This section contains the nature of the case and procedural background.

Ps are Medicare beneficiaries with chronic illnesses who depend on the services of home health aides. Ps allege that Medicare-enrolled providers have refused to provide them in-home care or offered fewer services than they were entitled to. They attribute this problem to the policies and priorities of D. Medicare covers home health aides for homebound beneficiaries who need assistance with personal and medical care. 4Home health aides help patients with bathing, dressing, grooming, and taking medications, and they are generally employed through health care providers known as home health agencies (HHAs). HHAs may not discriminate against patients based on disability. D administers the home health benefit and enforces the conditions of participation, including through regular audits of Medicare-enrolled HHAs. Johnson (P) alleges that her Medicare-enrolled HHA stopped providing her in-home services in 2021, and she has struggled to find an agency that would accept her as a patient ever since. Although some providers accepted her for short periods, they offered her fewer services than she was entitled to under Medicare, forcing Johnson to pay for additional care out of pocket. Bunnell (P) has the same problems. Ps are joined by the National Multiple Sclerosis Society and Team Gleason. Both organizations advocate for and assist individuals with chronic illnesses. They contend that the patients they serve struggle to find HHAs that will provide Medicare-covered home health services, and so the organizations pay for private home health aides for those who cannot afford it. Ps sued D and sought to represent a class of chronically ill and disabled Medicare beneficiaries who had similarly been unable to find Medicare-covered home health services. Ps claim that D is insufficiently enforcing the conditions of participation on HHAs and is violating the ban on disability discrimination. Ps are seeking a declaratory judgment and broad forms of injunctive relief. The court dismissed the complaint for lack of Article III standing because Ps 'failed to plausibly allege' that 'their requested relief would redress any harm.' The court found that the alleged injuries were caused by private HHAs not before the court and that they failed to demonstrate it was likely that enjoining D would cause the HHAs to change their behavior. The court also found that their injunctive relief was merely to obey the law. Ps appealed.

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