Alexander v. Choate
When, as a cost-saving measure, the state of Tennessee reduced from 20 to 14 the maximum number of days that it would provide support for hospital stays by Medicaid patients, a group of individuals with disabilities filed suit under Section 504. The plaintiffs in Alexander (1985) alleged that the change had such a disparate impact on persons with disabilities such as themselves that it amounted to unlawful discrimination. Further, the plaintiffs claimed that any limitation on the number of days was invalid for the same reason. After a federal trial court dismissed the complaint, the Sixth Circuit reversed in favor of the plaintiffs. The Supreme Court subsequently agreed to hear an appeal to consider the meaning of Section 504.
Writing for a unanimous Supreme Court, Justice Marshall ruled that Tennessee’s reduction in Medicaid benefits did not violate the nondiscrimination requirements of Section 504. First, the Court examined the issue of whether intent to discriminate was a necessary predicate to a finding of discrimination under Section 504. While the Court did not resolve this question, Justice Marshall noted that both the history of Section 504’s provision and a comparison to other federal discrimination statutes such as Title VI of the Civil Rights Act of 1964 suggested that Section 504 was designed to protect against disparate impact discrimination. As such, for the purposes of Alexander, the Court assumed that the law recognized such injuries and turned its attention to whether the state’s actions in this instance were “the sort of disparate impact that federal law might recognize” (p. 299).
Citing Southeastern Community College v. Davis (1979), one of its earlier opinions in which it interpreted the statute, the Supreme Court acknowledged that Section 504 required “reasonable” accommodations. However, the Court pointed out that Section 504 did not call for alterations to stateoperated programs that would have substantially or fundamentally altered the nature of the programs or benefits. As the Court explained,
[Section 504] requires that an otherwise qualified handicapped individual must be provided with meaningful access to the benefit that the grantee offers. The benefit itself, of course, cannot be defined in a way that effectively denies otherwise qualified handicapped individuals the meaningful access to which they are entitled; to assure meaningful access, reasonable accommodations in the grantee’s program or benefit may have to be made. (p. 301)
The Court concluded that the 14-day hospital stay that Tennessee allowed under its Medicaid program provided “meaningful access,” even though persons with disabilities may be more likely than those without disabilities to require longer stays. Likewise, the Court maintained that because the costs of making the requested accommodations would have been extensive, they exceeded the bounds of the “reasonable” accommodations contemplated by Section 504.
Julie F. Mead
See also Disparate Impact; Rehabilitation Act of 1973, Section 504; Southeastern Community College v. Davis
Ball, C. A. (2004). Preferential treatment and reasonable accommodation under the Americans with Disabilities Act. Alabama Law Review, 55, 951–995.
Paradis, L. (2003). Title II of the Americans with Disabilities Act and Section 504 of the Rehabilitation Act: Making programs, services, and activities accessible to all. Stanford Law and Policy Review, 14, 389–415.