Taylor v. Colorado Department of Health Care Policy

FILED
United States Court of Appeals
PUBLISH Tenth Circuit
UNITED STATES COURT OF APPEALS January 26, 2016
Elisabeth A. Shumaker
FOR THE TENTH CIRCUIT Clerk of Court
_________________________________
LESLIE TAYLOR; CAROLINE
NICHOLE COOKE; JACOB
COOKE; COLORADO CROSS-
DISABILITY COALITION,
Plaintiffs - Appellants,
v. No. 14-1161
COLORADO DEPARTMENT OF
HEALTH CARE POLICY AND
FINANCING; SUE BIRCH, in her
official capacity as Executive
Director of the Colorado Department
of Health Care Policy and
Financing,
Defendants - Appellees.
_________________________________
Appeal from the United States District Court
for the District of Colorado
(D.C. No. 1:12-CV-00300-PAB-KMT)
_________________________________
Kevin W. Williams (Andrew Christopher Montoya, with him on the briefs)
Colorado Cross-Disability Coalition Legal Program, Denver, Colorado, for
Plaintiffs-Appellants.
W. Eric Kuhn, Assistant Attorney General, (Cynthia H. Coffman, Attorney
General, with him on the brief) Office of the Attorney General, Denver,
Colorado, for Defendants-Appellees.
_________________________________
Before BRISCOE, MATHESON, and BACHARACH, Circuit Judges.
_________________________________
BACHARACH, Circuit Judge.
_________________________________
The Medicaid program is a federal-state joint venture that provides
medical assistance to low-income individuals like one of the plaintiffs, Ms.
Leslie Taylor. This assistance is provided to Ms. Taylor through two
programs administered in Colorado. One program subsidizes the cost of
attendants who provide in-home care; the other program compensates
recipients for mileage when they use their vehicles for medical
appointments.
Ms. Taylor owns a car, but she cannot drive because of a disability.
To get to her medical appointments, she asked the Colorado agency to
combine her benefits through the two programs. If approved, this
combination would allow the agency to pay attendants for time driving Ms.
Taylor to and from her medical appointments. The agency refused, and the
plaintiffs allege that the refusal constitutes discrimination against Ms.
Taylor based on her disability. 1
On appeal, we ask: Does the agency’s refusal to combine its
programs constitute discrimination against the disabled? We conclude the
agency did not discriminate against Ms. Taylor based on her disability; she
1
The plaintiffs include not only Ms. Taylor, but also two of her
attendants (Ms. Caroline Cooke and Mr. Jacob Cooke) and a nonprofit
organization (Colorado Cross-Disability Coalition). But all of the
plaintiffs’ claims involve discrimination against Ms. Taylor based on her
disability.
2
obtained the same benefits that all other Medicaid recipients would have
received in the same circumstances.
I. Ms. Taylor is the beneficiary of two Colorado Medicaid programs.
Ms. Taylor’s disability requires her to have attendants at home and
when she travels, including when she travels to medical appointments. Her
attendants are paid through a Colorado Medicaid program, Consumer
Directed Attendant Support Services, which the defendants administer. But
this program does not allow compensation for the attendants’ time spent
driving individuals to medical appointments. See Colo. Code Regs. § 2505-
10:8.489.30(Q).
Colorado also provides transportation assistance to Medicaid
recipients through the Non-Emergent Medical Transportation program.
This program is administered county by county, paying “for the least
expensive transportation suitable to the client’s condition.” Id. at § 2505-
10:8.014; Appellants’ App’x at 23.
In 2009, Ms. Taylor asked administrators of the medical
transportation program to compensate her attendants for time spent driving
to and from medical appointments. The administrators in Ms. Taylor’s
county ultimately determined that they would provide a wheelchair-
accessible van for Medicaid recipients over 60 years old and a per-mile
reimbursement for all other Medicaid recipients. At the time, Ms. Taylor
3
did not qualify for the van service because she was under 60 years old.
Accordingly, Ms. Taylor’s only option was the per-mile reimbursement. 2
The plaintiffs allege the per-mile reimbursement constitutes
discrimination by inadequately compensating Ms. Taylor for her
transportation costs. According to the plaintiffs, this discrimination
violates the Americans with Disabilities Act and the Rehabilitation Act.
The district court dismissed these claims and denied the plaintiffs’ motion
for reconsideration. The plaintiffs appeal both rulings.
II. The dismissal was correct.
For the dismissal, we engage in de novo review. Keith v. Rizzuto, 212
F.3d 1190, 1192 (10th Cir. 2000). In applying de novo review, we conclude
that the dismissal was correct.
A. We view the allegations in the complaint favorably to the plaintiffs.
Applying de novo review, we assume that the factual allegations in
the complaint are true. Id. The resulting question is whether these factual
allegations plausibly suggest that the defendants are liable. Khalik v.
United Air Lines, 671 F.3d 1188, 1191 (10th Cir. 2012).
2
Ms. Taylor has since turned 60 years old, qualifying her for the
county’s van service. This fact does not moot the appeal because (1) the
plaintiffs request compensation for the attendants’ previous driving time,
and (2) the plaintiffs allege that the van service is inadequate.
4
B. The plaintiffs do not allege facts that would constitute
discrimination against Ms. Taylor based on her disability.
To apply this standard, we are guided by the elements of the
plaintiffs’ claims. See id. at 1192 (“While the [Rule] 12(b)(6) standard
does not require that Plaintiff establish a prima facie case in her complaint,
the elements of each alleged cause of action help to determine whether
Plaintiff has set forth a plausible claim.”). Title II of the Americans with
Disabilities Act and § 504 of the Rehabilitation Act contain different
elements, but this appeal involves an element common to both statutes:
discrimination against Ms. Taylor based on a disability. 3 See 42 U.S.C.
§ 12132 (Americans with Disabilities Act); 29 U.S.C. § 794(a)
(Rehabilitation Act). Thus, both statutory claims trigger the same issue:
whether the Colorado agency’s actions were discriminatory. To decide this
3
To state a claim under Title II of the Americans with Disabilities
Act, the plaintiffs must show that (1) Ms. Taylor is a qualified individual
with a disability, (2) she was excluded from participation in or denied the
benefits of Medicaid services, programs, or activities, or was otherwise
discriminated against by the Colorado agency, and (3) this exclusion,
denial of benefits, or discrimination was by reason of Ms. Taylor’s
disability. See Robertson v. Las Animas Cnty. Sheriff’s Dep’t, 500 F.3d
1185, 1193 (10th Cir. 2007).
By contrast, to state a prima facie claim under § 504 of the
Rehabilitation Act, the plaintiffs must show that (1) Ms. Taylor is
disabled, as the Rehabilitation Act defines, (2) Ms. Taylor would be
“otherwise qualified” to participate in the Colorado Medicaid program, (3)
the Colorado Medicaid program receives federal financial assistance, and
(4) the Colorado Medicaid program discriminated against Ms. Taylor. See
Jarvis v. Potter, 500 F.3d 1113, 1121 (10th Cir. 2007).
5
issue, we apply the same standards to discrimination claims under both
statutes. See Cohon ex rel. Bass v. N.M. Dep’t of Health, 646 F.3d 717,
725-26 (10th Cir. 2011); Wilkerson v. Shinseki, 606 F.3d 1256, 1262 (10th
Cir. 2010).
The plaintiffs argue that the agency discriminated against Ms.
Taylor, raising four appeal points:
1. The Colorado agency discriminated by refusing to exercise its
discretion to compensate attendants for driving Ms. Taylor.
2. The Colorado agency discriminated in deciding to issue only a
per-mile reimbursement because the agency was obligated to
fully compensate Ms. Taylor.
3. The Colorado agency discriminated by refusing to pay for a
driver even though Ms. Taylor could not drive and similarly
situated recipients obtained subsidies for driving expenses.
4. The Colorado agency was obligated under 28 C.F.R.
§ 35.130(b)(7) to modify the medical transportation program.
We reject each argument. 4 As a result, we conclude that the complaint does
not state a valid claim for discrimination under the federal statutes. 5
4
The Supreme Court has assumed that the Rehabilitation Act “reaches
at least some conduct that has an unjustifiable disparate impact upon the
handicapped.” Alexander v. Choate, 469 U.S. 287, 299 (1985). But the
plaintiffs have disavowed any challenge based on disparate impact. See
Oral Arg. at 12:55-13:10. Thus, we express no view on whether the
Colorado Medicaid programs had an “unjustifiable disparate impact” on the
disabled who are unable to drive themselves to their medical appointments.
5
On appeal, the plaintiffs also argue that the Colorado agency
intentionally discriminated against Ms. Taylor and its actions were
“motivated by discriminatory animus.” Appellants’ Opening Br. at 35. But
the plaintiffs did not raise this argument in the district court. We would
ordinarily review this argument under the plain-error standard. See
6
1. The Colorado agency did not discriminate against Ms.
Taylor by declining to pay the attendants for their driving
time.
The plaintiffs contend that the Colorado agency had the “flexibility”
to pay the attendants for driving Ms. Taylor. Appellants’ Opening Br. at
24. But the agency’s flexibility does not create a statutory duty.
“The [federal Medicaid] Act gives States substantial discretion to
choose the proper mix of amount, scope, and duration limitations on
coverage, as long as care and services are provided in ‘the best interests of
the recipients.’” Alexander v. Choate, 469 U.S. 287, 303 (1985) (quoting
42 U.S.C. § 1396a(a)(19)). With this discretion, states can decline to alter
a benefit’s scope “simply to meet the reality that [certain] handicapped
have greater medical needs.” Id. As a result, the Colorado agency could
choose not to pay attendants for their driving time even if the agency had
the option of paying. That choice did not constitute discrimination because
the Colorado agency provided identical Medicaid benefits to every
similarly situated recipient, disabled or not.
Gorsuch, Ltd., B.C. v. Wells Fargo Nat’l Bank Ass’n, 771 F.3d 1230, 1239
(10th Cir. 2014). But because the plaintiffs have not urged plain error, we
decline to consider the issue. See Richison v. Ernest Grp., Inc., 634 F.3d
1123, 1131 (10th Cir. 2011).
7
2. The per-mile reimbursement was not discriminatory even if
the reimbursement was inadequate to fully compensate Ms.
Taylor for her transportation costs.
The plaintiffs also argue that the per-mile reimbursement was
discriminatory because it did not sufficiently compensate Ms. Taylor for
the attendants’ driving time. Considered this way, the reimbursement is
akin to a benefit “cap.” But a benefit cap is not discriminatory simply
because it fails to fully compensate certain disabled individuals. See, e.g.,
Patton v. TIC United Corp., 77 F.3d 1235, 1246 (10th Cir. 1996)
(explaining that though a damages cap for personal injury actions may
“fall[] disproportionately on the disabled,” the cap on damages is not
discriminatory when the “limitation applies to all”). 6
Neither the Americans with Disabilities Act nor the Rehabilitation
Act requires Medicaid programs to compensate the disabled for all of their
transportation costs. Though the per-mile reimbursement was inadequate
for Ms. Taylor, that inadequacy does not make the reimbursement
discriminatory.
6
The plaintiffs point out that a federal regulation requires state
Medicaid plans to specify that they “will ensure necessary transportation
for beneficiaries to and from providers.” 42 C.F.R. § 431.53(a). But the
plaintiffs do not base their claim on the regulation or contend that the
regulation creates a private right of action. Cf. Harris v. James, 127 F.3d
993, 1009-10 (11th Cir. 1997) (holding that 42 C.F.R. § 431.53(a) does not
confer an enforceable right of transportation to and from medical
providers).
8
3. The medical transportation program did not discriminate
against disabled individuals who require a driver for
transportation.
The plaintiffs also argue that the Colorado agency discriminated
against Ms. Taylor by failing to provide for a compensated driver, while a
compensated driver was provided to similarly situated Medicaid recipients.
Appellants’ Opening Br. at 30. But the plaintiffs erroneously define the
universe of similarly situated recipients.
The relevant geographic unit is the county because the Colorado
agency administers transportation assistance differently among counties. In
some counties, the agency provides brokered transportation for Medicaid
recipients. For example, Medicaid recipients in some counties can go to
medical appointments in a county-subsidized van. In Ms. Taylor’s county,
however, transportation assistance is provided in two ways: (1) a
wheelchair-accessible van for Medicaid recipients over 60 years old and
(2) a per-mile reimbursement for all other Medicaid recipients. No one in
Ms. Taylor’s county can obtain compensation for a driver under the
medical transportation program.
To determine whether Ms. Taylor suffered discrimination because of
her disability, we compare Ms. Taylor to other Medicaid recipients who
reside in her county, not recipients living elsewhere in Colorado. See
Boatman v. Hammons, 164 F.3d 286, 292 (6th Cir. 1998) (holding that
differences in county expenditures for transportation services, based on
9
factors such as geographic conditions, do not violate the regulatory
requirement of uniform operation of the Medicaid program within the
state); see also Bruggeman ex rel. Bruggeman v. Blagojevich, 324 F.3d
906, 911 (7th Cir. 2003) (stating that a Medicaid program need not “assure
identical convenience of service everywhere in the state”).
With this comparison, the plaintiffs’ discrimination claim fails
because Ms. Taylor is treated the same as every other Medicaid recipient in
her county. 7
4. The Colorado agency was not obligated to modify its
Medicaid programs to accommodate Ms. Taylor’s disability.
Under the regulations implementing the Americans with Disabilities
Act, Colorado must make reasonable accommodations for Ms. Taylor’s
disability only if necessary to avoid discrimination based on a disability.
28 C.F.R. § 35.130(b)(7). Invoking this regulation, the plaintiffs argue that
7
The claim would fail even if the relevant comparison involved
Medicaid recipients anywhere in the State of Colorado. In some of the
more populated counties, Medicaid recipients are entitled to use brokered
transportation services. These services are not provided in Ms. Taylor’s
county. As the plaintiffs point out, this renders the mix of services
different for Ms. Taylor and some other Medicaid recipients in Colorado.
But that difference is based on where Ms. Taylor lives, not the existence of
a disability. The Americans with Disabilities Act and Rehabilitation Act
prohibit discrimination based on the existence of a disability, not the place
of residence. As a result, the plaintiffs’ claims would fail even if we
compared the benefits of Ms. Taylor and Medicaid recipients anywhere in
Colorado.
10
the Colorado agency had to modify the medical transportation program. We
disagree.
Colorado must modify its Medicaid programs only if Ms. Taylor
could not otherwise obtain the same benefits made available to nondisabled
individuals. See Wis. Cmty. Servs., Inc. v. City of Milwaukee, 465 F.3d
737, 751 (7th Cir. 2006) (en banc) (“[T]he plain language of [28 C.F.R.
§ 35.130(b)(7)] . . . makes clear that an accommodation only is required
when necessary to avoid discrimination on the basis of a disability.”
(emphasis in original)). Under this standard, Ms. Taylor cannot prevail
because the requested accommodation (payment of her attendants to drive
to medical appointments) was not available to anyone, disabled or not.
Thus, Colorado was not obligated to alter its Medicaid programs by
creating a new benefit previously unavailable to any Medicaid recipients.
* * *
Having rejected the plaintiffs’ four arguments, we uphold the
dismissal of the discrimination claims. Even if the allegations in the
complaint are credited, the Colorado agency did not discriminate against
Ms. Taylor based on a disability. The Colorado agency provided the same
benefits to all similarly situated Medicaid recipients, disabled or not.
11
III. In denying the motion to reconsider, the district court acted
within its discretion.
After the district court ordered dismissal, the plaintiffs moved for
reconsideration, arguing that the court had mistakenly thought that the
state agency could not pay the attendants under the medical transportation
program. With the motion, the plaintiffs submitted a fee schedule for
services under the medical transportation program. The district court
denied the motion for reconsideration.
We review this ruling for an abuse of discretion. See Elephant Butte
Irrigation Dist. of N.M. v. U.S. Dep’t of the Interior, 538 F.3d 1299, 1301
(10th Cir. 2008). Under this standard, the plaintiffs’ challenge fails.
In denying the motion for reconsideration, the district court
concluded that the fee schedule would not have affected the need for
dismissal. This conclusion fell within the district court’s discretion. As the
district court concluded, the Colorado agency has unambiguously
interpreted its regulations to prohibit payment of attendants for driving
Ms. Taylor to and from her medical appointments.
If the Colorado agency is incorrectly interpreting state regulations,
the agency might be in violation of these regulations. But that violation
would not involve the Americans with Disabilities Act or the
Rehabilitation Act, the two statutes underlying Ms. Taylor’s claims.
12
IV. Conclusion
The plaintiffs’ arguments are invalid. 8 As a result, we affirm the
dismissal and the denial of the motion for reconsideration.
8
The plaintiffs also argue that
 the district court failed to credit their allegations that the
attendants would not continue to drive Ms. Taylor to medical
appointments without fair compensation and
 the agency once issued a check for drivers, but now says there
is a policy against payment of drivers.
We need not address these arguments. For the sake of argument, we can
assume the attendants would refuse to drive Ms. Taylor without fair
compensation. And the agency’s current position on compensation of
drivers is clear even if the agency had a different position in the past. The
plaintiffs’ claim involves discrimination, not misapplication of state
regulations.
13