EPSDT: Non-Compliance Challenged in Illinois in 2010
We filed a federal lawsuit in IL on November 3, 2010. Our son’s treatment has been covered under the EPSDT provision of Medicaid since April, 2008, and we have been denied coverage that was entitled to us by law. DCFS wrongly took custody of our son causing great distress to him and us and setting him backwards in therapy. This is a landmark case that will change the face of pediatric psychiatric lockout cases in Illinois, for Medicaid eligible children, as well as add to the precendents that have already been won in other states.
At least two other Illinois law firms have asked for copies of our complaint.
We were also asked and gave permission to add our case to the Appendix of the writ for a Supreme Court case in Pennsylvania.
Early, Periodic, Screening, Diagnostic and Treatment (EPSDT)
EPSDT Chapter 1 http://www.acmhai.org/pdf/EPSDT_Chapter_One.pdf
EPSDT Fact Sheet http://www.acmhai.org/pdf/factsheet_state_limits_on_EPSDT.pdf
Early, Periodic, Screening, Diagnosis and Treatment is an entitlement (Title XIX) under the Federal Medicaid program, which requires states to provide “necessary healthcare, diagnostic services, treatment, and other measures to correct or ameliorate defects and physical and mental illnesses and conditions for children under the age of 21.”
EPSDT Key Concepts
- EPSDT services must be provided to children enrolled in Medicaid whether or not the services are provided for in any State Plan.
- EPSDT require states to do more than merely offer to cover services. States are obligated to actively arrange for treatment, either by providing the service itself or through referral to appropriate agencies, organizations or individuals.
In short, if your child has a Medicaid card and “a practitioner of the healing arts deems a treatment to be medically necessary, the state MUST provide it.”
EPSDT does not require you to apply for ICG.
EPSDT does not require you to sue your school district for treatment.
EPSDT does not require you to apply for a Medicaid waiver.
EPSDT does not require you to file a dispute resolution with CRSA.
EPSDT requires the state to provide your any medically necessary treatment for your child as prescribed by a practitioner of the healing arts, including a doctor, psychiatrist, psychologist, or therapist.
EPSDT does not exclude residential treatment.
EPSDT does not require the barbaric practice of custody relinquishment of your child to the state in exchange for treatment.
EPSDT Litigation http://www.acmhai.org/pdf/Jane_Perkins_-_EPSDT_Litigation.pdf
These cases have already successfully been won in other states.
We have been robbed of custody of our son for the last 29 months because the state of Illinois refused to cover our son’s residential treatment under the Medicaid card he was awarded as part of a special needs adoption.
Other families interested in suing may contact:
Aaron W. Rapier
The Collins Law Firm, P.C.
1770 North Park Street, Suite 200
Naperville, IL 60563
Filed under: custody relinquishment, EPSDT, Foster Care and Adoption, Illinois no fault dependency, Mental Health, psychiatric lockout, RAD, PTSD, no fault dependency, mental health, trauma, bipolar disorder