Prado-Steiman v. Bush

• Decision Date: 11 August 2000
• Docket Number: PRADO-STEIMAN,No. 99-11034,99-11034
• Parties: (11th Cir. 2000) Wolf, by and through his mother and next friend Laura PRADO, M.C., by and through his mother and next friend, et al., Plaintiffs-Appellees, v. Jeb BUSH, in his official capacity as Governor and Chief Executive of the State of Florida, Kathleen Kearney, in her official capacity as Secretary, Department of Children and Families, et al., Defendants-Appellants.
• Court: U.S. Court of Appeals — Eleventh Circuit

Page 1266

221 F.3d 1266 (11th Cir. 2000)

Wolf PRADO-STEIMAN, by and through his mother and next friend Laura PRADO, M.C., by and through his mother and next friend, et al., Plaintiffs-Appellees, v. Jeb BUSH, in his official capacity as Governor and Chief Executive of the State of Florida, Kathleen Kearney, in her official capacity as Secretary, Department of Children and Families, et al., Defendants-Appellants.

No. 99-11034.

United States Court of Appeals Eleventh Circuit.

Aug. 11, 2000.

Appeal from the United States District Court for the Southern District of Florida.(No. 98-06496-CV-WDF), Wilkie D. Ferguson, Jr., Judge.

Before EDMONDSON and MARCUS, Circuit Judges, and STROM^*, District Judge.

MARCUS, Circuit Judge:

This is an interlocutory appeal from a class certification order. It also marks our first opportunity to explicate the circumstances in which a court of appeals should exercise its discretion to accept such an appeal under Federal Rule of Civil Procedure 23(f).

Defendants, Governor Jeb Bush and other named state officials, appeal the district court's order certifying a broad class of developmentally-disabled persons eligible for Florida's Home and Community Based Waiver Program, which provides Medicaid-related services in home- and community-based settings to individuals who meet certain level-of-care requirements. All parties agree that some kind of class or classes should be certified, but Defendants contend that the single class certified by the district court was too broad. Defendants specifically assert that Plaintiffs have not demonstrated that the claims of the named class representatives possess the requisite typicality with the claims of the class at large as required by Fed.R.Civ.P. 23(a). We agree and vacate the class certification order. On remand, the district court must ensure that at least one of the named class representatives possesses the requisite individual or associational standing to bring each of the class's legal claims.

I.

A.

The named plaintiffs are individuals with developmental disabilities who meet the level-of-care requirements of an intermediate care facility for individuals with developmental disabilities ("ICF/DD") under the Medicaid Act, Title XIX of the Social Security Act, 42 U.S.C. § 1396, et seq.¹ Medicaid is a cooperative federal-state program through which the federal government furnishes financial assistance to the states so that the states may provide necessary medical, rehabilitation, and other services to low-income persons. At present, the federal government pays for about 55% of the cost of Medicaid services in Florida. State participation in Medicaid is voluntary, but participating states must comply with certain requirements imposed by the Act as well as regulations promulgated by the Secretary of Health and Human Services ("Secretary"). Those provisions allow state Medicaid plans to apply a "medical necessity" test to all applicants to ensure that applicants receive medical services in order of need. However, state plans are required to provide "an opportunity for a fair hearing before the State agency to any individual whose claim for medical assistance under the plan is denied or is not acted upon with reasonable promptness." 42 U.S.C. § 1396(a)(3); see also 42 C.F.R. § 431.200, et seq.

Under the Home and Community Based Services Waiver Act, Title XIX of the Social Security Act, 42 U.S.C. § 1396n(c), Congress has authorized certain persons with developmental disabilities to receive Medicaid services in a community setting rather than in an institutional facility. The Act empowers the Secretary to grant a waiver to a state under which approved costs of home- and community-based services are reimbursed for eligible individuals who otherwise would require care in an ICF/DD facility, but who instead elect to remain in their homes. 42 U.S.C. § 1396n(c). To qualify for a waiver, a state must develop alternative regulatory schemes aimed at lowering the cost of medical assistance while still maintaining the same level of care.² Florida has chosen to participate in the Medicaid Home and Community Based Waiver Program.³

B.

On May 13, 1998, two of the named plaintiffs, Wolf Prado-Steiman and Marlon Christie, filed a class action lawsuit alleging that various Florida state officials in their official capacity, including the Governor and the Secretary of the Department of Children and Families, have acted unlawfully in their governance of Florida's Home and Community Based Medicaid Waiver Program. Plaintiffs allege violations of the American with Disabilities Act, 42 U.S.C. § 12101, et seq.; Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 794; Title XIX of the Social Security Act, 42 U.S.C. §§ 1396a, et seq., 1396n, et seq., and 42 C.F.R. § 431.200; the Due Process Clause; and 42 U.S.C. § 1983. Specifically, Plaintiffs contend that, contrary to federal law, state officials routinely deny or provide without reasonable promptness critical "Home and Community Based Waiver" ("HCBW") services for Medicaid-eligible, developmentally-disabled persons based on funding concerns rather than medical necessity concerns.⁴

Plaintiffs assert that as a result of this policy many developmentally-disabled persons who desire HCBW services have been forced to reside in institutional facilities in order to receive Medicaid services. Plaintiffs also allege that Defendants systematically deny Medicaid-eligible, developmentally-disabled persons who apply for HCBW services the procedural due process protections required by the Medicaid Act, including notice of their right to appeal adverse decisions and to continue receiving benefits pending appeal, as well as the opportunity for a fair hearing if their claims are denied or not acted upon with reasonable promptness.⁵ Plaintiffs seek, among other things, declaratory and injunctive relief which would require Defendants to provide necessary HCBW services to eligible persons and to comply with Medicaid procedural requirements in their adjudication and denial of HCBW services.

On July 31, 1998, Plaintiffs amended the complaint by right, adding four new individual plaintiffs, Lucy Adawi, Jennifer Batsidas, Daniel Lavin, and Daniel Shell, and one institutional plaintiff, the Advocacy Center for Disabled Persons, Inc. Plaintiffs then moved for class certification. On January 19, 1999, Plaintiffs sought to amend their complaint a second time to add, among other things, twelve further individual plaintiffs as well as a cause of action to enforce certain sections of the Medicaid Act requiring states participating in Medicaid to provide early and periodic screening, diagnosis, and treatment ("EPSDT") to eligible persons under the age of 21. On February 19, 1999, the court held a hearing on Plaintiffs' motion for class certification at which it apparently granted Plaintiffs' request to file the second amended complaint.

In March 1999, the district court granted the class certification motion. It identified as class representatives all seven of the plaintiffs named in the first amended complaint, but declined to identify as class representatives the twelve new plaintiffs added in the second amended complaint until Defendants could complete discovery.⁶ The court defined the class as follows:

[A]ll persons with developmental disabilities who are presently receiving Home and Community-Based Waiver Services or who are eligible to receive Home and Community- Based Waiver Services, or who would receive or be eligible for Home and Community- Based Waiver Services in the future.

The district court also identified ten substantive, classwide claims:

a. whether Defendants have violated the ADA by denying individuals, who live in their own homes or with their families in community settings, services such as physical therapy, speech therapy, and dental services that are available to individuals who are ICF/DD's;

b. whether Defendants have violated the ADA by engaging in diagnosis-based decision-making with their actions to deny or limit access to benefits, services, and opportunities because a person has a particular disability;

c. whether Defendants have violated § 504 of the Rehabilitation Act of 1973;

d. whether Defendants have violated the Medicaid statute's requirement of reasonable promptness, 42 U.S.C. § 1396a(8) and 42 U.S.C. § 1983, by failing to provide Medicaid Waiver Services with reasonable promptness;

e. whether Defendants have violated 42 U.S.C. § 1396n and 42 U.S.C. § 1983, by providing inadequate and inappropriate Home and Community-Based Waiver Services;

f. whether Defendants have violated 42 U.S.C. § 1396n and 42 U.S.C. § 1983, by funding institutional placements using Home and Community-Based Waiver Services g. whether Defendants have violated 42 U.S.C. § 1396n(c)(2) and 42 U.S.C. § 1983, by denying Plaintiffs their freedom of choice of an appropriate Home and Community-Based Waiver program that meets their health and welfare needs;

h. whether Defendants have violated Medicaid's state-wideness requirement, 42 U.S.C. § 1396a(a)(1), and 42 U.S.C. § 1983, by failing to provide Home and Community-Based Waiver services throughout the State of Florida;

i. whether Defendants have violated Medicaid's EPSDT requirements, violated 42 U.S.C. § 1396(a)(43)(C) and 42 U.S.C. § 1983, by failing to provide needed EPSDT services directly and to ensure that there are providers who are qualified and willing to provide EPSDT services for children with developmental disabilities;

j. whether Defendants have violated the Due Process Clause of the U.S. Constitution and 42 U.S.C. § 1983, by denying Plaintiffs and class members procedural due process, including notice and the opportunity for a fair hearing to challenge denials, reductions, and termination of Home and Community-Based Waiver benefits.

Applying the prerequisites for class certification required by Federal Rule of Civil Procedure 23(a), the district court...