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Recipients of “personal care services” under Washington’s state Medicaid plan made a sufficient showing that a reduction in these services would threaten them with institutionalization in violation of the Americans with Disabilities Act and Rehabilitation Act in order to grant them a preliminary injunction.

Washington Department of Social and Health Services issued a new regulation, which reduces at-home “personal care services” provided under the state Medicaid plan. The amount of hours allocated for personal care services was reduced an average of 10% in response to state budget shortfalls. Plaintiffs, comprised of personal care services recipients, advocacy groups and an at-home care workers union, filed an injunction in district court arguing that the regulation contravenes the Americans with Disabilities Act ("ADA") and Rehabilitation Act. The district court denied the preliminary injunction, holding that Plaintiffs had failed to show that the reduction creates a “serious risk of institutionalization” for personal care services recipients. The Ninth Circuit found that the district court had failed to consider Plaintiffs’ evidence of a risk of institutionalization on an individual basis, which would likely cause irreparable injury, as well as erroneously concluding that personal care services do not include medication management. The Court ruled that in a “balance of hardships,” the evidence favored Plaintiffs because they had shown more particularized injuries that created a threat of institutionalization in violation of the ADA and Rehabilitation Act, while the state was unable to show how, with any specificity, other programs would be affected by a preliminary injunction. Therefore, the Court held that a preliminary injunction should be awarded to Plaintiffs and, on remand, the district court could consider whether broader relief is warranted. REVERSED and REMANDED.