A class of children with health and developmental problems may bring suit against state officials under 42 U.S.C. §1983 to enforce federal requirements for coverage of Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services for Medicaid-eligible children, a West Virginia federal court has ruled.
The class includes Medicaid-eligible children who suffer from asthma, attention deficit hyperactivity disorder, depression and other health and developmental problems. The complaint alleges that West Virginia's Medicaid agency implemented a program called "Mountain Health Choices" that illegally and arbitrarily placed exclusions and quantitative limits on health services that federal law required the state to cover as EPSDT services The plaintiffs are seeking an order from the court that the state agency adhere to federal Medicaid requirements so that the described class of children will be able to obtain necessary health care, diagnostic services, treatment, and other measures to correct or ameliorate their physical and mental illnesses and conditions.
Enforceable rights
Section 1983 protects individual rights created by federal law. To determine whether individual rights exist in the § 1983 context, a court must determine whether or not Congress intended to confer individual rights upon a class of beneficiaries, the court explained. Soc. Sec. Act §1902(a)(8), which requires the state to furnish reasonably prompt medical assistance to all eligible individuals, does give rise to a right enforceable under § 1983, the court found. Similarly, the other statutes that the state allegedly violated, Soc. Sec. Act §§1902(a)(43), § 1905(a)(4)(B), and 1905(r), also are worded to require participating states to provide EPSDT care to individuals, the type of language that creates rights enforceable through a § 1983 complaint, the court said. The rights are clear and easily enforceable by courts, and § 1905(a)(4)(B) was intended to benefit the plaintiffs specifically, as they are individuals under the age of 21 as described in the statute, the court found.
The state's motion to dismiss this complaint was denied.
D.W. v. Walker, S.D. W. Va., May 15, 2009.
For more information on this and related topics, consult the CCH® Medicare and Medicaid Guide.
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