Benjamin H. v. Ohl

Medicaid was a joint federal and state program to provide medical care for certain individuals. Federal and state governments shared the costs of the program, with the federal government contributing a greater portion of the funds. States were not required to participate in Medicaid. Under Medicaid, West Virginia offered a program that provided intermediate-care-facility services for developmentally disabled individuals (facility program). An intermediate-care facility was a residential institution for providing health services to developmentally disabled individuals. The Home and Community-Based Waiver program (waiver program) was an alternative to the facility program and served individuals who were eligible to receive services under the facility program. The waiver program provided the facility-program level of services in homes instead of intermediate-care facilities, permitting individuals to avoid residing in institutions. Providing services through the waiver program cost much less than providing the services in an institution. Benjamin H. and four other individuals (collectively, applicants) (plaintiffs) were developmentally disabled, applied for the waiver program, and were placed on waiting lists for periods ranging from one to eight years. The applicants were eligible for the facility program and thus were entitled to participate in the waiver program. The services that the state was providing to the waitlisted applicants were insufficient to meet the level of services required for facility-program-eligible individuals. The applicants filed suit against the head of the state agency responsible for implementing West Virginia’s Medicaid plan (state) (defendant). The applicants asserted that the state was improperly denying Medicaid benefits and moved for a preliminary injunction requiring the state to provide all eligible individuals with waiver-program services. If granted, the injunction would entail a substantial cost to the state. The state provided testimony that additional state funding would be available to support no more than 25 new slots per year in the waiver program.