or Rehabilitation Act, in light of Social Security Act's express authorization for state to allocate portion of parent's income to child in assessing child's eligibility for medicaid whether or not parent is disabled and whether or not parent is himself or herself applying for medical assistance.

Vaughn v. Sullivan, 83 F.3d 907 (7th Cir. 1996).

  • Distinctions in Indiana's Medicaid plan allowing blind persons, but not other disabilities, to disregard Plan for Achieving SelfSupport (PASS) income when calculating eligibility for Medicaid benefits did not violate the Rehabilitation Act or the ADA.
  • Neither  the Rehabilitation Act nor ADA requires states to provide identical benefits for people with disabilities. States retain substantial discretion in choosing the proper mix of amount, scope and duration limitations on coverage. Plaintiffs' minimum obligation therefore is to show that the total package of benefits they receive is lower than that of some comparable group.