Case: Bertrand v. Maram

On January 31, 2005, private counsel filed a class-action suit against three Illinois state officials: the Director of the Illinois Department of Public Aid, the Secretary of the Illinois Department of Human Services, and the Director of the Office of Developmental Disabilities. On the following day (February 1, 2005), a slightly modified Amended Complaint and Motion for Class Certification was filed. The Plaintiffs alleged that Illinois had insufficiently funded its Medicaid Home and Community-Based Services (HCBS) waiver program, which was established under § 1915(c) of the Social Security Act. The purpose of the waiver program was to provide services to individuals with developmental disabilities who, in the absence of the HCBS, would require care in a large institution. The complaint listed two named plaintiffs, who were also representatives of the proposed class, defined as all developmentally disabled persons with intellectual disabilities, eighteen or older, who were HCBS recipients and who sought additional funding for services through the program.

Under 42 U.S.C. § 1396n(c)(1) and § 1915(c) of the Social Security Act, by opting to provide an HCBS waiver program, Illinois had committed to make available a specified number of HCBS waivers to participants (10,000 waivers in 2005), and to fully fund the services required by participants so as to enable them live in an integrated community setting. The Plaintiffs alleged that Illinois had issued too few waivers each year, and that it had denied waiver recipient requests for necessary services. Among the services available under HCBS was the option for individuals to live in Community-Integrated Living Arrangements (CILAs), a type of state-licensed group home for eight or fewer residents where individually customized habilitation and personal care support and services were provided. The complaint alleged that because of supposed insufficient funding, Illinois was denying the requests of qualified Medicaid HCBS recipients for placement in CILA residences, and instead was placing or offering to place them in large institutions where they would be effectively segregated from the rest of society. Both of the named plaintiffs had been denied placement in CILA residences despite being HCBS waiver recipients.

The Plaintiffs sought an injunction requiring Illinois to provide funding for and to make available to the Plaintiff class a full range of HCBS services, including CILA services. They sought a declaratory judgment holding the failure to provide funding unlawful under 24 U.S.C. §1396a(a) (the Medicaid Act) and 42 U.S.C. §1983, and further sought to recover attorneys' fees and costs.

Illinois argued that the federal Centers for Medicare and Medicaid Services (CMS) had specifically approved Illinois' use of certain priority criteria to limit the number of CILA recipients when it approved the state's HCBS waiver program, and that if CILA and other services were not distributed on a the basis of priority criteria, but on a first-come, first-served basis, those most in need would not necessarily receive them.

On June 8, 2005, the Plaintiffs filed a Motion for Summary Judgment, and on July 7, the Defendants filed their own summary judgment motion. On September 25, 2006, the Court (Judge Virginia M. Kendall) issued an Opinion and Order denying the Plaintiffs' motion and granting Illinois' motion. The Court held that, because the CMS had specifically approved Illinois' use of certain priority criteria to limit the number of CILA recipients when it approved the state's HCBS waiver program, Illinois was not in violation of federal law. The Plaintiffs' motion for class certification was denied as moot.

The Plaintiff filed an Appeal to the federal Seventh Circuit Court of Appeals. On September 9, 2007, the Court of Appeals (Chief Judge Frank Hoover Easterbrook, writing for a three judge panel) affirmed the lower court's decision. Bertrand ex rel. Bertrand v. Maram, 495 F.3d 452 (7th Cir. 2007) (rehearing denied).

The case is closed.