MENTALLY HANDICAPPED;

MENTAL RETARDATION;

Court Cases;

You asked for information on a Massachusetts court case dealing with that state’s waiting list for residential services for people with mental retardation. You particularly wanted to know how many people have been moved off the list since the case was settled and how much the state has spent.

SUMMARY

Boulet et al. v. Celluci was filed in March 1999 on behalf of plaintiffs and their families who claimed the state’s slow pace of reducing its waiting list for people with retardation living at home violated Medicaid law and the Americans with Disabilities Act. In July 2000, the U. S. District Court granted summary judgment in the plaintiffs’ favor ruling that the state had to furnish Medicaid residential services with reasonable promptness. In December 2000, the state and plaintiffs entered a formal settlement agreement that affected 2,437 people then on the waiting list, but not those that were wait listed after July 14, 2000.

The agreement committed the state to spending nearly $ 126 million between FYs 2001-02 and 2005-06 to provide out-of-home placements to the people it covered and interim services while they waited. The bulk of the money, $ 114 million, was for placements. Of this amount, $ 85 million had to be new funding, while $ 29 million was redirected from existing Department of Mental Retardation budget levels. The governor has requested and the legislature has appropriated the full funding the settlement required for FYs 2001-0 and 2002-03. The governor has requested the full amount for FY 2003-04, but the legislature has not yet passed a budget. And DMR has fully met the agreement’s placement requirements, according to officials in its legal department.

CASE FACTS

The case, Boulet et al. v. Celluci (107 F. Supp. 2d 61), was filed in March 1999 on behalf of plaintiffs and their families who were dissatisfied with the state’s pace of reducing its waiting list for people with retardation living at home. The plaintiffs asserted that the state was violating Medicaid law and the Americans with Disabilities Act by failing to provide residential services with reasonable promptness to eligible people and, instead, indefinitely placing them on a waiting list. The plaintiffs asked to represent all individuals currently on the waiting list and those who might become eligible in the future.

In July 2000, the U. S. District Court granted summary judgment in the plaintiffs’ favor (that is, the court held that there were no material facts in dispute and that no trial was needed) ruling that the state had to furnish Medicaid residential services with reasonable promptness. But the court narrowed the class of people to whom its judgment applied to those currently participating the state’s home- and community-based (HCB) waiver program who had been wait listed for “residential habilitation” services and those not served by the waiver who could be accommodated under its participant cap. The court directed the state to (1) provide residential services to class members within 90 days or (2) if the state could demonstrate this was not feasible, propose a plan to comply with reasonable promptness.

SETTLEMENT AGREEMENT

In December 2000, the state and plaintiffs entered a formal settlement agreement. The agreement modified the class members to include all individuals who were wait listed for DMR services as of July 14, 2000, whether or not they were receiving or eligible to receive HCB waiver services. It includes only these people; those who become eligible for HCB services after July 14, 2000 are not covered.

This modified class had 2,437 members: 1,961 who were waiting for out-of-home residential services, 266 who were waiting for both residential and nonresidential services (e. g. , day care), and 210 who were waiting just for nonresidential services.

The agreement committed the state to spending nearly $ 126 million between FYs 2001-02 and 2005-06 to provide out-of-home placements to the people it covered and interim services while they waited. The bulk of the money, $ 114 million, was for placements. Of this amount, $ 85 million had to be new funding, while $ 29 million was redirected from existing DMR budget levels. It specified annual spending and placement requirements for each source of funds. These are shown in Table 1. If DMR spends less than appropriated for the required number of new placements, the agreement requires it to use the remaining funds for interim services.

Table 1: Boulet Settlement Funding and Services Requirements

Source: Boulet v. Celluci settlement agreement

The agreement also required DMR to provide placements during FY 2000-01 for 300 people on the waiting list using funds already appropriated by the legislature.

Out-of-home placements can include group homes, staffed apartments, and family partnerships in the community; they may not include share living arrangement or adult foster care with DMR support. A family partnership is an arrangements in which a DMR client or his family provides or contributes toward the cost of a residence in which DMR provides or arranges for services. Under the agreement, DMR must notify the plaintiff class’ counsel if more than 10% of the individuals scheduled to receive new state-funded out-of-home placements in a year voluntarily select family partnerships. Counsel can withhold consent to these partnerships if its investigation leads it to believe the individuals’ decisions were not voluntary.

Interim services include in- and out-of-home respite care; child care; specialized diagnosis, evaluation, and treatment; specialized equipment supplies, nutrition, and clothing; recreation and social activities; vehicle modifications; therapeutic services and supports; and housing supports and modifications.

The agreement requires the governor to ask the legislature for the agreed-upon funds each year. If the legislature does not appropriate the requested amount in a particular year, the following year the governor must ask for that year’s required funds plus the gap in the previous year’s appropriation.

RESULTS

DMR legal department officials report that, for FYs 2001-0 and 2002-03, the governor has requested and the legislature has appropriated on an annualized basis the funding the settlement required. They also said that the governor has requested the full amount for FY 2003-04, but the legislature has not yet passed a budget.

DMR has fully met the agreement’s placement requirements, according to these officials.

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