necessary care. In there was no allegation that the defendants’ actions threatened any of Fisher, the plaintiffs with immediate institutionalization. 335 F.3d at 1185. Rather, the evidence showed that many of the plaintiffs would remain in their homes their health ha[d] “until deteriorated” and would end up in a nursing home.” (emphasis added). Indeed, Id. “eventually in the court explicitly rejected the defendants’ assertion that order Brantley v. Maxwell-Jolly, “in to state a Title II violation, Plaintiffs must show that the [State’s reduction in community-based services] leaves no choice other than to be institutionalized . . .” but rather concluded that “the of institutionalization is sufficient[,]” and thus granted the plaintiffs’ motion for a risk preliminary injunction. 656 F. Supp. 2d at 1170. (quotation marks omitted); 669 F. see also V.L., Supp. 2d at 1120 (concluding that plaintiffs may establish a violation of the integration mandate by showing that the denial of services could lead to an eventual in health” that puts them “decline at [of] being placed in a nursing home.”). “risk Recently, a district court considered whether the state of Missouri violated the integration mandate of the ADA when it refused, as a matter of statewide policy, to provide incontinence briefs under its Medicaid state plan to adults residing in the community. No. Hiltibran v. Levy, 10-4185 (D. Mo. Dec. 24, 2010) (attached as Exhibit C). The court held that despite the plaintiffs’ ability thus far to pay for the briefs themselves to avoid institutional placement, the plaintiffs were nonetheless likely at risk of institutionalization because the cost of the briefs strained the plaintiffs’ already precarious financial situations. at 11, 14. The district court Id. recognized that the risk of institutionalization does not need to be imminent; indeed, many individuals go to great lengths to stave off institutionalization. at 11. Similarly, in Id. Cruz v. No. 10-23048 (S.D. Fla. filed Aug. 18, 2010), the district court found that although the Dudek,
necessary care. In Fisher, there was no allegation that the defendants’ actions threatened any of the plaintiffs with immediate institutionalization. 335 F.3d at 1185. Rather, the evidence showed that many of the plaintiffs would remain in their homes “until their health ha[d] deteriorated” and would “eventually end up in a nursing home.” Id. (emphasis added). Indeed, in Brantley v. Maxwell-Jolly, the court explicitly rejected the defendants’ assertion that “in order to state a Title II violation, Plaintiffs must show that the [State’s reduction in community-based services] leaves no choice other than to be institutionalized . . .” but rather concluded that “the risk of institutionalization is sufficient[,]” and thus granted the plaintiffs’ motion for a preliminary injunction. 656 F. Supp. 2d at 1170. (quotation marks omitted); see also V.L., 669 F. Supp. 2d at 1120 (concluding that plaintiffs may establish a violation of the integration mandate by showing that the denial of services could lead to an eventual “decline in health” that puts them at “risk [of] being placed in a nursing home.”). Recently, a district court considered whether the state of Missouri violated the integration mandate of the ADA when it refused, as a matter of statewide policy, to provide incontinence briefs under its Medicaid state plan to adults residing in the community. Hiltibran v. Levy, No. 10-4185 (D. Mo. Dec. 24, 2010) (attached as Exhibit C). The court held that despite the plaintiffs’ ability thus far to pay for the briefs themselves to avoid institutional placement, the plaintiffs were nonetheless likely at risk of institutionalization because the cost of the briefs strained the plaintiffs’ already precarious financial situations. Id. at 11, 14. The district court recognized that the risk of institutionalization does not need to be imminent; indeed, many individuals go to great lengths to stave off institutionalization. Id. at 11. Similarly, in Cruz v. Dudek, No. 10-23048 (S.D. Fla. filed Aug. 18, 2010), the district court found that although the