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

The lead plaintiffs are Medicare beneficiaries with chronic illnesses who rely on the services of home health care workers. Although these services are generally covered by Medicare, the plaintiffs alleged that Medicare-enrolled home health agencies (HHAs) fail to provide home health care or provide fewer services than Medicare beneficiaries are entitled to under Medicare due to HHS policies, enforcement practices, and/or lax oversight of the HHAs.

Specifically, the plaintiffs sued HHS based on two types of claims. First, the plaintiffs alleged that HHS violated Medicare law by inadequately enforcing the conditions of participation for HHAs and unlawfully implementing Medicare home health benefits. The plaintiffs alleged that Medicare-enrolled HHAs routinely violated the conditions of participation for Medicare by underserving the chronically ill and that HHS continually failed to prevent these violations. In addition, the plaintiffs argued that HHS policies and practices contributed to the shortage of home health services for Medicare beneficiaries.

Second, the plaintiffs allege that HHS’s alleged actions (or lack thereof) violated the prohibition against disability discrimination. The HHA’s alleged refusal to admit or adequately care for Medicare beneficiaries resulted in patients being forced into nursing homes or other institutional settings. The plaintiffs therefore alleged that HHS violated its responsibility to ensure that health care is provided to people in the most integrated setting that meets their needs.

Based on these allegations, the plaintiffs sued HHS, seeking to represent a class of chronically ill and disabled Medicare beneficiaries who were also unable to find Medicare-covered home care services. The plaintiffs sought both a declaratory judgment and an injunction to compel system-wide reforms to improve the supply of Medicare-covered home care aides to Medicare beneficiaries, such as stricter enforcement of Medicare participation requirements for home care services and policy reforms related to HHS’s audit, payment, and quality rating system.

However, in an opinion written by Circuit Judge Neomi Rao, the DC Circuit affirmed U.S. District Judge Trevor McFadden’s ruling that the plaintiffs did not have standing to assert such claims. The DC Circuit agreed with the lower court’s ruling that the plaintiffs failed to plausibly demonstrate that the relief sought would repair any harm.

The DC Circuit found that plaintiffs’ claims regarding whether the denials of benefits were due to HHS enforcement practices were pure speculation. The DC Circuit also argued that HHAs are free to decide whether to admit a patient and that there are many economic and practical reasons why an HHA may choose not to provide benefits to chronically ill Medicare beneficiaries. The DC Circuit argued that the shortage of home care services was the result of decisions made by private HHAs.

The lack of a plausible causal connection between HHS enforcement practices and the injuries alleged by plaintiffs ultimately proved fatal to plaintiffs’ claims. Accordingly, the D.C. Circuit held that plaintiffs failed to demonstrate that their injuries were reparable and therefore failed to demonstrate standing.

The DC Circuit’s opinion is available here.