T.C. v. New York State Department of Health

Background

The plaintiffs are individuals with intellectual and developmental disabilities who were living in institutions while awaiting placement in community-based Certified Residential Opportunities and Medicaid Home and Community Based Services Waiver services. The opinion states that all plaintiffs were eligible and entitled to move to a community residence, but a residential provider had to agree to accept each individual. Plaintiff Disability Rights New York also participated in the case, and several individual plaintiffs appeared through a next friend.

The plaintiffs alleged that the New York State Department of Health, the New York State Office for People with Developmental Disabilities, and the agencies’ commissioners had taken too long to arrange placements. Their amended complaint asserted claims under the Medicaid Act, the Americans with Disabilities Act, the Rehabilitation Act, and the Fourteenth Amendment. They sought a preliminary injunction requiring defendants to promptly secure community placements. At the hearing, plaintiffs requested placement within 14 days or an explanation of why State-operated providers could not accept an unplaced plaintiff.

Defendants presented evidence that they had made numerous referrals and were continuing their efforts. They said providers had declined some plaintiffs because of complex clinical needs, behavioral challenges, medical requirements, staffing limitations, safety concerns, or geographic preferences. Three of the ten named plaintiffs who had appeared in the action had been placed by the time of the ruling.

Court’s analysis

A preliminary injunction is emergency relief issued before a final decision. Because the requested injunction would require defendants to take affirmative action, the court applied a heightened standard. Plaintiffs had to show irreparable harm, a likelihood of success on the merits, and that the public interest favored the injunction.

The court concluded that plaintiffs had not clearly shown a likelihood of success on any claim. On the Medicaid Act’s reasonable-promptness claim, the court assumed, without deciding, that the provision could be enforced through 42 U.S.C. § 1983. It nevertheless found that plaintiffs had not shown at this stage that defendants’ placement efforts were unreasonable. The court rejected plaintiffs’ argument that the length of the delays alone established a violation.

The court also found that plaintiffs had not shown a likelihood of success on their Medicaid freedom-of-choice claim. The court said the provision’s text may concern informing individuals about feasible and available alternatives rather than guaranteeing immediate provision of a particular alternative. The court further found that plaintiffs had not shown that suitable community residences were currently feasible and available for them.

Regarding the Medicaid fair-hearing claim, the court noted that plaintiffs had been found eligible for the services and therefore had not been denied benefits. The court found that defendants had acted on their claims by making placement efforts, so plaintiffs had not shown that their claims had been left unaddressed in a way requiring a hearing.

For the Americans with Disabilities Act and Rehabilitation Act claims, the court applied the rule requiring services in the most integrated setting appropriate to a person’s needs unless the requested change would fundamentally alter the program. The court accepted that community placement was appropriate and desired, but found that plaintiffs had not shown that near-immediate placement could be provided without fundamentally altering the State’s system. The court reasoned that compelling providers to accept people whom they believed they could not safely serve could create that fundamental alteration.

The court rejected the plaintiffs’ constitutional theories at this stage as well. It found no right to a hearing about a delay in providing benefits where the benefits had not been denied. It also found that the plaintiffs were not being subjected to bodily restraint because they were free to leave the institutions, and plaintiffs had not presented evidence that the institutions failed to meet professionally accepted minimum care standards.

The court additionally found that plaintiffs had not clearly shown that the public interest favored the injunction. Immediate placements over providers’ objections could affect the safety and needs of other residents. The court noted that plaintiffs’ descriptions of the requested relief had been vague and changed during the hearing. Although the court found that plaintiffs prevailed on irreparable harm under governing Second Circuit precedent because they asserted constitutional claims, that finding did not overcome their failure to show likely success and a favorable public interest.

Disposition

Judge Mary Kay Vyskocil denied plaintiffs’ motion for a preliminary injunction. The ruling did not finally resolve the underlying claims. The court separately ordered defendants to file an affidavit by January 30, 2023, detailing the further steps taken since November 2022 to place each plaintiff.