• Toni Hoy

    In the depths of winter, there arose in me, an invincable summer. Albert Camus

  • This blog is dedicated to children whose adoptive parents were forced into trading their custody rights for mental healthcare due to pre-adoptive trauma tonihoy@gmail.com

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EPSDT: Non-Compliance Challenged in Illinois 2010

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 Chapter 2      http://www.acmhai.org/pdf/Federal_EPSDT_Coverage_-_Chapter_Two.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




One Response

  1. I applaud you blog and what you are doing. We are in a similar situation where our adopted son is currently on week 3 of his 4th hospitalization because he cannot be safely maintained at home. We have 2 younger children and the day he was admitted for his 4th hospitalizatin he attacked myself and his 4 year old sister while sitting at a doctors appointment. He said he did this because he wanted to go into the hospital. In addition to his mental health issues my son is also autistic, has a seizure disorder, severe ADHD and has an IQ that falls into the mild-mental retardation category. We have denied our ICG grant and have no success so far with getting his PUNS upgraded to Urgent. We are being told that we need to consider a “no fault dependency” in order to get him into Residential which everyone involved with him (numerous agencies) all agree is what he requires at this time.

    Please let me know if there is anything I can do. I have written my Congressmen as well my local State Rep. I don’t want to give up my son but I, too, want to give him the help he needs.

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