M.R. v. Dreyfus

Plaintiffs, Washington State Medicaid beneficiaries with severe mental and physical disabilities, appeal the district court’s denial of their motion for a preliminary injunction. Plaintiffs seek to enjoin the operation of a regulation promulgated by Washington’s Department of Social and Health Services (“DSHS”) that reduces the amount of in-home “personal care services” available under the state’s Medicaid plan. The United States Department of Justice has filed a “statement of interest” in the district court supporting Plaintiffs’ request for an injunction.

“Personal care services” provide assistance in performing basic life activities— such as eating, bathing, dressing, moving from place to place, and using the toilet— that Plaintiffs, because of their disabilities, cannot perform by themselves. To comply with Governor Christine Gregoire’s executive order that directed an across-the-board reduction in all state agency expenditures, DSHS promulgated a regulation that cut the base hours of covered in-home personal care services by an average of 10 percent per beneficiary per month.

Plaintiffs argue principally that the regulation violates the antidiscrimination…

dissenting:

I respectfully dissent from the majority opinion in this case. It is important to note at the outset that this appeal challenges the denial of a preliminary injunction. Our review is for an abuse of the considerable discretion afforded the district court in making the determination whether a preliminary injunction should be entered. See Alliance for the Wild Rockies v. Cottrell, 632 F.3d 1127, 1131 (9th Cir.2011). So long as the district court “got the law right,” we “will not reverse the district court.” Id. (citation omitted). Our scope of review is necessarily limited. See Sports Form, Inc. v. UPI, Inc., 686 F.2d 750, 752 (9th Cir.1982).

In a thoughtful and comprehensive 50-page order, the district court denied the request for a preliminary injunction. As the majority acknowledges, any factual findings made by the district court must be accepted unless clearly erroneous. See Alliance for the Wild Rockies, 632 F.3d at 1131 . The district court prefaced its decision by noting its “careful” review” of the 164+ documents filed by the parties and the 5 + hours of oral argument during two hearings. See District Court Order, p. 2 n. 4. The district court also recognized…

I. Background and Procedural History

A. Factual Background

Medicaid is a cooperative federal-state program under which the federal

government provides states with financial assistance to supply medical services to

low-income people. Arc of Wash. State Inc. v. Braddock, 427 F.3d 615, 617 (9th

3 Cir. 2005). State participation is voluntary, but once a state chooses to participate,

the state must submit for federal approval a plan that complies with federal

statutory and regulatory requirements. Alexander v. Choate, 469 U.S. 287, 289 n.

(1985); Townsend v. Quasim, 328 F.3d 511, 514 (9th Cir. 2003). A state plan must

cover the cost to eligible people of certain medical services, including inpatient and

outpatient hospital care; laboratory and X-ray services; nursing facility care; and

services provided by physicians, dentists, nurse-midwives, and pediatric or family

nurse practitioners. See 42 U.S.C. §§ 1396a(a)(10)(A), 1396d(a)(1)-(5), (17), (21);

42 C.F.R. §§ 440.210, 440.220. Within this federal framework, however, states

retain “substantial discretion to choose the proper mix of amount, scope, and

duration limitations on coverage.” Alexander, 469 U.S. at 303; see…