Case: Ligas v. Maram [now Ligas v. Hamos]

On July 28, 2005, nine individuals with developmental disabilities filed this lawsuit against the Illinois Department of Healthcare and Family Services, the Illinois Department of Human Services, and the Illinois Department of Public Health in the United States District Court for the Northern District of Illinois. They alleged that they were eligible for long-term care through state-administered Medicaid Services but were forced to reside in large congregate care institutions rather than community-based facilities as a condition of receiving care in violation of the Americans with Disabilities Act, the Medicaid Act, and the Rehabilitation Act. They sought declaratory and injunctive relief.

A group of developmentally disabled individuals who could receive community-based care but did not wish to do so sought to intervene. On December 22, 2005, the District Court (Judge James F. Holderman) denied this petition on the grounds that their rights were not at issue in the case. This group appealed, but on February 15, 2007, the Seventh Circuit Court of Appeals (Judges Easterbrook, Kanne, and Williams) affirmed the District Court. On March 7, 2006, the District Court certified a class consisting of all persons in Illinois with developmental disabilities who qualified for long-term care and were capable of being cared for in a community-based facility but were either institutionalized in large congregate care facilities or at risk of being so institutionalized.

The parties reached an agreement on a consent decree and submitted it to the court on November 13, 2008. Numerous objections were filed by those who feared they would be forced into community-based care or that institutionalized care would suffer because of the consent decree. On July 7, 2009, the Court (Judge Holderman) refused to approve the consent decree and decertified the class on the grounds that the named plaintiffs did not represent class members who either were not eligible for community based treatment or did not wish to have such treatment. On August 31, 2009, the plaintiffs filed a second amended complaint narrowing the proposed class to only those individuals who had requested community-based placements.

On January 25, 2010, the parties filed a revised consent decree and motion for class certification. On January 26, 2010, the United States filed a Statement of Interest in support of the revised consent decree. A number of previous objectors sought to intervene and on April 7, 2010, the Court (Judge Holderman) granted their motion for limited intervention. The parties and the intervenors proceeded to negotiate and on January 11, 2011, the parties and intervenors filed a motion for class certification and preliminary approval of a new consent decree. The court (Judge Holderman) granted these motions on January 13, 2011. The consent decree provided for increased placement of developmentally disabled individuals into community-based treatment programs should they desire it, a statewide database and waitlist, and the development of transition service plans. It also contained measures protecting institutionalized care and called for various benchmarks and the appointment of a monitor. Judge Holderman approved the consent decree on June 15, 2011.

Since monitoring began in 2011, the Monitor, Tony Records, had filed three yearly reports, reporting one major instance of noncompliance in 2012 when an intermediate care facility serving 205 individuals closed quickly and residents were transitioned to new placements without the protected processes required by the consent decree. The 2013 report noted concerns about reimbursement to intermediate care facilities and other issues that would require additional efforts by the defendants.

On June 17, 2015, the Court Executive Committee reassigned the case to Judge Sharon Johnson Coleman, as Judge Holderman had retired.

In June of 2015, the Illinois state legislature faced a budget crisis, so the Court (Judge Coleman), approved the parties' Agreed Order on June 30, 2015, that even in the absence of an FY 2016 budget, the state of Illinois would continue to pay all service providers covered under the consent decree. However, in an order issued on August 18, 2015, Judge Coleman noted that in absence of a state budget, the State Comptroller had issued letters describing the state's intent to only pay for services provided to members of the class covered by the consent decree. Since many service providers work with both class members and non-class members across the population with developmental disabilities, this practice put the entire population at risk, and Judge Coleman ordered that the state continue timely payments for all service providers. In response to an emergency motion filed by plaintiffs and intervenors, Judge Coleman issued another order on September 1, 2015, again ordering the state to make timely payments for services to individuals with developmental disabilities in the interim until the state passed an FY 2016 budget. On June 22, 2016, Plaintiffs and Defendants submitted a proposed Agreed Order which would order the State to continue to pay for all services and personnel required by the consent decree during FY 2017. Judge Johnson Coleman granted the order on June 28, 2016, requiring the State to provide funding in the absence of an FY 2017 budget.

The Monitor's Fourth Annual Report, submitted in January 2016, indicated several concerns over the State's financial status and its impact on resources available to implement the decree, particularly with respect to shortages of staff members able to provide adequate services to class members in the community. This was true despite Defendants' efforts to implement the terms of the decree. The Fifth Annual Report, filed in January of 2017, indicated that there had been no improvement with respect to direct service provider shortages over the past year. It also noted that, because of staffing shortages, the availability of small community assisted living homes was actually decreasing. Another concern noted was the availability of adequate day activity and employment programs.

Citing the Monitor's findings, on April 7, 2017, plaintiffs and intervenors filed a joint motion to enforce the consent decree. They indicated that a major reason behind Defendants' failure to properly implement the decree was the State's inadequate reimbursement rates. On August 11, 2017, Judge Coleman granted the motion, finding that Defendants had failed to provide class members by failing to provide them with resources of sufficient quality, scope, and variety. On August 18, 2017, she ordered Defendants to devise a plan to address the issues causing the reduction in services and to bring the State into substantial compliance.

Defendants attempted to formulate a compliance plan that would meet the consent decree's standards and be practical given the State's budgetary constraints. On March 30, 2018, and April 11, 2018, defendants submitted status reports in which they described actions taken to bring the State into compliance. Judge Coleman found that the State's efforts did not bring it into compliance in a June 6, 2018, order. The order did recognize a "good faith effort" on the part of the defendants consisting of a pilot program to expand access to direct support professionals (DSPs), funding increases for DSPs, enhanced monitoring of service delivery, and additional programmatic improvements. Judge Coleman directed Defendants to "develop adequate solutions" to the continuing problems.

A status hearing was held on July 10, 2018, where the parties reported on the progress addressing four primary areas to bring the State in compliance with the consent decree. On September 12, 2018, the Monitor reported on the progress of the parties. A Rates Methodology Oversight Committee had been established and a meeting schedule had been set. A draft tool for a quality monitoring program had also been developed, which began implementation on May 10, 2019.

On November 14, 2019, the Monitor reported that federal CMS approved the 3.5% increase for community-based providers, which will implement a rate increase to $13.00/hour. It is unclear whether a temporary rate increase for ICFs will be approved. Continued reports from the Monitor at status hearings describe that Defendants remain out of compliance, but have made significant efforts toward progress.

On May 10, 2022, sample exit plans were discussed and the need for community crisis services was brought up. In particular, the Monitor reported that 185 class members remain in SODCs, a number of whom arrived there by crisis. On August 31, 2022, the Monitor and the parties continued to discuss their positions on implementing an exit plan. Plaintiffs and intervenors argued that termination of the consent decree is premature and that the proposed exit plan fails to address the Court's and the Monitor's findings of non-compliance. In regards to the SODC/crisis issue, matters were referred to Magistrate Judge Jeffrey Cole for supervision.

The next status hearing was set for June 29, 2023, and the case is ongoing.