Case Update – May 20, 2022
U.S. District Judge Howard Gilliam heard oral arguments in federal court in Oakland on May 19, 2022 on Defendants’ motion to dismiss. The Daily Journal reported on the argument, “State says no end to claims if wheelchairs must be covered in ACA insurance plans,” May 20, 2022.
The DJ quotes plaintiffs’ court filings: “They have alleged a particularized and concrete injury – the denial of coverage for medically necessary wheelchairs that are required for disabilities.” The DJ notes that plaintiffs “are seeking to compel the defendants to change the coverage plans to include wheelchairs.”
Defendants argued in the hearing that plaintiffs have failed to allege a reasonable inference of intentional discrimination. Plaintiffs rebutted this point by quoting a U.S. Supreme Court opinion that states “Discrimination against the handicapped was perceived by Congress to be most often the product, not of invidious animus, but rather of thoughtlessness and indifference – of benign neglect.”
Press Release – October 7, 2021
Kaiser and the California Dept. of Managed Health Care Face Lawsuit for Discriminatory Failure to Cover Wheelchairs
On October 7, 2021, the Disability Rights Education and Defense Fund (“DREDF”) and Rosen Bien Galvan & Grunfeld LLP filed a class action lawsuit in federal court against Kaiser Foundation Health Plan and the California Department of Managed Health Care (“DMHC”) challenging disability discrimination in insurance coverage of wheelchairs. Health plans administered by Kaiser and endorsed by DMHC do not provide effective coverage of wheelchairs needed by people with disabilities. The first amended complaint is here. A story about the lawsuit appeared in the Los Angeles Times on November 15, 2021, Wheelchair users can face hefty costs not covered by insurance.
Wheelchairs are used by many disabled people to remain or become mobile, stay healthy, commute to work, and participate fully in community living. The Affordable Care Act (“ACA”) mandates disability nondiscrimination and coverage of certain essential health benefits, including rehabilitative and habilitative devices (such as wheelchairs). Power wheelchairs needed by people with disabilities can cost up to $50,000.
Despite the ACA mandate, Kaiser and the State of California fail to cover wheelchairs in ACA-regulated health plans, leaving many people with disabilities without the mobility devices they need to work, pursue education, take care of their families, or even leave their homes. This lawsuit challenges Kaiser’s health insurance plan – which is also California’s “benchmark” or model plan under the ACA – that pays only a maximum of $2,000 toward a wheelchair intended for “home use.” The complaint alleges that the exclusion of a quintessential “rehabilitative and habilitative device” that people with disabilities uniquely rely on is in violation of the ACA’s nondiscrimination and “essential health benefits” provisions.
“This case is about independence and the right to live and move in the world,” said Ernest Galvan, a partner with RBGG. “An insurance benefit that provides only enough coverage to stay at home and not work is not a real benefit. It’s discrimination.”
“The ACA was intended to ensure a basic package of necessary health benefits for everyone, including people with disabilities who need wheelchairs,” said Claudia Center, Legal Director for DREDF. “The package offered by Kaiser and endorsed by California fails to meet the minimum requirements of the ACA.”
“The Plaintiffs in this case have waited long enough to access a safe and functional wheelchair,” said Carly A. Myers, Staff Attorney at DREDF. “We are not just talking about a health insurance policy here; we are talking about the basic human right to leave your home, access employment, and live full community lives. Without the tools they need to become mobile, justice is denied.”
Plaintiffs seek injunctive relief to eliminate Kaiser’s limitations on the coverage of necessary wheelchairs and to require DMHC to list wheelchairs as an essential health benefit under the ACA.
Director of Communications
Disability Rights Education and Defense Fund
(510) 544-6555 ext. 5256
Carl Whitaker (510) 847-0599 firstname.lastname@example.org
Disability Rights Education and Defense Fund (DREDF) – DREDF is a national cross-disability law and policy center that protects and advances the civil and human rights of people with disabilities through legal advocacy, training, education, and development of legislation and public policy. We are committed to increasing accessible and equally effective healthcare for people with disabilities and eliminating persistent health disparities that affect the length and quality of their lives.
Rosen Bien Galvan & Grunfeld LLP (RBGG) – RBGG is a complex litigation firm based on San Francisco. RBGG regularly handles high profile cases that move and shape public policy. The firm has, for example, prevailed repeatedly in major class actions against the State of California regarding constitutional rights, health care, disability rights, and mental health care.