On August 9, 2024, the U.S. Court of Appeals for the District of Columbia upheld a lower court’s decision to dismiss a proposed class action accusing HHS of causing a shortage of home health aides willing to assist Medicare beneficiaries. The D.C. Circuit Court affirmed the lower court’s ruling that the lead plaintiffs lacked standing because they failed to prove the causation and redressability requirements of standing.

The lead plaintiffs consist of Medicare beneficiaries with chronic illnesses that depend on the services of home health aides. While these services are generally covered by Medicare, the plaintiffs alleged Medicare-enrolled home health agencies (HHAs) have failed to provide in-home care or offered fewer services than the Medicare beneficiaries are entitled to under Medicare due to HHS’s policies, enforcement practices, and/or lax oversight of HHAs.

Specifically, the plaintiffs sued HHS under two types of claims. First, the plaintiffs alleged HHS violated Medicare laws by insufficiently enforcing the conditions of participation on HHAs and unlawfully implementing the Medicare home health benefit. The plaintiffs claimed Medicare-enrolled HHAs regularly disregard the Medicare conditions of participation by underserving the chronically ill and that HHS has continuously failed to prevent these violations. Moreover, the plaintiffs argued that HHS’s policies and practices contributed to the shortage of home health services available to Medicare beneficiaries.

Second, the plaintiffs claim that HHS’s alleged actions (or lack thereof) violated the ban on disability discrimination. HHA’s alleged refusal to accept or adequately care for Medicare beneficiaries has led to patients being forced into nursing homes or other institutionalized settings. The plaintiffs therefore contended HHS violated its responsibility to ensure health care is provided to individuals in the most integrated setting appropriate to their needs.

Based on these allegations, the plaintiffs sued HHS and sought to represent a class of chronically ill and disabled Medicare beneficiaries who had similarly been unable to find Medicare-covered home health services. The plaintiffs requested both declaratory judgement and injunctive relief in an effort to compel systemwide reforms to improve the provision of Medicare-covered home health aides to Medicare beneficiaries, such as stricter enforcement of the Medicare conditions of participation governing home health services and policy reforms related to HHS’s auditing, payment, and quality rating system.

However, in an opinion authored by Circuit Judge Neomi Rao, the D.C. Circuit affirmed the U.S. District Court Judge Trevor McFadden’s decision that the plaintiffs lacked standing to bring such claims. The D.C. Circuit agreed with the lower court’s ruling that the plaintiffs failed to plausibly allege that the requested relief would redress any harm.

The D.C. Circuit noted that the plaintiffs’ allegations were purely speculative as to whether the denials of services can be traced to HHS’s enforcement practices. The D.C. Circuit also reasoned that HHAs can freely choose whether to accept a patient and that there are many economic and practice reasons why an HHA may decide against providing services to chronically ill Medicare beneficiaries. The D.C. Circuit reasoned that the shortage of home health care services are a result of choices made by private HHAs.

The lack of a plausible causal link between HHS’s enforcement practices and the injuries alleged by the plaintiffs ultimately proved fatal to the plaintiff’s claims. Accordingly, the D.C. Circuit held that the plaintiffs failed to demonstrate their injuries are redressable and therefore failed to establish standing.

The D.C. Circuit’s opinion is available here.