Full opinion text
OPINION AND ORDER GEORGE C. SMITH, District Judge. I. Overview This class action involves the State of Ohio’s role in providing services to a large and diverse population of mentally retarded and developmentally disabled persons. In essence plaintiffs seek to have these services furnished to them and the class in less restrictive, integrated community settings, as opposed to receiving services in existing institutions which plaintiffs say are segregated from the community. Defendants do not oppose the general concept of providing community-based services, and in fact defendants and their predecessors have created programs to provide community-based services to some mentally retarded and developmentally disabled individuals in Ohio. Despite defendants efforts, however, it appears that many individuals who may qualify for community-based services remain on lengthy waiting lists, and plaintiffs contend that the waiting lists do not move at a reasonable pace as required by federal law. So the question in this case is not whether providing additional community-based services is a good idea. Rather, the core issue is one of state sovereignty and the requirements of federal law, including the Americans with Disabilities Act (“ADA”). Defendants vigorously argue that this federal court may not impose a remedy under federal law and decide for the State when and how to allocate limited resources, including federal Medicaid funds, to make additional community-based services available. This decision addresses two important written motions filed by the parties, but does not determine the outcome of this case. The Court does decide, however, that defendants are not immune from suit in this federal court, and that as a result plaintiffs may proceed with most of their federal law claims against defendants. The Court also finds that plaintiffs cannot prevail on their ADA claim solely on the basis of their written motion for partial summary judgment because certain factual issues necessary to establish their ADA claim can only be decided by trial. II. Introduction Plaintiffs are individual citizens of Ohio who are mentally retarded or developmentally disabled, and who live or have lived in institutions licensed or run by the State of Ohio. They represent a class of about 12,-000 people defined as “all persons in Ohio with mental retardation or developmental disabilities who are or will be in need of community housing and services which are normalized, home-like, and integrated.” Plaintiffs ask the Court “to enjoin the Defendants to create over a reasonably short, fixed time, not to exceed five years, the community housing and support services for each Plaintiff and class member as determined by the needs of the class member.” (Third Am. Compl. (Doc. 331) at 71). Remarkably, plaintiffs allege that the community-based services they seek will cost the State of Ohio less than providing such services in institutional settings. Nonetheless, as it will be discussed below, the matter is not so simple, inasmuch as the State will continue to incur costs associated with maintaining the availability of institutional services in recognition of the fact that there will always be some individuals in need of such care. Plaintiffs assert their claims under the public services portion (Title II) of the ADA, 42 U.S.C. § 12132 and related federal regulations, the Rehabilitation Act of 1973 (“RA”), 29 U.S.C. § 794, Title XIX of the Social Security Act, 42 U.S.C. § 1396a, et seq., and related federal regulations (“Medicaid law”), the Due Process and Equal Protection Clauses of the Fourteenth Amendment to the U.S. Constitution, and 42 U.S.C. § 1983. Defendants move to dismiss or, in the alternative, for summary judgment as to the third amended complaint (Doc. 336), arguing primarily that plaintiffs’ claims are barred under the Eleventh Amendment to the U.S. Constitution. Plaintiffs move for partial summary judgment (Doc. 364). They contend they are entitled to judgment in their favor as a matter of law on their ADA claim under the U.S. Supreme Court’s decision in Olmstead v. L.C., 527 U.S. 581, 119 S.Ct. 2176, 144 L.Ed.2d 540 (1999). Olmstead held that the ADA requires a state to provide community-based treatment to mentally disabled persons “when the State’s treatment officials have determined that community placement is appropriate, the transfer from institutional care to a less restrictive setting is not opposed by the affected individual, and the placement can be reasonably accommodated, taking into account the resources available to the State, and the needs of others with disabilities.” 527 U.S. at 587, 119 S.Ct. 2176. For the reasons that follow, the Court concludes that defendants are not immune from suit under the Eleventh Amendment, and that, for the most part, plaintiffs have stated viable claims under federal law. The Court therefore denies defendants’ motion to dismiss in part and grants it in part. Hence, plaintiffs may proceed with their claims. The Court also finds, however, that genuine issues of material fact exist as to whether a reasonable accommodation is available for the State to provide plaintiffs and the class the community-based services they seek, or whether the relief plaintiffs’ request would fundamentally alter the nature of defendants’ existing program for community-based services. The Court therefore denies plaintiffs’ motion for partial summary judgment. III. Facts The facts of this case are based upon submissions by the parties made within the months after plaintiffs filed their third amended complaint in April 2000. Neither side has sought leave to file additional evidentiary material, although it appears matters of concern to this case have continued to develop and change since that time. Be that as it may, the Court must limit its decision to the facts as they appear in the current, albeit somewhat dated, record. The Court set forth a detailed statement of facts in its earlier decision in this case, much of which remains applicable to the pending motions. See Martin v. Voinovich, 840 F.Supp. 1175, 1179-85 (S.D.Ohio 1993). For purposes of ruling on defendants’ motion to dismiss, the Court accepts as true the well-pleaded facts set forth in the third amended class action complaint (Doc. 331). The Court will refer to additional facts, as appropriate, in connection with its discussion of plaintiffs’ motion for partial summary judgment. A. Procedural history Plaintiffs filed this action on April 27, 1989. The Court certified this case as a class action under Fed.R.Civ.P. 23 on February 5,1990 (Doc 46). On December 11, 1992, by agreement of the parties, the Court appointed local civil rights attorney Benson A. Wolman to serve as a mediator (Doc. 127). During the months that followed, attorneys and representatives for all parties met regularly with Mr. Wolman in a concerted attempt to settle this case. These efforts continued until about July 1993 (see Doc. 144). Plaintiffs filed their second amended class action complaint on August 17, 1993. On September 23, 1993, defendants moved to dismiss (Doc. 150). On December 14,1993, this Court issued a comprehensive, 73-page opinion and order, granting defendants’ motion to dismiss in part and denying it in part (Doc. 186). On January 5, 1994, the Court granted defendants’ motion to certify an interlocutory appeal under 28 U.S.C. § 1292(b). The Court found that such an appeal would materially advance the case, which presented several novel legal issues. The Court reasoned that the United States Court of Appeals for the Sixth Circuit would be in a position to issue a definitive ruling that would be binding on this Court and would serve to guide the remainder of the proceedings in this case (Doc. 200). The Court of Appeals agreed initially to hear the case, and during the pendency of the appeal, this Court’s role in the case was limited. About 18 months later, on June 12, 1995, the Court of Appeals changed its position and announced that it would not hear the appeal (Doc. 254). Following the attempted appeal, the parties continued with their discovery and motions practice. Then, on August 30, 1996, the parties agreed to stay all discovery in the case to focus on settlement. Voluntary settlement discussions continued for almost two years. After the stay was lifted, the Court conducted a conference with attorneys representing all of the parties in December 1999. The attorneys indicated that settlement was still possible, but that negotiations were slow and difficult because several different governmental agencies were involved, including at least one federal agency that is not a party' to this case. In an attempt to facilitate the process, the Court gave the parties detailed instructions requiring them to exchange formal written offers and demands on a regular basis, and to submit written status reports for review by the Magistrate Judge. The settlement process was ultimately unsuccessful, however, and on April 25, 2000, plaintiffs filed their third amended complaint (Doc. 331), reflecting a major change in ADA law as a result of the U.S. Supreme Court’s watershed decision in Olmstead. Defendants moved to dismiss on May 12, 2000. Plaintiffs moved for partial summary judgment on their ADA claim under Olmstead on July 31, 2000 (Doc. 364). Since that time, the parties have litigated discovery disputes, and plaintiffs have filed several memoranda alerting the Court to recent decisions pertinent to the issues this case presents. B. Parties The third amended class action complaint names plaintiff representatives Nancy Martin, Kathy R., Claude Martin, and Warren B. All of the plaintiffs are eligible for and receive federal Medicaid benefits. All of the plaintiffs have been housed in institutions which received funds from Medicaid. All of the plaintiffs are eligible to be moved to noninstitutional, integrated community-based housing, and several of the plaintiffs have taken specific steps to obtain such housing. Plaintiffs name three defendants: Governor Robert Taft; Kenneth Ritchey, Director of the Ohio Department of Mental Retardation and Developmental Disabilities (“ODMR/DD”); and Jacqueline Rom-er-Sensky, Director of the Ohio Department of Human Services (“ODHS”). Plaintiffs sue defendants in defendants’ official capacities only. 1. Plaintiff representatives a. Nancy Martin Nancy Martin is a fifty-two year old woman who has disabilities, including cerebral palsy, mental retardation, and depression. She has an intelligence within the moderate range of mental retardation. Ms. Martin is confined to an electric wheelchair due to her cerebral palsy and spastic quadriplegia. She has a limited ability to speak, and communicates through use of a word book, an augmentative communication device, gestures, ver-balizations, pointing and nodding. Ms. Martin has experienced depression for many years. She treats her depression with antidepressant medication. Ms. Martin has lived in institutional settings for more than thirty years. She was originally involuntarily committed to the Mount Vernon Developmental Center because her father died and her mother was unable to care for her. She remained in the Mount Vernon facility for about twenty-five years. During that period, the Mount Vernon facility housed more than 300 individuals with mental retardation and developmental disabilities. The Mount Vernon facility is operated by defendant Kenneth Ritchey. Individuals who reside at the Mount Vernon facility are segregated from non-handicapped persons. Throughout her years at the Mount Vernon facility, Ms. Martin wanted to live in the community, and she expressed this desire to the staff at the facility. Professional staff at the Mount Vernon facility acknowledged for many years that Ms. Martin’s placement at the facility was inappropriate, and recommended that Ms. Martin be moved to a community setting. On October 9, 1991, Ms. Martin was removed from the Mount Vernon facility and placed at the Echoing Lake facility in Lorain County. Echoing Lake is known as an Intermediate Care Facility for the Mentally Retarded (“ICF/MR”). Echoing Lake is an eight-bed institution licensed by defendant Ritchey. In May 1993, Ms. Martin had surgery to place a PEG Tube in her stomach to address increased problems she had swallowing. After the operation, Echoing Lake insisted that Ms. Martin be moved to a different facility, stating she required 24-hour availability of nursing staff in the event she had problems with her PEG Tube. Plaintiffs aver that people with this condition are regularly served in integrated community settings, and hence placement in the more restrictive setting was unnecessary. Ms. Martin, however, was moved to Echoing Ridge Residential Center, a fifty-bed ICF/MR in Stark County. Echoing Ridge is segregated from non-handicapped persons. As a result of the move, Ms. Martin was forced to quit her employment and leave her friends, and live farther from her family. Eventually Ms. Martin was able to eat without the PEG Tube, and she was then moved to another Echoing Lake ICF/MR facility located in Vermillion, Ohio. At some point, it again became necessary for Ms. Martin to be fed through her PEG Tube, and once again the facility made plans to move her to the larger, more restrictive Echoing Ridge facility. In this instance, however, legal counsel intervened and prevented the move. Ms. Martin is eligible for and receives Medicaid benefits. Medicaid has paid for her care at the Echoing Lake and Echoing Ridge facilities. Defendant Romer-Sen-sky has certified and funded each of the Echoing facilities as ICFs/MR under the Medicaid program. Each year professionals who treat Ms. Martin evaluate her to determine the level of care she requires. Each year the treating professionals have determined that Ms. Martin requires the level of care provided by an ICF/MR in order to re-certify her to receive Medicaid funding at the institution. Plaintiffs aver that the treating professionals generally fail to consider whether Ms. Martin meets the essential eligibility requirements for habilitation in a community-based program. In pursuit of her goal to live in the community, Ms. Martin has told her case workers that she wants to move to a community setting, and has asked to be added to the supported living waiting list. Ms. Martin was placed on a waiting list for community-based services through the Individual Options waiver in April 1995. At the time plaintiffs filed their motion for partial summary judgment in July 2000, Ms. Martin was still on the waiting list and was living in an institution. b. Kathy R. Kathy R. is a forty-nine year old woman who has disabilities of mental retardation and chronic schizophrenia. From time to time Kathy R. suffers from auditory hallucinations. Kathy R. was involuntarily committed to the Gallipollis Developmental Center (“GDC”) in 1967. She remained there until April 1974. Kathy R. was re-institutionalized at GDC in October 1984 due to her mental illness and behavioral disabilities. She remained there until the commencement of this lawsuit. When Kathy R. was living at GDC, it housed about 280 individuals with mental retardation or developmental disabilities. At the time the third amended complaint was filed in April 2000, about 255 individuals lived at GDC. Throughout her institutionalization at GDC, Kathy R. was medicated with psychotropic drugs. These drugs caused her to suffer the side effect akathesia, which caused a subjective feeling that she needed to keep moving. Kathy R. has occasional aggressive outbursts. She has received treatment for these outbursts in a behavioral management program. Kathy R. did not want to live at GDC. She desired to live in a community group home. The interdisciplinary team at GDC determined that Kathy R. could be placed appropriately in small licensed group or foster home that offered the various services she required. As a result, in January 1994, Kathy R. was moved to Peterson Enterprises Ridge, a ten-bed ICF/MR in Hamilton County. The facility was eventually operated by We Care Homes. In 1998, We Care Homes determined that all of the individuals who were institutionalized at its eight ICF/MR facilities, including Kathy R., could be served in noninstitutional, waiver-funded settings. To accomplish this, We Care Homes suggested to defendants’ predecessors that it would voluntarily decertify its ICF/MR facilities, and over the course of a year work with the residents to determine where they wanted to live and with whom. We Care Homes proposed to fund the new services through a Medicaid Home and Community-Based Services (“HCBS”) waiver using money currently paid by the State to the institutions. Defendants’ predecessors rejected the proposal, which would have allowed the residents of eight ICF/MR institutions, including Kathy R., to choose community-based services at a cost not greater than the that of institutional services. Each year professionals who treat Kathy R. evaluate her to determine the level of care she requires. As was the case with Ms. Martin, each year the treating professionals have determined that Kathy R. requires the level of care provided by an ICF/MR in order to re-certify her to receive Medicaid funding at the institution. Plaintiffs aver that the treating professionals generally fail to consider whether Kathy R. meets the essential eligibility requirements for habitation in a community-based program. Kathy R. was placed on a waiting list for community-based services in October 1994. At the time plaintiffs filed their motion for partial summary judgment in July 2000, she was still on the waiting list and was living in an ICF/MR. c. Claude Martin Claude Martin is a fifty-three year old man who has disabilities of cerebral palsy with spastic quadriplegia and mild mental retardation. He functions with severe deficits in adaptive behavior. Mr. Martin is confined to a wheelchair as a result of his cerebral palsy and spastic quadriplegia. He grooms and feeds himself independently. He bathes himself but needs help to get in and out of the bathtub. Mr. Martin uses an electric or manual wheelchair by himself, but needs assistance to transfer to and from the chair. In December 1982, Mr. Martin was placed in the Echoing Valley Residential Home (“EVRH”) in Dayton, Ohio. EVRH is a thirty-six bed ICF/MR. It is segregated from non-disabled persons. Defendant Ritchey has licensed EVRH and defendant Romer-Sensky provides Medicaid funds to EVRH for its operation. Mr. Martin has tried for many years, without success, to find a place to live that provides semi-independent living with some attendant care services. He wrote letters to defendants’ predecessors, his Congressman, and the Dayton Daily News, which published his letter. Mr. Martin was on a waiting list for residential services in Montgomery County, Ohio for years. Mr. Martin was denied placement in the LADD group homes in Cincinnati on the basis of his behavioral and physical handicaps. Mr. Martin filed a complaint against LADD and ODMR/DD with the federal Office of Civil Rights of the Health Care Financing Administration (“HCFA”), asserting that he had been discriminated against by reason of his disability. The HCFA proposed a voluntary remedial agreement to resolve the matter, but defendant Ritchey’s predecessor refused to sign the agreement. In August 1990, Mr. Martin was referred to Choices in Community Living, a residential services provider. He was denied residential services, however, because he is unable to transfer in and out of his wheelchair without assistance. In January 1993, Mr. Martin applied for community-based services through the Individual Options HCBS waiver. His request was initially denied and he was placed on a waiting list. At the time, about 4000 people were on the list. Mr. Martin began receiving community-based services funded under the Individual Options waiver in 1996. d. Warren B. Warren B. is a thirty year old man with disabilities including closed head injury, mental retardation, seizure disorder, and behavioral impediments. He is developmentally disabled. Warren B. was struck by a car when he was eight years old. His disabilities are the result of the accident. In 1997, Warren B., through his guardian and mother, sought residential services in the TBI Outlier program, the only program in Ohio offering services for individuals with traumatic brain injury. TBI Outlier is an intensive behavioral program operated in a separate four-bed unit of a nursing facility. Treatment in the TBI Outlier program is typically limited to ninety days, after which clients are moved to more permanent housing. Warren B. participated in the TBI Outlier program from August 1997 to February 1998. While there, Warren B. showed progress in several areas. He became more independent in bathing, dressing, and toileting. His communication advanced from single words to short phrases. Warren B.’s negative behaviors include biting, spitting, pinching, and tripping others. His behavior appears to be affected by noise levels, transitions such as shift changes or transportation, and overstimu-lation. At times his maladaptive behavior indicates that he is experiencing pain. While at the Outlier program Warren B. experienced fewer and less intense behavioral episodes. Upon discharge from the TBI Outlier program, Warren B. was placed in the Belmont Habilitation Center (“BHC”) in Belmont County, Ohio. BHC is an eighty-five bed ICF/MR licensed by defendant Ritchey and funded by defendant Romer-Sensky under Medicaid. While he was at BHC, Warren B. regressed. His behavioral episodes increased, his ability to care for himself diminished, and he refused to eat or take medication. In the fall of 1999, the Belmont County Board of Mental Retardation and Developmental Disabilities instituted proceedings to have Warren B. involuntarily institutionalized. Warren B. thereafter was committed to the Cambridge Developmental Center (“CDC”), a 100-bed ICF/MR operated by defendant Ritchey. Plaintiffs aver that Warren B.’s behavior improved at TBI Outlier in part because he was placed with more capable clients because he models the behavior and skills of his peers. Most of the individuals residing at CDC are less capable than Warren B. CDC controls Warren B.’s behavior by restraining him, against his will, in a helmet with a face guard strapped to a vest. The team at CDC has determined that alternative placements in foster care, group homes, or Individual Options waiver with well-trained staff may be the best long term goal for Warren B. Warren B. applied for the Individual Options waiver on January 13, 1993. At the time plaintiffs filed their motion for partial summary judgment in July 2000, Warren B. was still living at CDC. 2. Defendants a.Governor Robert Taft Defendant Robert Taft is the Governor of the State of Ohio. Governor Taft appointed defendant Kenneth Ritchey to be Director of ODMR/DD and defendant Ja-queline Romer-Sensky to be director of the ODHS. Under Article III Section 6 of the Ohio Constitution, Governor Taft is charged with ensuring that the laws are faithfully executed by his officers, b.Kenneth Ritchey Defendant Kenneth Ritchey is the director of ODMR/DD. Under Ohio law, Ritchey controls all duties performed by ODMR/DD. In his official capacity, Mr. Ritchey operates twelve developmental centers for individuals with mental retardation and developmental disabilities. These twelve institutions receive federal funds in the form of Medicaid. Mr. Ritchey is responsible for preadmission screening (“PAS”), which determines whether individuals seeking admission to a nursing facility require the level of services provided by such a facility. He is also responsible for Resident Review (“RR”), which determines whether current nursing facility residents require the services of a nursing facility or an ICF/MR, and whether residents require any specialized services. Also among Ritchey’s official duties is promulgation of rules governing the development of residential services for mentally retarded and developmentally disabled individuals. These rules include development plans for each county MR/DD board and eligibility criteria for selecting providers of residential services. c.Jaqueline Romer-Sensky Defendant Jacqueline Romer-Sensky is the Director of the ODHS. Under Ohio law, Romer-Sensky controls ODHS and all of its duties. ODHS is the designated single state agency responsible for administration of the federal Medicaid program in Ohio. The Medicaid program is a joint federal/state program providing federal financial assistance to states, like Ohio, that have elected to participate. Medicaid reimburses the participating states for certain costs of medical treatment for needy persons. Romer-Sensky is responsible for ensuring that Ohio’s Medicaid program complies with all relevant federal requirements, including the provisions upon which plaintiffs rely in their claims. C. Facts underlying plaintiffs’ claims Plaintiffs allege, in essence, that defendants have failed to develop community-based services for the class, and have in fact hindered the expansion of such services, instead favoring institutional care. Plaintiffs aver that resources exist to fund community-based services in the form of Medicaid waivers, and that the cost of community-based care is, on the average, less then the cost of providing services in an institution. Plaintiffs maintain that thousands of mentally retarded and developmentally disabled individuals remain unnecessarily institutionalized. 1. Institutions The third amended complaint explains the types of institutions in which class members currently receive services. Plaintiffs assert generally that these institutions are segregated from the larger community of non-disabled persons. First, as alluded to above, ODMR/DD Director Ritchey directly operates twelve institutions referred to as developmental centers. About 2000 mentally retarded and developmentally disabled individuals in Ohio receive care in State developmental centers. Ohio’s developmental centers are designated Intermediate Care Facilities for the Mentally Retarded (“ICFs/MR”) for purposes of receiving federal benefits under Medicaid. Second, class members reside in privately operated ICFs/MR. These institutions are licensed by ODMR/DD and receive Medicaid funds through ODHS. Private ICFs/MR range in size from four bed facilities to facilities serving more than 100 individuals. A majority of individuals served in ICFs/MR live in facilities with more than 16 beds. Plaintiffs contend that Ohio relies heavily on providing care in ICFs/MR. About 5,TOO individuals with mental retardation and developmental disabilities reside in privately owned ICFs/MR. Ohio ranks fifth in the nation in the number of individuals served in ICFs/MR, behind Texas, New York, California, and Illinois, each of which has a larger population than Ohio. Ohio ranks third in the percentage of federal ICFs/MR funds used, behind only New York and Texas. The annual cost of ICFs/MR in Ohio totals about $535 million. The federal government pays about 59 percent of this cost, and the State pays the remainder. Third, services are provided to about 2,400 mentally retarded and developmentally disabled individuals in nursing facilities. These nursing facilities are not certified to care for people with mental retardation or developmental disabilities. Ohio has more individuals with mental retardation and developmental disabilities in nursing facilities than any other state in the nation. Plaintiffs aver that Congress passed laws in 1990 to limit placement of individuals with mental disabilities in nursing facilities. They maintain that in response most states dramatically reduced the number of mentally retarded and developmentally disabled individuals in nursing facilities, moving many into smaller community based settings. In Ohio, however, the number of such individuals in nursing facilities has not changed significantly. 2. Medicaid Waivers Plaintiffs maintain that thousands of individuals in Ohio qualify for community-based care but have been placed in segregated institutions.' Plaintiffs contend that this is due in part to defendants refusal or failure use existing Medicaid Home and Community-Based Services (“HCBS”) waiver slots or to apply for additional waiver slots. The HCBS waiver program is an important aspect of plaintiffs’ case. Congress enacted the HCBS waiver program in 1981. Flexibility is the touchstone of the HCBS waiver program, and it was intended to provide the states latitude to create new approaches for providing health care services financed by Medicaid. See 42 C.F.R. § 430.25(b). To this end, § 1915(c) of the Social Security Act provides that states may request waivers of certain federal requirements to obtain Medicaid funding for programs to provide community-based services. 42 U.S.C. § 1396n(c)(l). Such programs may provide “habilitation services,” which are “designed to assist individuals in acquiring, retaining and improving the self-help, socialization, and adaptive skills necessary to reside successfully in home and community based settings.” 42 U.S.C. § 1396n(c)(4)(B) and (c)(5). Under this system, if the State program meets certain criteria, three Medicaid requirements are waived: (1) the statewide requirement of 42 U.S.C. § 1396a(a)(l); (2) the single eligibility standard of 42 U.S.C. § 1396a(a)(10)(C)(i)(II); and (3) the comparability of services requirement of 42 U.S.C. § 1396a(a)(10)(B). See 42 U.S.C. § 1396n(c)(3). For a program to qualify for an HCBS waiver, the state must provide assurances that there are adequate safeguards in place to protect the health and welfare of individuals who participate in the waiver program. 42 U.S.C. § 1396n(c)(2)(A). The state must also provide the following assurance: under such waiver the average per cap-ita expenditure estimated by the State in any fiscal year for medical assistance provided with respect to such individuals does not exceed 100 percent of the average per capita expenditure that the State reasonably estimates would have been made in that fiscal year for expenditures under the State plan for such individuals if the waiver had not been granted. 42 U.S.C. § 1396n(c)(2)(D). Further, the state must assure that individuals in hospitals, nursing facilities, and ICFs/MR are informed of feasible alternatives available under the waiver. 42 U.S.C. § 1396n(c)(2)(C). Under the HCBS waiver program, states request a specific number of “slots” for individuals to be approved by the federal Health Care Financing Administration (“HCFA”). Ohio participates in several waiver programs designed to serve individuals who are otherwise eligible to receive services in an ICF/MR. The two programs most significant to this case are the Individual Options (“10”) waiver and the Residential Facilities Waiver (“RFW”). The 10 waiver uses certified providers of supported living services for home and personal care services. The HCFA initially approved 2,512 10 waiver slots for Ohio. Plaintiffs assert that defendants used these slots to fund preexisting community-based programs that had been financed by the State or counties. For example, about 250 individuals who had been served under a model waiver program were simply transferred to 10 waiver slots. In a similar vein, plaintiffs aver defendants encouraged providers in another early, state-funded group home program to enroll their residents in the 10 waiver program. Plaintiffs maintain that about 700 individuals from the group home program became recipients of the 10 waiver. These individuals were not given a choice of providers, and the services they received did not change under the 10 waiver. In essence, plaintiffs allege that defendants and their predecessors used this as a device to shift the cost of earlier state-funded community-based programs to Medicaid, and defendants did little to use the 10 waiver to create community-based services for more individuals. Plaintiffs also aver that the State has failed to provide the necessary matching funds for 10 waiver slots. As a result, many approved slots have not been made available to qualified individuals currently in institutions. Plaintiffs assert that as of May 1996, 11,000 individuals were on a waiting list for 10 waiver services. Plaintiffs state that the average annual cost of 10 waiver services is about $39,000 per person, compared to an average annual cost of $65,933 per person to provide services in an ICF/ MR. The State also administers the RFW program. Service providers of service under the state-funded Purchase of Service (“POS”) program had gone without any per diem rate increases for many years before the RFW program. Plaintiffs say the State used the RFW to obtain federal Medicaid dollars to allow a rate increase for POS providers that were already providing community-based services in group homes. The RFW program has 3,434 approved slots. Nonetheless, only about 2800 individuals receive services under the RFW. The vast majority of these 2800 individuals simply continue to receive the same services from the same provider as they had before the RFW program. Therefore, in Ohio the RFW program has not resulted in any significant number of additional individuals receiving community-based services. Plaintiffs also maintain that the RFW program is not administered statewide. Seventy counties participate in the RFW, and many of the participating counties’ MR/DD boards will not refer an individual from outside their county for an RFW opening in their county. Service providers participating in the RFW are often allowed to select the individuals they want to serve regardless to that individual’s place on a waiting list. Many service providers have refused to accept individuals with mobility impairments or other significant physical disabilities. Plaintiffs aver that the average annual cost of serving an individual under the RFW is $29,250, compared to $65,938 for ICF/MR services, and $39,000 for services under the 10 waiver. In sum, plaintiffs assert that defendants have failed properly to use approved waiver slots, and have instead continued to rely heavily on developmental centers, ICFs/ MR, and nursing facilities. This, plaintiffs say, has resulted in the unnecessary institutionalization of thousands of mentally retarded and developmentally disabled individuals in Ohio. IY. Defendants’ motion to dismiss A motion to dismiss for failure to state a claim should not be granted “unless it appears beyond doubt that the plaintiff can prove no set of facts in support of his claim which would entitle him to relief.” Conley v. Gibson, 355 U.S. 41, 45-46, 78 S.Ct. 99, 2 L.Ed.2d 80 (1957). All well-pleaded allegations must be taken as true and be construed most favorably toward the non-moving party. Scheuer v. Rhodes, 416 U.S. 232, 236, 94 S.Ct. 1683, 40 L.Ed.2d 90 (1974). A 12(b)(6) motion to dismiss is directed solely to the complaint and any exhibits attached to it. Roth Steel Prods. v. Sharon Steel Corp., 705 F.2d 134, 155 (6th Cir.1983). The merits of the claims set forth in the complaint are not at issue on a motion to dismiss for failure to state a claim. Consequently, a complaint will be dismissed pursuant to Fed.R.Civ.P. 12(b)(6) only if there is no law to support the claims made, or if the facts alleged are insufficient to state a claim, or if on the face of the complaint there is an insurmountable bar to relief. Rauch v. Day & Night Mfg. Corp., 576 F.2d 697, 702 (6th Cir.1978). Rule 12(b)(6) must be read in conjunction with Fed.R.Civ.P. 8(a) which provides that a pleading for relief shall contain “a short and plain statement of the claim showing that the pleader is entitled to relief.” 5A Charles Alan Wright & Arthur R. Miller, Federal Practice and Procedure § 1356, at 296 (2d ed.1990). The moving party is entitled to relief only when the complaint fails to meet this liberal standard. Id. On the other hand, more than bare assertions of legal conclusions are required to satisfy the notice pleading standard. Scheid v. Fanny Farmer Candy Shops, Inc., 859 F.2d 434, 436 (6th Cir.1988). “In practice, -a complaint must contain either direct or inferential allegations respecting all the material elements to sustain a recovery under some viable legal theory.” Id. at 437. (Quotes omitted). [W]e are not holding the pleader to an impossibly high standard; we recognize the policies behind rule 8 and the concept of notice pleading. A plaintiff will not be thrown out of court for failing to plead facts in support of every arcane element of his claim. But when a complaint omits facts that, if they existed, would clearly dominate the case, it seems fair to assume that those facts do not exist. Id. Defendants advance four categories of arguments in support of their motion to dismiss. First, they argue that Congress exceeded its authority to abrogate Eleventh Amendment immunity in enacting the ADA and RA. Second, they maintain that the ADA and RA do not require the creation of new Medicaid services. Third, defendants contend that plaintiffs’ § 1983 Medicaid law claims fail because the federal statutes and regulations to which plaintiffs refer do not create enforceable rights. Fourth, defendants assert that plaintiffs fail to state a due process claim under Youngberg v. Romeo, 457 U.S. 307, 102 S.Ct. 2452, 73 L.Ed.2d 28 (1982). A. Eleventh Amendment Immunity Defendants once again argue that the Eleventh Amendment bars plaintiffs’ ADA and RA claims. Plaintiffs maintain that the Eleventh Amendment does not apply to their claims because they seek only prospective injunctive and declaratory relief. The United States Court of Appeals for the Sixth Circuit has held that Ohio waived its sovereign immunity against Rehabilitation Act claims when it agreed to accept federal funds under the Act. Carien v. Kent State Univ., 282 F.3d 391, 398 (6th Cir.2002); Nihiser v. Ohio EPA, 269 F.3d 626, 628 (6th Cir.2001). The Court therefore rejects defendants’ Eleventh Amendment argument as it applies to plaintiffs’ RA claims. Analysis of Eleventh Amendment immunity as to plaintiffs’ ADA claims, however, is more complex. The Eleventh Amendment to the U.S. Constitution states: The Judicial power of the United States shall not be construed to extend to any suit in law or equity, commenced or prosecuted against one of the United States by Citizens of another State, or by Citizens or Subjects of any Foreign State. U.S. Const, amend. XI. In recognition of “the broader concept of immunity, implicit in the Constitution,” the U.S. Supreme Court has extended the Eleventh Amendment’s meaning to preclude suits in federal court against a state by its own citizens. Idaho v. Coeur d’Alene Tribe of Idaho, 521 U.S. 261, 267, 117 S.Ct. 2028, 138 L.Ed.2d 438 (1997); see also Hans v. Louisiana, 134 U.S. 1, 10 S.Ct. 504, 33 L.Ed. 842 (1890). The Eleventh Amendment not only protects states from suit in federal court but may also shield state officials with immunity. Lee v. W. Reserve Psychiatric Habilitation Ctr., 747 F.2d 1062, 1065 (6th Cir.1984). Nonetheless, a suit that claims that a state official’s actions violate the U.S. Constitution or federal law is not deemed a suit against the state, and is therefore not barred by sovereign immunity, so long as the state official is the named defendant and the relief sought is only equitable and prospective. Ex parte Young, 209 U.S. 123, 160-62, 28 S.Ct. 441, 52 L.Ed. 714 (1908); Westside Mothers v. Haveman, 289 F.3d 852, 860 (6th Cir.2002). Hence, ‘“[sjince Ex parte Young, ... it has been settled that the Eleventh Amendment provides no shield for a state official confronted by a claim that he had deprived another of a federal right under the color of state law.’ ” Westside Mothers, 289 F.3d at 860-61 (quoting Hafer v. Melo, 502 U.S. 21, 30, 112 S.Ct. 358, 116 L.Ed.2d 301 (1991)). The Ex parte Young doctrine “gives life to the Supremacy Clause.” Green v. Mansour, 474 U.S. 64, 68, 106 S.Ct. 423, 88 L.Ed.2d 371 (1985). “Remedies designed to end a continuing violation of federal law are necessary to vindicate the federal interest in assuring the supremacy of that law.” Id. The U.S. Supreme Court has suggested in dicta that ADA claims which seek prospective injunctive relief are not barred by the Eleventh Amendment. Bd. of Tr. of the Univ. of Ala. v. Garrett, 531 U.S. 356, 374 n. 9, 121 S.Ct. 955, 148 L.Ed.2d 866 (2001). Citing Garrett, the United States Court of Appeals for the Sixth Circuit has held expressly that the Eleventh Amendment does not bar an ADA Title II claim for prospective relief against state officials in their official capacities. Carten, 282 F.3d at 396-97. Moreover, in cases factually similar to the case at bar, at least two district courts have held that the Eleventh Amendment does not prevent injunctive relief against state officials for violation of the ADA or the RA, or provisions of Medicaid law. See Bryson v. Shumway, 177 F.Supp.2d 78, 87 (D.N.H.2001)(in suit by persons with acquired brain disorders seeking provision of community-based care with “reasonable promptness” under Medicaid Act, the court held that the Eleventh Amendment does not bar claim for prospective relief under Ex parte Young)-, Frederick L. v. Dept. of Pub. Welfare, 157 F.Supp.2d 509, 531-32 (E.D.Pa.2001)(Title II ADA and RA claims by disabled patients in state mental hospital seeking community services not barred by Eleventh Amendment under Ex parte Young); but see Lewis v. N.M. Dept. of Health, 94 F.Supp.2d 1217, 1230 (D.N.M.2000)(in suit by disabled individuals asserting impermissible delay of Medicaid waiver services, the court held that ADA claims against state officials were not properly brought pursuant to Ex Parte Young because ADA Title II provided for claims for discrimination by “any such entity ” and named state officials could not be entities, but claims under § 1983 were not barred), aff'd, 261 F.3d 970 (10th Cir.2001). The U.S. Supreme Court has clarified the dividing line between permissible relief and relief proscribed by the Eleventh Amendment, distinguishing between prospective and retroactive relief in Edelman v. Jordan, 415 U.S. 651, 664-68, 94 S.Ct. 1347, 39 L.Ed.2d 662 (1974). The Eleventh Amendment bars the award of retroactive relief for violations of federal law which would require the payment of funds from a state treasury. Id. at 663, 94 S.Ct. 1347. “The federal court may award an injunction that governs the official’s future conduct, but not one that awards retroactive monetary relief.” Pennhurst State Sch. & Hosp. v. Halderman, 465 U.S. 89, 102-03, 104 S.Ct. 900, 79 L.Ed.2d 67 (1984). The immunity is triggered when relief amounts to the payment of state funds as a form of compensation for past breaches of legal duties by state officials. Edelman, 415 U.S. at 668, 94 S.Ct. 1347. Nonetheless, the Eleventh Amendment does not bar prospective relief that has an ancillary or incidental effect on the state treasury. Id. In Edelman, the U.S. Supreme Court stated: State officials, in order to shape their official conduct to the mandate of the Court’s decrees, would more likely have to spend money from the state treasury than if they had been left free to pursue their previous course of conduct. Such an ancillary effect on the state treasury is a permissible and often an inevitable consequence of the principle announced in Ex parte Young, supra. 415 U.S. at 667-68, 94 S.Ct. 1347; see also Nelson v. Miller, 170 F.3d 641, 646-47 (6th Cir.1999)(applying Edelman, holding that injunction requiring state to purchase voting devices to ensure privacy for blind voters would not violate the Eleventh Amendment, even though state would be required to buy such devices). The Supreme Court has further stated that the distinction between retroactive and prospective relief does “not immunize the States from their obligation to obey costly federal-court orders. The cost of compliance is ‘ancillary’ to the prospective order enforcing federal law.” Hutto v. Finney, 437 U.S. 678, 690, 98 S.Ct. 2565, 57 L.Ed.2d 522 (1978). To determine whether a claim falls within the Ex parte Young doctrine, the Court need conduct only “ ‘a straightforward inquiry into whether [the] complaint alleges an ongoing violation of federal law and seeks relief properly characterized as prospective.’ ” Verizon Md., Inc. v. Pub. Serv. Comm’n Of Md., 535 U.S. 635, 122 S.Ct. 1753, 1760, 152 L.Ed.2d 871 (2002)(quoting Idaho v. Coeur d’Alene Tribe of Idaho, 521 U.S. 261, 296, 117 S.Ct. 2028, 138 L.Ed.2d 438 (1997)(0’Connor, J., joined by Scalia and Thomas, JJ., concurring in part and concurring in judgment)); Westside Mothers, 289 F.3d at 861. The Court therefore will examine whether the relief plaintiffs seek is prospective. The plaintiffs express the essence of the relief they seek as follows: “to enjoin the Defendants to create over a reasonably short, fixed time, not to exceed five years,* the community housing and support services for each Plaintiff and class member as determined by the needs of the class member.” (Third Am. Compl. (Doc. 331) at 71). Plaintiffs seek only prospective relief. In addition, the third amended complaint implicitly alleges ongoing violations of federal law. Moreover, plaintiffs sue defendants in defendants’ official capacities only. (Third Am. Compl. (Doc. 331) ¶¶ 259, 267, and 292). Hence, the requirements of the application of Ex parte Young are satisfied in this case. Although defendants generally acknowledge the Ex parte Young doctrine, they nonetheless contend that plaintiffs’ ADA claims are barred because Congress exceeded its authority when it purported to abrogate Eleventh Amendment immunity in enacting the ADA. Defendants are partially correct in arguing that Congress exceeded its authority with respect to the ADA. See Popovich v. Cuyahoga County Ct. of C.P., 276 F.3d 808, 812 (6th Cir.2002)(ew banc Xholding that the Equal Protection Clause does not provide Congress with a basis to abrogate Eleventh Amendment immunity with respect to ADA Title II claims). The abrogation issue is, however, a red herring. As the Court in Garrett observed, even where Congress lacks authority to abrogate a state’s sovereign immunity to ADA damages claims, ADA standards remain enforceable in actions for injunctive relief under Ex parte Young. 531 U.S. at 374 n. 9, 121 S.Ct. 955; Carien, 282 F.3d at 396-97. Defendants also argue that plaintiffs’ ADA claims would require them to reorder the State’s budgetary priorities, and therefore fall within the special sovereignty interest exception to the Ex parte Young doctrine, as articulated in Idaho v. Coeur d’Alene Tribe of Idaho, 521 U.S. 261, 281, 117 S.Ct. 2028, 138 L.Ed.2d 438 (1997). In Coeur d’Alene, the Court recognized that even when the requirements for application of Ex parte Young have been met, in unusual cases a claim may nonetheless be barred by the Eleventh Amendment if it implicates a special state sovereignty interest. 521 U.S. at 281, 117 S.Ct. 2028. The principal plaintiff in Coeur d’Alene was a federally-recognized Native Ameri-can Tribe. The Tribe filed suit in federal court against the State of Idaho and various state officials and agencies, seeking a declaratory judgment that the Tribe owned certain submerged land, and injunc-tive relief prohibiting the defendants from regulating, permitting the use of, or taking any action in violation of the Tribe’s asserted exclusive rights to the land. The defendants in Coeur d’Alene moved to dismiss on the bases of Eleventh Amendment Immunity and failure to state a claim. The district court granted the motion, holding that the Eleventh Amendment barred the Tribe’s claims against the state and its agencies, and that the Eleventh Amendment further precluded the Tribe’s quiet title and declaratory judgment claims against the state officials because they were the functional equivalent of a damages award against the state. The Ninth Circuit Court of Appeals affirmed in part and reversed in part, stating that the Eleventh Amendment did not bar the Tribe’s claims for declaratory and in-junctive relief against the state officials for violation of federal law. The U.S. Supreme Court reversed. Coeur d’Alene, 521 U.S. at 288, 117 S.Ct. 2028. The Court observed: “An allegation of an ongoing violation of federal law where the requested relief is prospective is ordinarily sufficient to invoke the Young fiction. However, this case is unusual in that the Tribe’s suit is the functional equivalent of a quiet title action which implicates special sovereignty interests.” Id. at 281, 117 S.Ct. 2028. The Court then examined the nature of the interest of the state, as a sovereign, in the disputed land, tracing the history of sovereigns’ land interests from the Institutes of Justinian, through English common law and Ameri-can law as it developed during the nineteenth century. Id. at 283-87, 117 S.Ct. 2028. The Court determined that the state’s interest in the disputed submerged lands was “ ‘an essential attribute of sovereignty’ ” id. at 283, 117 S.Ct. 2028 (quoting Utah Div. of State Lands v. United States, 482 U.S. 193, 195, 107 S.Ct. 2318, 96 L.Ed.2d 162 (1987)), concluding “under these particular and unique circumstances, we find the Young exception inapplicable.” Id. at 287, 117 S.Ct. 2028. Key to the Court’s analysis was that, as the equivalent to a quiet title action, the relief the Tribe sought would have extinguished forever any and all rights the state may have had to the submerged land, and hence, “if the Tribe were to prevail, Idaho’s sovereign interest in its lands and waters would be affected in a degree fully as intrusive as almost any conceivable retroactive levy upon funds in its Treasury.” Id. Coeur d’Alene requires a two-step inquiry: First, the court must determine whether the relief requested implicates a special or core state sovereignty interest. MacDonald v. Vill. of Northport, Mich., 164 F.3d 964, 972 (6th Cir.1999); Ellis v. Univ. of Kan. Med. Ctr., 163 F.3d 1186, 1198 (10th Cir.1998). If the first requirement has been satisfied, then the court must proceed to examine whether the relief sought is so intrusive upon the state’s sovereignty that it constitutes the functional equivalent of relief the Eleventh Amendment bars. MacDonald, 164 F.3d at 973; Ellis, 163 F.3d at 1198. Recognizing the unusual nature of the circumstances facing the Court in Coeur d’Alene, federal circuit courts have been circumspect in applying its holding, interpreting Coeur d’Alene as a narrow exception to the Ex parte Young doctrine. See MCI Telecomm. Corp. v. Bell Atlantic-Pennsylvania, 271 F.3d 491, 514-15 (3rd Cir.2001)(state lacked special sovereignty interest in regulating local telephone competition where authority to do so derives solely from grant of power by Congress); Antrican v. Odom, 290 F.3d 178, 189-90 (4th Cir.2002)(state’s election to participate in Medicaid precluded finding of special sovereignty interest in administering program); TFWS, Inc. v. Schaefer, 242 F.3d 198, 206 (4th Cir.2001)(despite Twenty-First Amendment, state did not have special sovereignty interest in regulation of liquor sales); Lipscomb v. Columbus Mun. Separate Sch. Dist., 269 F.3d 494, 501-02 (5th Cir.2001)(lessee’s Contract Clause action to declare as enforceable the terms of leases state entered in the early nineteenth century did not implicate special state sovereignty interest); MCI Telecomm. Corp. v. Ill. Bell Tel. Co., 222 F.3d 323, 347-48 (7th Cir.2000)(state did not have special sovereignty interest in regulation of telecommunications providers); Goldberg v. Ellett, 254 F.3d 1135, 1143 (9th Cir.2001)(no special state sovereignty interest implicated by discharge of state taxes in federal bankruptcy proceeding as relief sought merely related to, but did not intrude upon, core state sovereign interest in taxation); Agua Caliente Band of Cahuilla Indians v. Hardin, 223 F.3d 1041, 1048 (9th Cir.2000)(same); Robinson v. Kansas, 295 F.3d 1183, 1191-92 (10th Cir.2002)(no special sovereignty interest at stake in case seeking to enjoin state school finance law); Joseph A. ex rel. Wolfe v. Ingram, 275 F.3d 1253, 1261 (10th Cir. 2002)(state’s interest in administering welfare program partially funded by federal government not a core sovereign interest); Lewis v. N.M. Dept. of Health, 261 F.3d 970, 978 (10th Cir.2001)(state’s interest in taxation of Indian tribe important but not core in light of federal interest in Indian immunity); Roe v. Ogden, 253 F.3d 1225, 1233-34 (10th Cir.2001) (action under ADA by law students to enjoin use of questions in bar application relating to past treatment for mental disorders and substance addiction did not implicate special state sovereignty interest); J.B. ex rel. Hart v. Valdez, 186 F.3d 1280, 1286 (10th Cir.1999)(state’s interest in administering welfare program partially funded by federal government not a core sovereign interest); Ellis v. Univ. of Kan. Med. Ctr., 163 F.3d 1186, 1198 (10th Cir.1998)(plaintiffs claims for prospective relief in employment discrimination suit did not implicate special sovereign interest); Branson Sch. Dist. RE-82 v. Romer, 161 F.3d 619, 632-33 (10th Cir.1998)(relief sought by school districts and public school students to enjoin changes to state management of land trust for public schools was not equivalent to quiet title action); Elephant Butte Irrigation Dist. of N.M. v. Dept. of Interior, 160 F.3d 602, 612-13 (10th Cir.l998)(suit by irrigation district to enjoin state to pay district a share of net profits under recreational land lease with United States did not entail special state sovereignty interest, and relief sought was not equivalent to quiet title action); Summit Med. Assoc. v. Pryor, 180 F.3d 1326, 1340-41 (11th Cir.1999)(state lacked special sovereignty interest to impose criminal penalties for partial-birth and post-viability abortions); cf. Duke Energy Trading and Mktg., L.L.C. v. Davis, 267 F.3d 1042, 1053-54 (9th Cir.2001)(governor’s emergency power to take private property a core state sovereignty interest, although lawsuit merely implicating that power did not trigger Co-eur dAlene); ANR Pipeline Co. v. Lafaver, 150 F.3d 1178, 1193-94 (10th Cir.1998)(state power to tax property is a core sovereignty interest, and lawsuit seeking recertification of state property tax assessment was fully as intrusive as retroactive money judgment). The United States Court of Appeals for the Sixth Circuit has likewise declined to extend Coeur d'Alene. See Arnett v. Myers, 281 F.3d 552, 567-68 (6th Cir.2002)(Coeur dAlene does not extend to every case involving state property interest, and state’s interest in regulation of riparian rights does not implicate Coeur dAlene where the suit does not seek to quiet title); Hamilton v. Myers, 281 F.3d 520, 526 (6th Cir.2002)(same). The Sixth Circuit specifically has determined that Coeur d’Alene does not apply to claims for prospective relief brought under federal anti-discrimination laws. Carten v. Kent State Univ., 282 F.3d 391, 397 (6th Cir.2002)(holding that Coeur d’Alene does not bar claim for prospective relief under ADA Title II, citing Garrett, 121 S.Ct at 968 n. 9). In two other decisions, however, the Sixth Circuit has recognized the presence of a special state sovereignty interest. Barton v. Summers, 293 F.3d 944, 951 (6th Cir.2002)(state interest in allocating proceeds of tobacco settlement implicates special sovereignty issue where Congress expressly enacted that states may allocate the proceeds as they please); MacDonald v. Village of Northport, Mich., 164 F.3d 964, 972 (6th Cir.1999)(suit seeking declaration that right of way belonged to plaintiffs similar to quiet title action and was therefore barred by Eleventh Amendment). Along with the decision of the Tenth Circuit in ANR Pipeline, and of the Ninth Circuit in Duke Energy, Barton and MacDonald represent the relatively few cases in which a special state sovereignty issue has been found to exist. Viewed together, the circuit court decisions applying Coeur d’Alene illustrate that even significant or important state concerns do not necessarily rise to the level of special state interests. See Agua Caliente, 223 F.3d at 1048. To qualify as a special state interest, the attribute of state sovereignty must be “core,” Goldberg, 254 F.3d at 1143; ANR Pipeline, 150 F.3d at 1193, “essential” Coeur d’Alene, 521 U.S. at 283, 117 S.Ct. 2028; MCI Telecomm, 271 F.3d at 508, or “fundamental” 271 F.3d at 508. Thus far, the only four special interests have been identified: (1) a state’s rights in real property — at least where the lawsuit threatens to eliminate the state’s interest entirely — Coeur d’Alene, 521 U.S. at 283, 117 S.Ct. 2028; MacDonald, 164 F.3d at 972; (2) the power to tax, ANR Pipeline, 150 F.3d at 1193; (3) the emergency power of a state governor to take private property for the benefit and safety of the public, Duke Energy, 267 F.3d at 1053-54; and (4) the authority of the state to allocate tobacco settlement funds, which authority Congress expressly granted to the state, Barton, 293 F.3d at 955. Even the presence of a special state sovereignty issue is not, by itself, sufficient to immunize the state. Rather the second requirement of Coeur d’Alene also must be fulfilled, namely, the relief sought must intrude upon the state’s sovereignty such that it constitutes the functional equivalent of relief the Eleventh Amendment bars. Duke Energy, 267 F.3d at 1053; MacDonald, 164 F.3d at 973. Hence, even when a lawsuit relates to the state’s taxation system, Ex parte Young will apply if the relief sought does not rise to the level of interference with state sovereignty present in Coeur d’Alene. See Agua Caliente, 223 F.3d at 1048. Here, defendants contend that the relief plaintiffs seek would require the state to alter its budget. They argue that plaintiffs’ ADA claim therefore implicates the state’s sovereign interest in controlling and prioritizing its budget. A state’s authority to control its budget is unquestionably an important state interest. Nonetheless, virtually any prospective relief against a state will affect the state’s budget. For this very reason, courts have held that an ancillary effect of prospective relief on a state’s treasury does not violate Eleventh Amendment immunity. See Edelman, 415 U.S. at 668, 94 S.Ct. 1347 (“State officials, in order to shape their official conduct to the mandate of the Court’s decrees, would more likely have to spend money from the state treasury than if they had been left free to pursue their previous course of conduct. Such an ancillary effect on the state treasury is a permissible and often an inevitable consequence of the principle announced in Ex parte Young ”). To adopt defendants’ approach would expand Coeur d’Alene to the point that it would eviscerate Ex parte Young. Furthermore, this case involves programs that are funded in part by federal money under Medicaid. Indeed, the subclass is defined as persons who, in addition to being class members, are also Medicaid recipients. As other courts have noted, a state’s interest in administering a welfare program partially funded by the federal government is not a core sovereign interest. Joseph A. ex rel. Wolfe, 275 F.3d at 1261; J.B. ex rel. Hart, 186 F.3d at 1286. In sum, the Court finds that no special state sovereignty issue is at stake in this case. The first requirement for the application of Coeur d’Alene has not been satisfied. Additionally, even if the state had a special sovereignty interest in prioritizing its budget, the Court would nonetheless find that the relief plaintiffs seek does not so intrude upon that interest that it constitutes a form of relief equivalent to one foreclosed by the Eleventh Amendment. The relief plaintiffs seek is