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From Health Law Daily, October 12, 2018

Suit alleging that Medi-Cal failed to provide sufficient in-home nursing care proceeds

By Robert B. Barnett Jr., J.D.

A California federal district court has subject matter jurisdiction to hear a putative class action complaint by parents of severely disabled children against the operators of Medi-Cal asserting that Medi-Cal failed to supply them with the authorized amounts of medically necessary in-home nursing care in violation of the Medicaid Act, the Americans with Disabilities Act, and the Rehabilitation Act. In rejecting the California Department of Health Care Services’ argument that no causation existed because any harm was caused by a shortage of nurses in the state or by the actions of the third-party in-home care providers, the court ruled that ultimate responsibility to ensure treatment rests with the state, even where the state delegates that responsibility to a third party. Based on the allegations in the complaint, a jury could find it plausible that the state has not done all that is required of it in providing the in-home nursing care (I.N. v. Kent, October 10, 2018, Alsup, W.).

Background. Two California mothers, acting as guardian ad litem of their severely disabled five- and seven-year-old children, sued the California Department of Health Care Services (DHCS) and its director for failing to supply them with the hours of in-home nursing care that Medi-Cal, the state Medicaid agency, agreed to provide them. One mother, who had been authorized to receive 56 hours of in-home nursing services per week, was receiving about 10 percent fewer hours than guaranteed. The other mother, who had been authorized to receive 135 hours of in-home nursing care per week and two hours of monthly RN case management, was receiving about 50 percent of what she was promised. The suit alleged violations of (1) Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program, (2) Medicaid’s reasonable promptness requirement, (3) the Americans with Disabilities Act, and (4) Section 504 of the Rehabilitation Act. DHCS moved to dismiss the complaint for lack of subject matter jurisdiction.

Article III standing. Article III standing requires a showing that the plaintiff has (1) suffered an injury in fact, (2) that it is traceable to the defendant’s challenged conduct, and (3) that the injury can be redressed by a favorable decision. The court noted, the first requirement, injury in fact, was not in dispute.

Causation. DHCS’s primary line of defense was that no standing existed because the mothers could not trace the harm to DHCS’s conduct. If the mothers suffered from insufficient hours of in-home nursing, it argued, the insufficient hours were due to the actions or inactions of the independent third-party nursing care providers. DHCS also blamed a shortage in California of qualified nursing care providers. DHCS argued, in effect, that it extinguished its responsibility when it arranged the care. The court rejected that argument. While DHCS cannot be blamed for a nursing shortage in California, the mothers’ complaint alleged more than that. It alleged that DHCS failed to supply medically necessary nursing services even though qualified in-home nursing care existed in their geographic areas. The complaint alleged that DHCS provided insufficient case management and gave the mothers inaccurate and out-of-date referral lists when they asked for referrals. Perhaps, the court said, DHCS will ultimately be able to prove that the harm caused was not its fault. At the pleading stage, however, where allegations are accepted as true, the mothers have adequately pleaded that DHCS failed to supply them with adequate in-home nursing care. A state cannot delegate away its responsibility for providing promised treatment. Ultimate responsibility rests with the state.

Redressed by a decision. The mothers were seeking a declaratory judgment and injunctive relief requiring DHCS to comply with its requirements. The allegations set forth in the mothers’ complaint, the court said, sufficiently established a "line of causation" from DHCS’s actions to the alleged harm. A court could fashion injunctive relief that eliminated the problem. A court might, for example, require DHCS to update its referral lists. Because the mothers were not required at this point to describe the exact contours of their requested relief, they satisfied the requirement that the harm be addressable by a court decision. As a result, their pleadings satisfied all the requirements for establishing standing under Article III.

The court, therefore, denied DHCS’s motion to dismiss for lack of subject matter jurisdiction.

The case is No. C 18-03099 WHA.

Attorneys: Allen L. Lanstra (Skadden Arps Slate Meagher and Flom LLP) for IN. Maryam Toossi Berona, California Department of Justice, for Jennifer Kent and State of California Department of Health Care Services.

Companies: State of California Department of Health Care Services

MainStory: TopStory CaseDecisions CMSNews CoPNews MedicaidNews ProviderNews QualityNews

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