Jenkins v. Washington State Department of Social and Health Services

David Jenkins, Venetta Gasper, and Tommye Myers (defendants) were disabled individuals receiving at-home care through Medicaid. The Washington State Department of Social and Health Services (DSHS) (plaintiff) assessed that Jenkins, Gasper, and Myers all needed high levels of care and assigned each recipient approximately 185 care hours per month. Then, because Jenkins, Gasper, and Myers all lived with caregivers, their assigned Medicaid care hours were reduced by 15 percent pursuant to DSHS’s shared-living rule, down to approximately 153 hours per month. DSHS did not evaluate whether Jenkins’s, Gasper’s, and Myers’s needs would still be adequately met following the reduction. The shared-living rule created an irrebuttable presumption that Medicaid recipients living with caregivers needed fewer care hours; however, it did not consider an individual Medicaid recipient’s needs or living situation before applying the reduction. The rationale behind the shared-living rule was that a live-in caregiver, such as a friend, family member, or employee, could easily duplicate basic living tasks performed for themselves or the household to cover the Medicaid recipient’s needs. However, Jenkins’s, Gasper’s, and Myers’s caregivers all reported that even the 185 monthly care hours DSHS originally granted were insufficient to meet their care needs. Jenkins, Gasper, and Myers challenged the shared-living rule, arguing it violated the Medicaid Act’s comparability requirement by discriminating between individuals with the same care needs. The trial court agreed and invalidated the shared-living rule. The appellate court affirmed. DSHS appealed to the Washington Supreme Court.