Defendants’ recently proposed Policy Changes evidences an unambiguous termination of the practices that have allegedly harmed Plaintiffs and their proposed class members is suspect. 608 F.3d at 1266. These Policy Changes stand in stark contrast to Defendants’ prior, Harrell, unambiguous efforts to reduce the availability of in-home nursing services, and instead require individuals to receive PPEC services. For example, in a 2010 budget proviso, the Legislature reduced funding for private duty nursing services by several million dollars, directed AHCA to limit availability of the service to twelve continuous hours per day, and mandated parental participation in care. In the same year, the Legislature added a budget proviso requiring AHCA to beneficiaries to PPEC services instead of private duty nursing, and to offer private “direct” duty nursing as a supplemental service only. AHCA followed suit through implementing the policies that they now propose to change. There is thus a strong basis to suspect that the instant Policy Changes, which are an abrupt about-face from prior policies, are driven not by the desire to the Medicaid program or existing policies, but instead to deprive the “improve” “clarify” Court of subject matter jurisdiction. In sum, as in and in contrast with the and content” of Harrell Troiano, “timing Defendants’ Policy Changes here do not make it clear” that Defendants have “absolutely effectuated an termination” of their objectionable policies. 608 F. 3d at Harrell, “unambiguous 1268; 633 F.3d at 1310. NABP, B. Defendants’ Proposed Policy Changes Not Support Dismissal Even If They Mooted Some of Plaintiffs’ Allegations. Even if the Policy Changes were fully effectuated and permanent, dismissal would still be inappropriate. As noted above, case becomes moot . . . when the issues presented are no “[a] longer or the parties lack a legally cognizable interest in the outcome.” 133 S. Ct. Already, ‘live’
Defendants’ recently proposed Policy Changes evidences an unambiguous termination of the practices that have allegedly harmed Plaintiffs and their proposed class members is suspect. Harrell, 608 F.3d at 1266. These Policy Changes stand in stark contrast to Defendants’ prior, unambiguous efforts to reduce the availability of in-home nursing services, and instead require individuals to receive PPEC services. For example, in a 2010 budget proviso, the Legislature reduced funding for private duty nursing services by several million dollars, directed AHCA to limit availability of the service to twelve continuous hours per day, and mandated parental participation in care. In the same year, the Legislature added a budget proviso requiring AHCA to “direct” beneficiaries to PPEC services instead of private duty nursing, and to offer private duty nursing as a supplemental service only. AHCA followed suit through implementing the policies that they now propose to change. There is thus a strong basis to suspect that the instant Policy Changes, which are an abrupt about-face from prior policies, are driven not by the desire to “improve” the Medicaid program or “clarify” existing policies, but instead to deprive the Court of subject matter jurisdiction. In sum, as in Harrell and in contrast with Troiano, the “timing and content” of Defendants’ Policy Changes here do not make it “absolutely clear” that Defendants have effectuated an “unambiguous termination” of their objectionable policies. Harrell, 608 F. 3d at 1268; NABP, 633 F.3d at 1310. B. Defendants’ Proposed Policy Changes Not Support Dismissal Even If They Mooted Some of Plaintiffs’ Allegations. Even if the Policy Changes were fully effectuated and permanent, dismissal would still be inappropriate. As noted above, “[a] case becomes moot . . . when the issues presented are no longer ‘live’ or the parties lack a legally cognizable interest in the outcome.” Already, 133 S. Ct.
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