Violation of the Availability Requirement of the Medicaid Act  200.  Plaintiffs repeat and re-allege Paragraphs 1-199 as if set forth fully herein.  201.  As set forth above, Defendants have failed to provide Plaintiffs with the available  assistance that is medically necessary and that they have requested. Defendants’ failure to  provide the requested assistance in sufficient amount, duration and scope to reasonably achieve  the purpose of the Medicaid Act violates the Act’s “availability” requirement. 42 U.S.C. §  1396a(a)(10)(A). Plaintiffs and the class may enforce the Act’s availability requirement under 42  Violation of Article I and the Due Process Clause of the U.S. Constitution  194.  Plaintiffs repeat and re-allege Paragraphs 1-193 as if set forth fully herein.  195.  The United States Constitution bars Congress from delegating to private parties  the power to regulate the conduct of other parties.  196.  The Healthfirst MLTC plans are “not a department, agency, or instrumentality of  the United States Government,” but rather private entities. They are ultimately owned, operated  and managed by for-profit entities, including HF Management Services, LLC, and HF  Administrative Services, Inc.  197.  The Healthfirst MLTC plans and the Healthfirst Enterprise benefit financially  whenever the plans deny or refuse to accept a request for increased home care hours or reduce  the authorized hours of home care service.  198.  The Medicaid Act vests state agencies responsible for its administration at the  state level (DOH, in this case) with legislative and rule-making authority to determine Medicaid  recipients’ levels of coverage for home care services and to carry out the provision of Medicaid  benefits. DOH, however, has unconstitutionally delegated this legislative and rule-making  authority to the Defendants in the Healthfirst Enterprise, as set forth above, including but not  limited to the following ways: (a) permitting or even encouraging the Healthfirst MLTC plans  and the Healthfirst Enterprise to violate the provisions of the Medicaid Act, the ADA and  Section 504 (and their accompanying regulations) and the Due Process clause of the U.S.  44  Constitution; (b) failing to supervise and monitor the Healthfirst MLTC plans and the Healthfirst  Enterprise to ensure that they are abiding by the provisions of the Medicaid Act, the ADA and  Section 504 (and their accompanying regulations) and the Due Process clause of the U.S.  Constitution; (c) permitting or even encouraging the Healthfirst MLTC plans and the Healthfirst  Enterprise to engage in their own rule-making in carrying out the provisions of the Medicaid Act,  and specifically permitting or encouraging them to promulgate rules favoring the financial  interests of the Healthfirst Enterprise, to the detriment of the class members, all of whom are  Medicaid recipients; and (d) failing to enforce the provisions of the Medicaid Act, the ADA and  Section 504 (and their accompanying regulations) and the Due Process clause of the U.S.  Constitution against the Healthfirst MLTC plans and the Healthfirst Enterprise, despite having  delegated its authority to administer a portion of New York’s Medicaid program to those entities.    199.  Plaintiffs have no adequate remedy at law for DOH’s unconstitutional delegation  of legislative and rule-making authority.   Violation of the Reasonable Promptness Requirement of the Medicaid Act  203.  Plaintiffs repeat and re-allege Paragraphs 1-202 as if set forth fully herein.  204.  As set forth above, it is medically necessary that Plaintiffs receive more home  care services than Defendants are currently providing to them, and they are entitled to receive  those additional services under the Medicaid Act. Defendants have failed to provide Plaintiffs, in  a reasonably prompt manner, with the assistance to which they are entitled. Defendants’ failure  to timely provide medically necessary home care services to Plaintiffs violates the reasonable  promptness provision of the Medicaid Act, 42 U.S.C. § 1396a(a)(8). Plaintiffs may enforce the  Act’s reasonable promptness requirement under 42 U.S.C. § 1983.  205.  Plaintiffs have no adequate remedy at law for these violations of the Medicaid  Act.  FOURTH CLAIM FOR RELIEF: Against All Defendants  Violation of the Americans with Disabilities Act  206.  Plaintiffs repeat and re-allege Paragraphs 1-205 as if set forth fully herein.   207.  Plaintiffs are “qualified individual[s] with a disability” within the meaning of 42 