A brief description of EPSDT litigation involving mental health services is provided below.
Katie A., ex rel. Ludin v. L.A. County, 481 F.3d 1150 (9th Cir. 2007), rev’g and remanding, 433 F.Supp.2d 1065 (C.D. Cal. 2006)
This class action was filed on behalf of foster children with serious emotional disturbance. Plaintiffs’ sought and received a preliminary injunction requiring the provision of medically necessary wraparound services and therapeutic foster care (TFC). On appeal, the 9th Circuit found that wraparound and TFC were within the state’s EPSDT obligations, citing to the Rosie D. decision. However, the Circuit Court also held that, to the extent the mandated components of these services were effectively delivered within the state’s existing programs, the defendants were afforded discretion under the law in exactly how to package those services. The preliminary injunction was reversed and the case remanded for further proceedings.
Katie A. litigation updates are available at www.bazelon.org
Emily Q. v. Bonta, 208 F.Supp. 2d 1078 (C.D. Cal. 2001)
Plaintiff class sought a range of EPSDT services to address their intensive mental health needs, including a short term, home-based intervention called Therapeutic Behavioral Service (TBS). Their complaint led to stipulations by the defendant and the entrance, in part, of a permanent injunction. The published decision affirms the responsibilities of the single state Medicaid agency for administration of its EPSDT services, including notice, screening and delivery of TBS treatment by qualified professionals.
John B. v. Menke, 176 F.Supp.2d 786 (M.D. Tenn. 2001)
Filed in 1998, this class action alleged a failure to implement EPSDT in Tennessee’s statewide managed care organization, TennCare. Following noncompliance with an agreed upon consent decree, the plaintiffs filed a motion for contempt. While denying the motion, the District Court found that federal violations had occurred, ordering a special master to improve compliance. The Court clearly recognized that States cannot relinquish their EPSDT obligations to private contractors or managed care entities, or their ultimately responsible for the delivery of mandatory Medicaid services.
Chisholm v. Hood, 133 F.Supp.2d 894 (E.D. La. 2001); aff’d 391 F.3d 581 (5th Cir. 2004)
A class action settlement failed to resolve issues concerning the state’s obligation to provide psychological and behavioral services for children with Autism. The Court recognized violations of the EPSDT treatment provisions, findings these to be covered services which must be provided when necessary to correct or ameliorate identified conditions, and not otherwise available through the current mental health system. The Court of Appeals affirmed, finding that EPSDT creates enforceable rights and that incontinence services were covered under Medicaid, even though the federal government approved a state plan that did not include these services.
J.K. v. Dillenberg, 836 F.Supp.694, 699 (D. Ariz. 1993)
Plaintiff class challenged the sufficiency of behavioral health services provided by contractors to the single state Medicaid agency, alleging unlawful restrictions on the duration, scope and amount of medically necessary services, and the violation of federal regulations governing the termination or reduction of those services. Ruling on cross-motions for summary judgment and defendants’ motions to dismissal, the Court held that the conduct of regional behavioral health contractor amounted to state action for purposes of determining whether federal EPSDT violations occurred.