Emily Fitzmorris, et al. v. Lori Weaver, Commissioner, New Hampshire Department of Health and Human Services, et al.

Summary

The United States District Court for the District of New Hampshire addresses cross-motions for summary judgment in a class action brought by participants in New Hampshire’s Choices for Independence Medicaid waiver program. The plaintiffs allege that deficient administration of the program places disabled individuals at serious risk of unjustified institutionalization in violation of Title II of the Americans with Disabilities Act and Section 504 of the Rehabilitation Act. The court denied both motions because material factual disputes remained, including disputes concerning standing, the applicability of Olmstead to serious-risk claims, class-wide injury, causation, and reasonable modifications.

Holdings

1. The plaintiffs have constitutional standing because the alleged injury is the concrete and imminent loss of authorized community-based services, not merely the abstract risk of institutionalization, and that injury is redressable by an order requiring program changes.
2. A disabled person need not already be institutionalized to assert an Olmstead claim; an Olmstead claim may be based on a serious risk of unjustified institutionalization.
3. The defendants were not entitled to summary judgment on the ground that the plaintiffs could not prove a class-wide serious risk of institutionalization.
4. Genuine disputes of material fact existed regarding whether DHHS's reimbursement policies, monitoring practices, contingency-plan oversight, and accountability practices caused or exacerbated service gaps and whether those gaps placed participants at serious risk of institutionalization.
5. An Olmstead plaintiff bears the initial burden of proposing modifications and demonstrating that they are facially reasonable and necessary; the burden then shifts to the public entity to show that the modifications are otherwise unreasonable or unnecessary or that they would fundamentally alter the program.

Questions Presented

1. Whether the plaintiffs have Article III standing based on failure to receive authorized community-based services and the resulting increased likelihood of institutionalization.
2. Whether an Olmstead claim under Title II of the ADA may be based on a serious risk of unjustified institutionalization rather than actual institutionalization.
3. Whether the plaintiffs' evidence could establish a class-wide serious risk of institutionalization despite disputes regarding the percentage of participants experiencing service gaps.
4. Whether disputed evidence existed regarding whether DHHS's acts or omissions caused service gaps and whether those gaps placed participants at serious risk of institutionalization.
5. How the burdens of proof apply to reasonable and necessary modifications under 28 C.F.R. § 35.130(b)(7)(i), and whether either party was entitled to summary judgment on the reasonable-modifications or fundamental-alteration issues.

Disposition

other