Medicaid Early & Periodic Screening, Diagnosis & Treatment

Executive Summary

Fact Sheet: Medicaid Early and Periodic Screening, Diagnosis and Treatment: Recent Case Developments
Over the last three years, a number of courts have decided questions about EPSDT.2 The cases discussed below are significant because they decide substantive (as opposed to procedural) questions about how states must implement EPSDT to comply with the Medicaid Act?s minimum standards. After listing the cases, this fact sheet discusses the trends emerging from them and then summarizes each case. 
 
The EPSDT Cases
Frew v. Hawkins, 124 S.Ct. 899 (2004), rev?g., Frazar v. Gilbert, 300 F.3d 530 (5th Cir. 2002), vacating and remanding, 109 F. Supp. 2d 579 (E.D. Tex. 2000)
 
Collins v. Hamilton, 349 F.3d 371 (7th Cir. 2003), aff?g, 231 F. Supp. 2d 840 (S.D. Ind. 2002)(hereinafter Collins)
 
Pediatric Specialty Care v. Ark. Dep?t of Human Services & Knickrehm, 364 F.3d 925 (8th Cir.2004) (hereinafter Pediatric Specialty Care II), same case 293 F.3d 472 (8th Cir. 2002) (hereinafter Pediatric Specialty Care I)
 
Clark v. Richman, 2004 U.S. Dist. LEXIS 21732 (M.D. Penn. Oct. 7, 2004)
 
Memisovski v. Maram, 2004 U.S. Dist. LEXIS 16772 (N.D. Ill. Aug. 23, 2004)
 
S.D. v. Hood, 2002 U.S. Dist. LEXIS 23535 (E.D. Tex. Dec. 5, 2002) (hereinafter S.D.)
 
Emily Q. v. Bonta, 208 F. Supp. 2d 1078 (C.D. Cal. 2001) (hereinafter Emily Q.)
John B. v. Menke, 176 F. Supp. 2d 786 (M.D. Tenn. 2001) (hereinafter John B.)
Chisholm v. Hood, 133 F. Supp. 2d 894 (E.D. La. 2001) (hereinafter Chisholm)
Hawkins v. NH Dep?t of Health and Human Services, 2004 DNH 23 (D. NH 2004)
Lawson v. Dep?t of Health & Soc. Services, 2004 De. Super. LEXIS 60 (Super. Ct. Del. Feb. 25, 2004)

Jacobus v. Dep?t of PATH, 2004 Vt. 70 (S.Ct. 2004) (hereinafter Jacobs)
Semerzakis v. Wilson-Coker, 2003 Conn. Super. LEXIS 2378 (Dec. 24, 2003) (hereinafter Semerzakis)
Manglass v. R.I. Dep?t of Human Services, 2003 R.I. Super. LEXIS 122 (Super. Ct. Oct. 6, 2003) (hereinafter Manglass)
Jackson v. Millstone, 369 Md. 575, 801 A.2d 1034 (Md. Ct. App. 2002) (hereinafter Jackson)
Georgia Dep?t of Community Health v. Freels, 258 Ga. App. 446, 576 S.E. 2d 2 (Ga. Ct. App. 2002) (hereinafter Freels)
 
Emerging themes
The recent EPSDT decisions involved a range of individual and class plaintiffs and various legal forums. Some cases were prosecuted as federally-certified class actions. Others were filed by individual plaintiffs in state courts, and still other cases arrived in state court on appeal from adverse administrative decisions. Regardless of these differences, the cases brought a remarkable level of success to the plaintiffs. When compared with one another, some common themes emerge:
 
1. State attorneys are filing motions to dismiss EPSDT cases on procedural grounds. The 2001-2004 cases rejected these arguments. Future cases must be closely monitored because, if accepted, these arguments will deny Medicaid beneficiaries their ?day in court? regarding the substantive nature of their EPSDT claims.
Provisions of the Medicaid Act have traditionally been enforced in federal courts through another federal statute, 42 U.S.C. § 1983. State attorneys are now arguing that Medicaid beneficiaries cannot enforce the EPSDT provisions through § 1983 because Congress did not intend them to be privately enforced. The question of when a federal statute creates a privately enforceable right has been discussed previously. E.g., Sarah Somers, National Health Law Program, NAPAS Fact Sheet: An Update on Sovereign Immunity Defenses and Private Rights of Action in Medicaid Cases (Dec. 31, 2002); see also Jane Perkins, 42 U.S.C. § 1983 and Medicaid Act ? Docket (updated regularly) (available from NHeLP, NC office). 
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