OLRS 2008 Annual Report
G.D. v. Riley

OLRS is engaged in active mediation of G.D. v. Riley, a class action lawsuit OLRS filed against the Ohio Department of Job and Family Services (ODJFS). The case is in the U.S. District Court for the Southern District of Ohio and seeks to require the state to comply with federal laws related to the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program.

EPSDT, known in Ohio as Healthchek, is a required Medicaid program covering children under age 21. The program requires state officials to periodically screen Medicaid eligible children for health problems. If a child's screening identifies health problems, the law also requires the EPSDT program to provide necessary health care, diagnostic services and treatment. Those services include medical, vision, hearing and lead testing. However, any service that will correct or improve a child's health problems must be provided, if the service is included in a list of federal Medicaid services.

OLRS alleges that ODJFS violates federal law because it does not have a system in place that allows Medicaid eligible children to apply for and receive necessary treatment services from the EPSDT program. At the request of the judge hearing the case, OLRS continues to meet with the defendants under the supervision of the mediator for the U.S. District Court for the Southern District of Ohio.

OLRS continues to monitor complaints from families about obtaining EPSDT services for their children with disabilities. In a recent complaint, a family was unable to get Medicaid funding for equipment needed by a young child with significant developmental disabilities. The child's physician determined that the equipment was necessary for the child's safe transportation and self-care. Medicaid denied the equipment as not medically necessary, a decision that was overturned on appeal. However, the equipment was denied a second time when a subsequent review required by the appeal determined again that the equipment was not medically necessary. Frustrated by the delay, the family is now seeking other sources of funding for the equipment.

The lawsuit and any settlement seeks to address the barriers encountered by this family and a multitude of others, by ensuring that Ohio's EPSDT program complies with federal Medicaid law, including applying the appropriate standard of medical necessity to EPSDT requests, and ensuring that ODJFS is responsive to families in its administration of the EPSDT program.