On January 21, 2003 Judge Hutton of the U.S. District Court for the Eastern District of Pennsylvania dismissed a Title XIX lawsuit based on the Supreme Courts decision in Gonzaga v. Doe. The lawsuit, Sabree v. Houstoun , was filed in May 2002 on behalf of a class of persons with mental retardation who are on waiting lists for residential services. The plaintiffs alleged that Pennsylvania violates Title XIX in two respects: (1) failing to provide appropriate ICF/MR services to which they are entitled, and (2) failing to provide appropriate ICF/MR services with reasonable promptness. The defendant moved to dismiss the lawsuit. Relying almost exclusively on Gonzaga, the defendant asserted that plaintiffs could not enforce the Medical Assistance provisions at issue.
In its decision, the court held that Title XIX as a whole was not intended to confer rights on beneficiaries. Looking at the general statutory authorization for Medical Assistance, 42 U.S.C. sec. 1396, the court noted that the statute focuses on the state, rather than individuals and states that the individuals referenced are merely beneficiaries, not persons entitled to privately enforce the statute. The court also looked to 42 U.S.C. sec. 1396c (concerning termination of federal funding to a state that does not substantially comply with its Medical Assistance plan) and determined that this shows that the statute looks to the aggregate function of the State, rather than whether the needs of any particular person have been satisfied.
With respect to the particular ICF/MR provisions, the court did not address at all plaintiffs citation to the general entitlement provisions of Title XIX (i.e., 42 U.S.C. sec. 1396a(a)(10)), which provides that Medical Assistance must be made available to all individuals who meet eligibility criteria and that Medical Assistance is defined to include ICFs/MR). The court also held, without citation, that plaintiffs had no right to ICF/MR services in small settings. While plaintiffs did seek services in small settings, they argued that their right was to ICF/MR services and the question of size went merely to what was appropriate to meet their needs not to whether they could enforce the right itself.
As for the reasonable promptness claim, the court apparently disregarded the statutory language of 42 U.S.C. sec. 1396a(a)(8), which refers to individuals. Instead, the court stated that the provision was merely a condition on the receipt of federal funds. The court also concluded that the lack of any specific time period (and the possibility that a reasonable time period would vary from person to person) precluded private enforcement of this provision.
Counsel for plaintiffs plan to appeal the decision
On January 21, 2003 Judge Hutton of the U.S. District Court for the Eastern District of Pennsylvania dismissed a Title XIX lawsuit based on the Supreme Courts decision in Gonzaga v. Doe. The lawsuit, Sabree v. Houstoun , was filed in May 2002 on behalf of a class of persons with mental retardation who are on waiting lists for residential services. The plaintiffs alleged that Pennsylvania violates Title XIX in two respects: (1) failing to provide appropriate ICF/MR services to which they are entitled, and (2) failing to provide appropriate ICF/MR services with reasonable promptness. The defendant moved to dismiss the lawsuit. Relying almost exclusively on Gonzaga, the defendant asserted that plaintiffs could not enforce the Medical Assistance provisions at issue.
In its decision, the court held that Title XIX as a whole was not intended to confer rights on beneficiaries. Looking at the general statutory authorization for Medical Assistance, 42 U.S.C. sec. 1396, the court noted that the statute focuses on the state, rather than individuals and states that the individuals referenced are merely beneficiaries, not persons entitled to privately enforce the statute. The court also looked to 42 U.S.C. sec. 1396c (concerning termination of federal funding to a state that does not substantially comply with its Medical Assistance plan) and determined that this shows that the statute looks to the aggregate function of the State, rather than whether the needs of any particular person have been satisfied.
With respect to the particular ICF/MR provisions, the court did not address at all plaintiffs citation to the general entitlement provisions of Title XIX (i.e., 42 U.S.C. sec. 1396a(a)(10)), which provides that Medical Assistance must be made available to all individuals who meet eligibility criteria and that Medical Assistance is defined to include ICFs/MR). The court also held, without citation, that plaintiffs had no right to ICF/MR services in small settings. While plaintiffs did seek services in small settings, they argued that their right was to ICF/MR services and the question of size went merely to what was appropriate to meet their needs not to whether they could enforce the right itself.
As for the reasonable promptness claim, the court apparently disregarded the statutory language of 42 U.S.C. sec. 1396a(a)(8), which refers to individuals. Instead, the court stated that the provision was merely a condition on the receipt of federal funds. The court also concluded that the lack of any specific time period (and the possibility that a reasonable time period would vary from person to person) precluded private enforcement of this provision.
Counsel for plaintiffs plan to appeal the decision
