Prado-Steiman v. Bush (2000)

By Nikki Rivas

Overview 

In Prado-Steiman v. Bush, the U.S. Court of Appeals for the 11th Circuit addressed the state’s treatment of individuals with developmental disabilities who were eligible for Medicaid-funded services under Florida’s Home and Community Based-Waiver (“HCBW”) Program. The state’s program was established under the Home and Community Based Services Act which provides qualifying individuals to elect for in-home or community services rather than an intermediate care facility for individuals with developmental disabilities (“ICF/DD”). In an ICF/DD program, individuals with severe developmental disabilities receive active training, treatment, and services aimed at acquiring behaviors to be as independent as possible and prevent regression of that functional status. If a state voluntarily elects to adopt such a waiver, treatment costs would be covered pending federal approval. 

Summary 

HCBW eligibility was determined to be met if an applicant (1) is a client of developmental services, (2) meets the level-of-care criteria for admission to an ICF/DD, and (3) elects waiver of services in lieu of institutionalized care at an ICF/DD. Plaintiffs consisted of individuals with developmental disabilities who were presently receiving, eligible, or would receive or be eligible in the future to receive HCBW services. Plaintiffs claimed that Florida state officials, including Governor Jeb Bush and others, acted unlawfully in their governance of Florida’s HCBW program which resulted in many individuals being forced to stay in institutional facilities in order to receive Medicaid services. 

Defendants were alleged to be in violation of the Americans with Disabilities Act and Section 504 of the Rehabilitation Act by delaying and denying services to qualified individuals who were deemed ICF/DD’s, 42 U.S.C. § 1396 by failing to provide adequate and appropriate Medicaid Waiver Services with “reasonable promptness” throughout Florida, and the Due Process Clause of the Constitution by denying class members notice and opportunity for a fair hearing to challenge denial, reductions, and termination of the HCBW services. 

Defendants appealed under Rule 23 of the Federal Rules of Civil Procedure claiming that the class certified by the lower court was over-broad and lacked standing to bring forth suit. It cited that certain members of the previously certified class were unaffected by the claims being made because their qualification had yet to be determined. 

The court ultimately vacated the class certification, finding that only some individuals had been ruled eligible while others were still awaiting determination. It determined that the claims would be better litigated through creation of additional subclasses rather than through HCBW status alone to properly address each claim and ensure plaintiffs received the proper remedies. 

Impact 

Prado-Steiman v. Bush is a landmark case in which public policy and civil procedure intersect. The court had to face the procedural barriers of certifying a class of individuals with developmental disabilities seeking financial assistance for services at different stages and narrowing the typicality requirement of the class. While the court did not directly resolve the claims presently made, it did provide an opportunity for the claims to be remedied directly and accordingly to each affected individual. 

Court Documents 

Prado-Steiman v. Bush (2000) 

Citations 

American with Disabilities Act, 42 U.S.C. § 12101 et. seq. (1990). 

Section 1915(c) of the Social Security Act, 42 U.S.C. § 1396a (1973). 

Section 504 of the Rehabilitation Act, 29 U.S.C. § 749 (1973). 

U.S. Const. amend. XIV, § 1. 

Home and Community Based Services Waivers, Fla. Admin. Code § 59G-8.200.