Royal v. Reese
| Decision Date | 30 May 2014 |
| Docket Number | No. 1:14–cv–25–WSD.,1:14–cv–25–WSD. |
| Parties | Zachary ROYAL, Plaintiff, v. Clyde L. REESE, III, in his official capacity as Commissioner of the Georgia Department of Community Health, and Frank Berry, in his official capacity as Commissioner of the Georgia Department of Behavioral Health and Developmental Disabilities, Defendants. |
| Court | U.S. District Court — Northern District of Georgia |
Joshua H. Norris, Georgia Advocacy Office, Decatur, GA, for Plaintiff.
Jason S. Naunas, Shalen S. Nelson, Attorney General's Office, Michelle Townes, State of Georgia Law Department, Atlanta, GA, for Defendants.
This matter is before the Court on Defendants' Motion to Dismiss [41].
Plaintiff Zachary Royal (“Plaintiff”) suffers from Spinal Muscle Atrophy Type 1 (“SMA”), a progressive and degenerative condition of the central nervous system. Plaintiff's condition causes him to suffer a deterioration of all parts of his neuromuscular system. (Id. ) As a result, Plaintiff is not able move functionally, with the exception of limited movement of his left hand. He cannot control his tongue or control or maintain his head position. (Id. ¶ 17.) He has substantial limitations in “self-care, mobility, and capacity for independent living.”
(Id. ¶ 20.) Plaintiff's condition requires a variety of treatments and interventions, including continuous monitoring of his respiratory system, nebulizer
treatments, theravest treatments, and suctioning to prevent choking. (Id. ¶¶ 13–16.)
Before his 21st birthday on January 6, 2014, Plaintiff was a beneficiary of the Georgia Pediatric Program (“GAPP”) Medicaid program available to individuals under the age of 21. (Id. ¶¶ 4, 21.) As a person under 21, Plaintiff was entitled under GAPP to receive certain care, including 84 hours per week of in-home skilled nursing care. (Id. ¶ 21.) The skilled nurses provided by GAPP performed many of Plaintiff's various treatments and interventions. (See id. ¶ 15.) Plaintiff alleges that his health will deteriorate and he will require hospitalization if he does not receive 84 hours per week of in-home skilled nursing care. (Id. ¶ 4.)
Before Plaintiff turned 21, he sought to secure continuation of the 84 hours of in-home skilled nursing care he was receiving under GAPP by applying for services from two Georgia Medicaid programs: the Comprehensive Supports Waiver Program (the “COMP Waiver”), administered by the Georgia Department of Behavioral Health and Developmental Disabilities (“DBHDD”), and the Independent Care Waiver Program (the “IC Waiver”), administered by the Georgia Department of Community Health (“DCH”). (Id. ¶ 23.) On April 24, 2013, DBHDD denied Plaintiff's application for COMP Waiver services on the ground that Plaintiff does not have an intellectual disability and therefore is not eligible for participation in the COMP Waiver. (Id. ¶ 27.) DCH approved Plaintiff for some services under the IC Waiver, but did not approve in-home skilled nursing care. (Id. ¶¶ 30–31.)
On January 3, 2014, Plaintiff filed this action against Defendants Clyde L. Reese, III (“Reese”), in his official capacity as Commissioner of DCH, and Frank Berry (“Berry”), in his official capacity as Commissioner of DBHDD (collectively, “Defendants”). In his Complaint [1], Plaintiff alleges that Berry violated Title II of the Americans with Disabilities Act of 1990 (the “ADA”) and the Rehabilitation Act of 1973 (the “Rehabilitation Act”) by denying Plaintiff's application for participation in the COMP Waiver. Plaintiff alleges that Reese violated Title II of the ADA and the Rehabilitation Act by failing to include in Plaintiff's IC Waiver services at least 84 hours per week of in-home skilled nursing care.
On March 6, 2014, Defendants filed their Motion to Dismiss seeking dismissal, for failure to state a claim under Rule 12(b)(6) of the Federal Rules of Civil Procedure, of Plaintiff's claims against Berry based on the COMP Waiver.1
On a motion to dismiss pursuant to Rule 12(b)(6) of the Federal Rules of Civil Procedure, the Court must “assume that the factual allegations in the complaint are true and give the plaintiff[ ] the benefit of reasonable factual inferences.” Wooten v. Quicken Loans, Inc., 626 F.3d 1187, 1196 (11th Cir.2010). Although reasonable inferences are made in the plaintiff's favor, “ ‘unwarranted deductions of fact’ are not admitted as true.” Aldana v. Del Monte Fresh Produce, N.A.,
416 F.3d 1242, 1248 (11th Cir.2005) (quoting S. Fla. Water Mgmt. Dist. v. Montalvo, 84 F.3d 402, 408 n. 10 (1996) ). Similarly, the Court is not required to accept conclusory allegations and legal conclusions as true. See Am. Dental Ass'n v. Cigna Corp., 605 F.3d 1283, 1290 (11th Cir.2010) ( Ashcroft v. Iqbal, 556 U.S. 662, 129 S.Ct. 1937, 173 L.Ed.2d 868 (2009) ; Bell Atl. Corp. v. Twombly, 550 U.S. 544, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007) ).
“To survive a motion to dismiss, a complaint must contain sufficient factual matter, accepted as true, to ‘state a claim to relief that is plausible on its face.’ ” Iqbal, 556 U.S. at 678, 129 S.Ct. 1937 (quoting Twombly, 550 U.S. at 570, 127 S.Ct. 1955 ). Mere “labels and conclusions” are insufficient. Twombly, 550 U.S. at 555, 127 S.Ct. 1955. “A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Iqbal, 556 U.S. at 678, 129 S.Ct. 1937 (citing Twombly, 550 U.S. at 556, 127 S.Ct. 1955 ). This requires more than the “mere possibility of misconduct.” Am. Dental, 605 F.3d at 1290 (quoting Iqbal, 556 U.S. at 679, 129 S.Ct. 1937 ). The well-pled allegations must “nudge[ ] their claims across the line from conceivable to plausible.” Id. at 1289 (quoting Twombly, 550 U.S. at 570, 127 S.Ct. 1955 ).
Title II of the ADA prohibits certain forms of discrimination by “public entities,” including state government agencies, against individuals with disabilities:
[N]o qualified individual with a disability shall, by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any such entity.
See 42 U.S.C. § 12132 ; see also id. § 12131(1) (defining “public entity”). The Rehabilitation Act similarly prohibits such discrimination by entities that receive federal funds:
No otherwise qualified individual with a disability in the United States ... shall, solely by reason of her or his disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance....
29 U.S.C. § 794(a). Individuals may bring private actions, and obtain injunctive and declaratory relief, for violations of these provisions. See 42 U.S.C. § 12133 (); 29 U.S.C. § 794a(2) (); see also Alexander v. Sandoval, 532 U.S. 275, 280, 121 S.Ct. 1511, 149 L.Ed.2d 517 (2001) (); Cone Corp. v. Fla. Dep't of Transp., 921 F.2d 1190, 1201 n. 36 (11th Cir.1991) ().
To state a claim under either Title II of the ADA or the Rehabilitation Act, a plaintiff must allege “(1) that he is a qualified individual with a disability; (2) that he was either excluded from participation in or denied the benefits of a public entity's services, programs, or activities, or was otherwise discriminated against by the public entity; and (3) that the exclusion, denial of benefit, or discrimination was by reason of the plaintiff's disability.” See Bircoll v. Miami–Dade County, 480 F.3d 1072, 1083 (11th Cir.2007) (citing Shotz v. Cates,
256 F.3d 1077, 1079 (11th Cir.2001) ); see also Cash v. Smith, 231 F.3d 1301, 1305 (11th Cir.2000) ().
A “qualified individual with a disability” is “an individual with a disability who, with or without reasonable modifications to rules, policies, or practices, the removal of architectural, communication, or transportation barriers, or the provision of auxiliary aids and services, meets the essential eligibility requirements for the receipt of services or the participation in programs or activities provided by a public entity.” 42 U.S.C. § 12131(2). With respect to Plaintiff's claims based on his alleged exclusion from the COMP Waiver program, Defendants argue that Plaintiff failed to allege that he is a “qualified individual with a disability.” Defendants contend that the Complaint shows that Plaintiff does not qualify for participation in the COMP Waiver and is thus not “qualified” under Title II and the Rehabilitation Act.
The parties agree that, to be eligible for participation in the COMP Waiver, an individual must, among other things, have an intellectual disability or a “closely related” condition. See DCH Division of Medicaid, Policies and Procedures for Comprehensive Supports Waiver Program (COMP) General Manual § 706.2 (Jan. 1, 2014) [hereafter COMP Manual].2 Plaintiff concedes that he does not have an intellectual disability, but argues that the Complaint shows that he has a “closely related” condition.3
The parties agree that whether a person has a “closely related” condition is governed by the COMP Manual, which incorporates the definition of “persons with related conditions” provided in 42 C.F.R. § 435.1010 :
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Royal v. Reese, 1:14–cv–25–WSD.
...24 F.Supp.3d 1243Zachary ROYAL, Plaintiff,v.Clyde L. REESE, III, in his official capacity as Commissioner of the Georgia Department of Community Health, and Frank Berry, in his official capacity as Commissioner of the Georgia Department of Behavioral Health and Developmental Disabilities, D......