Court Upholds In-Home Care for N.C. Disabled

     (CN) – A federal judge had the right idea, but violated procedure, in continuing in-home personal care services for certain disabled North Carolinians, the 4th Circuit ruled.
     A group of 13 North Carolina residents had filed suit after the North Carolina General Assembly decided in 2010 to heighten eligibility requirements for in-home personal care services, or PCS, an optional Medicaid program that assists disabled adults with routine daily tasks.
     The affected citizens claimed that Policy 3E for the In-Home Care for Adults program violated the Social Security Act, the Americans with Disabilities Act and the Rehabilitation Act. They further challenged he benefits termination notice as inadequate, in violation of their due-process rights under the 14th Amendment.
     U.S. District Judge Terrence Boyle in Raleigh granted the plaintiff a preliminary injunction and class certification, prompting an appeal from the state’s health department secretary, Albert Delia.
     A divided three-judge panel affirmed last week despite finding that the injunction did not comport with Rule 65 of the Federal Rules of Civil Procedure.
     Boyle erred because he disregarded the bond requirement and failed to describe the acts being restrained or required in “reasonable detailed,” according to the appellate ruling.
     The majority nevertheless found that the plaintiff PCS recipients had adequately demonstrated the merits of their ADA, Rehabilitation Act and Social Security Act claims.
     Declarations submitted to the court show that the PCS recipient plaintiffs cannot “live on their own without in-home PCS or that it would be unsafe for them to do so,” according to the ruling.
     “These declarations demonstrate that the PCS recipients face a significant risk of institutionalization due to the termination of their in-home PCS under IHCA Policy 3E,” Judge Henry Floyd wrote for a three-member panel.
     “We join the Third, Ninth, and Tenth Circuits in holding that, although budgetary concerns are relevant to the fundamental alteration calculus, financial constraints alone cannot sustain a fundamental alteration defense,” Floyd added. “Because the PCS recipients face a significant risk of institutionalization, because North Carolina’s ACHs are institutions, and because the DHHS has failed to make out a successful fundamental alteration defense, the District Court did not abuse its discretion in holding that the PCS Recipients are likely to succeed on the merits of their ADA and Rehabilitation Act claims.”
     Judge G. Steven Agee argued otherwise in a 20-page dissent.
     “The District Court’s analysis and rationale in granting the preliminary injunction was, to be charitable, perfunctory and conclusory; to be accurate, it was plainly arbitrary and capricious and an abuse of the district court’s discretion,” Agee wrote.
     “In affirming the District Court, the majority opinion also limits its analysis to the PCS recipients’ ‘significant risk of institutionalization’ and fails to acknowledge and weigh the state’s justifications for its change in policies,” he added. “I believe this is an abuse of discretion as a matter of law and requires reversal of the district court’s grant of the preliminary injunction.”
     Agee said both the lower court and the circuit majority failed to explain the reasoning behind their determinations “that ‘individuals who must enter institutions to obtain Medicaid services for which they qualify may be able to raise successful Title II and Rehabilitation Act claims because they face a risk of institutionalization.'”
     In doing so, “neither the district court nor the majority consider all the objective facts in the record or the case-law on point,” according to the dissent.
     “The only evidence that the PCS Recipients provide to demonstrate that they face institutionalization consists of self-serving declarations of a limited minority of their membership that they ‘may,’ ‘might,’ ‘probably,’ or ‘likely’ would enter an adult care home because their in-home PCS coverage had been terminated,” Agee added.
     “In addition, by concluding that the PCS Recipients are likely to succeed on their ADA claim, the majority opinion appears to equate any risk of institutionalization with the substantially higher actual legal standard, which is a ‘serious risk of institutionalization,'” the dissent states later.
     Agee said North Carolina’s “distinctions in the provision of PCS coverage are drawn across a rational, needs-based consideration among two distinct groups: those who can live safely at home, and those who cannot.”
     “North Carolina’s PCS policy simply does not violate the actual, express requirements of the Medicaid Act,” he wrote.
     “For all these reasons, I would hold that the PCS Recipients failed to demonstrate that they are likely to succeed on the merits of their Medicaid Act comparability claim and that the district court abused its discretion by failing to apply, or even recognize, the correct legal standards in determining that issue,” the dissent concludes.

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