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Ninth Circuit Allows Medical Act and Disability Discrimination Claims to Proceed Without Exhausting IDEA Administrative Remedies
Hawaii Disability Rights Center (HDRC) is a federally authorized and funded protection and advocacy organization representing individuals in Hawaii with developmental disabilities, including children and young adults with autism. HDRC filed a lawsuit on behalf of children and young adults under 22 diagnosed with autism who required Applied Behavioral Analysis (ABA) services. HDRC alleged that Hawaii’s Departments of Education (DOE) and Department of Human Services (DHS) unlawfully deny students with autism access to ABA services during the school day, even when those services are medically necessary and prescribed. ABA is a form of individualized behavioral therapy focused on reinforcing positive behavior in individuals with autism and other developmental disabilities. Both parties agreed that ABA therapy is one of the few effective, evidence-based treatments available for autism.
HDRC alleged that DOE’s and DHS’s policies generally do not provide ABA services during the school day. Under these policies, a student with autism who has been medically prescribed ABA services cannot receive services during the school day unless DOE approves it, deems it educationally relevant, and has DOE-approved personnel provide the service. This is true even if the services are covered by insurance or parents and could be provided at no cost to DOE.
HDRA argued that this restriction results in some students receiving no ABA services during school, even when medically necessary. HDRA argued that other students receive inadequate ABA services that fail to address their social and medical needs because DOE limits the services to ensuring students can keep up with the educational curriculum.
HDRC sought injunctive and declaratory relief, alleging that DOE’s and DHS’s policies limiting access to medically prescribed ABA services during the school day violate the Americans with Disabilities Act (ADA), Section 504 of the Rehabilitation Act, the Medicaid Act, and the Individuals with Disabilities Education Act (IDEA).
Under the IDEA, the DOE must provide children with disabilities a free appropriate public education (FAPE), which might require special education and related services. Eligibility and services are determined by an Individualized Education Program (IEP) team, which includes school staff, district administrators, and the child’s parent or guardian. If an IEP team member disagrees with the IEP or lack thereof, they must first exhaust administrative remedies by filing a complaint and undergoing a due process hearing. A party may only bring a civil lawsuit regarding the complaint after obtaining a decision through the administrative hearing process. If a party files a lawsuit that does not explicitly claim a violation of the IDEA but seeks relief that is available under the IDEA, they must first exhaust all administrative remedies before proceeding with the lawsuit.
DOE and DHS moved for summary judgment, asserting that all claims required administrative exhaustion under the IDEA before proceeding with a lawsuit. The trial court granted the motion, concluding that the ADA, Section 504, and Medicaid Act claims were subject to IDEA’s exhaustion requirement because their “gravamen”, which mean the main part of the dispute, sought relief available under IDEA. The trial court rejected HDRC’s argument that protection and advocacy organizations were exempt from the exhaustion requirement and determined that none of the exceptions to IDEA’s exhaustion rule applied.
HDRC appealed. The Ninth Circuit Court of Appeal examined whether HDRC was required to exhaust administrative procedures available under the IDEA for each of its claims.
First, the Ninth Circuit examined HDRC’s IDEA claim. HDRC alleged that DOE violated the IDEA because it implemented policies and practices that failed to provide appropriate ABA services for students with autism. HDRC argued that DOE categorically failed to provide ABA services through qualified professionals, did not offer adequate ABA services, and prohibited ABA providers from delivering medically necessary ABA on campus during school hours. Additionally, HDRC claimed that DOE predetermined ABA services should not be included in IEPs, failed to provide a FAPE to students who needed ABA services during the school day, and did not adequately integrate students with autism into regular classrooms.
The Ninth Circuit held that HDRC, as a protection and advocacy organization, is authorized to represent its constituents in administrative proceedings under the Developmental Disabilities Assistance and Bill of Rights Act. HDRC argued that it was exempt from the IDEA’s administrative exhaustion requirement but the Ninth Circuit disagreed. The Ninth Circuit further determined that none of the recognized exemptions to exhaustion, such as futility, systemic applicability, or inadequacy of administrative remedies, applied to HDRC’s IDEA claim. The allegations focused on a specific component of the special education program (ABA services) rather than systemic flaws, and the Ninth Circuit found the administrative process was capable of addressing the issues that HDRC raised. Therefore, HDRC was required to exhaust administrative procedures for its IDEA claim before seeking judicial review.
Next, the Ninth Circuit summarized the purpose of the Medicaid Act. It explained that states participating in Medicaid and receiving federal funds must comply with federal regulations. In Hawaii, DHS administers Medicaid, including “Quest Integration” health plans offered through private health providers. Under the Medicaid Act, DHS is required to provide free screening and medically necessary treatment services to qualified individuals, including ABA therapy for Medicaid beneficiaries with autism. The Ninth Circuit pointed out that Medicaid Act prohibits DHS from “restrict[ing] payment . . . for medical assistance for covered services furnished to a child with a disability because such services are included in the child’s [IEP].”
HDRC’s Medicaid Act claim alleged that DHS failed to provide medically necessary ABA services during school hours, improperly delegated this responsibility to DOE (which does not accommodate ABA services), and failed to coordinate a system to ensure students with autism receive necessary services. HDRC argued these failures violated the Medicaid Act’s requirement to provide necessary services to children receiving Medicaid.
The Ninth Circuit explained that the ADA and Section 504 of the Rehabilitation Act require public entities to ensure equal access to benefits, services, and programs for individuals with disabilities. HDRC’s ADA and Section 504 claims alleged that DOE and DHS discriminated against students with autism by failing to provide reasonable accommodations, using discriminatory administrative methods, denying equal access to programs and services, and offering less effective services to students with autism compared to others.
The Ninth Circuit held that HDRC’s non-IDEA claims under the ADA, Section 504, and Medicaid Act did not seek relief for the denial of a FAPE, which is the only relief available under the IDEA. Therefore, HDRC was not required to exhaust the IDEA’s administrative procedures for those claims.
The Ninth Circuit affirmed in part and reversed in part the trial court’s summary judgment decision and remanded the case for further proceedings consistent with its opinion.
Hawai’i Disability Rights Ctr. V. Kishimoto (9th Cir. 2024) 122 F.4th 353