No. The state's plan is not illegal discrimination. The anti-discrimination law is about giving people a fair shot, not about making sure everyone gets a perfect outcome. Tennessee is offering the exact same benefit—14 days of paid hospital care—to both disabled and non-disabled people. Everyone gets equal access to this benefit. The law doesn't force the state to create a special plan just because disabled people might have greater medical needs. That would be like asking the state to completely change its program, which the law doesn't require. Forcing the state to find the 'least harmful' way to save money would be impossible and create too much paperwork.

No, it's not discrimination. Justice Marshall explained that the cut in hospital days is the same for everyone and doesn't target handicapped people on purpose. Handicapped people still get access to the same Medicaid services as everyone else, just with a limit on hospital days that applies to all. The state doesn't have to make sure handicapped people get more days in the hospital than others. Also, the state doesn't have to get rid of the rule that limits hospital days for everyone just to avoid affecting handicapped people differently. The Court thought about whether the law could apply to situations where handicapped people are affected differently without a good reason, but they didn't decide that here. They also mentioned that the law needs to be used in a way that makes sense and doesn't make things too complicated. So, the way Tennessee changed its Medicaid program isn't considered unfair to handicapped people under the law.

"[A] n otherwise qualified handicapped individual must be provided with meaningful access to the benefit that the grantee offers....[T] o assure meaningful access, reasonable accommodations in the grantee's program or benefit may have to be made."

Discrimination against the handicapped was perceived by Congress to be most often the product, not of invidious animus, but rather of thoughtlessness and indifference—of benign neglect

The Supreme Court has made clear that an educational institution is not required to make fundamental or substantial modifications to its program or standards; it need only make reasonable ones.

The Supreme Court has "assume [d] without deciding that [Section 504 of the Rehabilitation Act] reaches at least some conduct that has an unjustifiable disparate impact upon the handicapped."

The state had proposed reducing the number of annual days of inpatient hospital care covered by its Medicaid program from twenty days to fourteen days.

Indeed, the Supreme Court has cautioned that Section 504, and thus Title III, must be interpreted in light of "two powerful but countervailing considerations—the need to give effect to the statutory objectives and the desire to keep [the Acts] within manageable bounds."

The concept of "discrimination" under Section 504 and the ADA encompasses more than disparate treatment of people with disabilities as compared to non-disabled individuals.

"The [federal Medicaid] Act gives States substantial discretion to choose the proper mix of amount, scope, and duration limitations on coverage, as long as care and services are provided in `the best interests of the recipients.'"

In determining that the benefit provided in Choate was "individual services offered," rather than the more amorphous benefit of "adequate health care," the Court noted that "[t] he 14-day limitation will not deny [the disabled individuals] meaningful access to Tennessee Medicaid services or exclude them from those services."

No. A state's facially neutral reduction in Medicaid benefits does not violate Section 504 of the Rehabilitation Act, even if it has a disparate impact on the handicapped, as long as the benefit provides them with meaningful and equal access. The court assumed, without deciding, that Section 504 reaches some conduct with an unjustifiable disparate impact, noting that discrimination against the handicapped often results from 'thoughtlessness and indifference' rather than intentional animus. However, the key inquiry, based on *Southeastern Community College v. Davis*, is whether handicapped individuals are afforded 'meaningful access' to the benefit the state offers. Here, the benefit is defined as 14 days of inpatient hospital coverage, a benefit equally available to both handicapped and nonhandicapped recipients. Section 504 guarantees an equal opportunity to receive the offered benefit, not an equal result in terms of health outcomes. The Act does not require Tennessee to redefine its benefit package to accommodate the greater medical needs of the handicapped, as this would fundamentally alter the nature of the program. Forcing the state to adopt the recipients' alternative plan would impose an unworkable, NEPA-like requirement to analyze the impact of every fiscal decision on the handicapped, a burden Congress did not intend to create.

No. The majority opinion, delivered by Justice Marshall, held that the reduction in covered inpatient days does not deny the handicapped meaningful access to Medicaid services or exclude them from those services. The 14-day rule is neutral on its face, does not rest on a discriminatory motive, and does not deny the handicapped access to the Medicaid services Tennessee has chosen to provide. The State is not required to assure the handicapped 'adequate health care' by providing them with more coverage than the nonhandicapped. Furthermore, the State is not obligated to modify its Medicaid program by eliminating annual durational limitations on inpatient coverage. The Court assumed without deciding that Section 504 reaches some conduct that has an unjustifiable disparate impact on the handicapped, but the reduction in annual inpatient coverage is not among the impacts recognized as discriminatory under Section 504. The Court also noted the need to interpret Section 504 in light of the need to give effect to the statutory objectives while keeping the Act within manageable bounds.

Alexander v. Choate

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