Fighting for Access to Medicaid Services for Kids with Disabilities

Since 1967, the federal Medicaid statute included a requirement for Early Periodic Screening, Diagnostic and Treatment (EPSDT) services for all Medicaid-eligible children and youth up to age 21.  In 1989, Congress greatly expanded the EPSDT mandate by requiring states to ensure that Medicaid-eligible children are provided with all Medicaid services available under the federal statute, even if the state does not provide those services for adults.  In 1991, DRP, along with the Public Interest Law Center, Education Law Center (ELC), Juvenile Law Center, and Community Legal Services, filed Scott v. Snider.  Scott, a class action, presented a broad challenge to Pennsylvania’s failure to fully implement the expanded EPSDT program.  In 1994, the parties entered into a comprehensive settlement that required the state to take a number of steps to ensure full implementation of the EPSDT program, including:  providing behavioral health rehabilitation (wrap-around) services to all children and youth who need them, regardless of whether they have a mental health diagnosis; issuing a bulletin to assure access to personal care services, various therapies, and case management; approving higher payments to providers when no willing provider can be found who will accept the Medicaid rate; and requiring automatic approval of requests for certain services within 21 days of a request if the state did not deny the request with in that time.

DRP has pursued other cases as well to enforce Medicaid entitlements for children and youth.  In Kirk T. v. Houstoun (1999), DRP brought a class action lawsuit to ensure that behavioral health rehabilitative services for children with mental and behavioral health disabilities were timely delivered to those who needed them.  In 2005, DRP filed Jonathan M. v. Richman to secure Medicaid in-home nursing services for children who experience frequent interruptions in care.   In 2014, DRP represented a class of autistic children in Sonny O. v. Mackereth, which established the access to Applied Behavior Analysis (ABA) therapy under Medicaid.  In 2017, DRP filed S.R. v. DHS on behalf of class of children with mental and behavioral health disabilities in the foster care system to ensure that they have access to Medicaid services that they need to remain in their homes and communities.  This case is still being litigated today.