OLRS 2008 Annual Report
Protecting the Right to Medically Necessary Services
Receiving needed services can mean the difference between life in the community or life in an institution. OLRS took legal action after receiving complaints from families about proposed administrative rule changes that would have discontinued services to children in inclusive settings.
Federal Judge James L. Graham issued a preliminary injunction to prevent the implementation of proposed state rules that would have eliminated Medicaid reimbursement for medically necessary services to children with autism and other conditions that cause severe or intense behavior. "Without these critical services, the children were at risk for regression in their skills, increased unwanted behavior and an increased chance of being placed in an institution or segregated classroom," said OLRS attorney Michelle Atkinson. "The injunction was a necessary legal protection for them, so they could stay at home in their communities," added OLRS chief legal counsel Sue Tobin.
OLRS filed the lawsuit on behalf of three children with autism and the Parents' League for Effective Autism Services (PLEAS), an association of parents and families who are receiving Medicaid services. A motion and complaint was filed in the U.S. District Court, Southern District of Ohio, seeking a temporary restraining order and declaratory and permanent injunctive relief prohibiting the defendants, officials at the Ohio Department of Job and Family Services (ODJFS), the agency responsible for the administration of the Medicaid program in Ohio, and the Ohio Department of Mental Health (ODMH), from enforcing the proposed rules. The Centers for Medicare and Medicaid Services, per the judge's orders, was also added as a defendant in the case.
OLRS requested the injunction, an extraordinary remedy that courts use in special cases, to prevent the harm that would occur to the children if the defendants implemented the rules and discontinued payment for the children's services. A court hearing was held where parents of children with autism and a psychologist familiar with the children gave powerful testimony about the children's need for intensive behavioral services and the harm they would suffer without such services. They told the court the children had no other options for services and risked substantial regression in their behavior and skills.
Judge Graham viewed the proposed rules as an effort to avoid having to pay for certain services under the federal Early Periodic Screening, Diagnosis and Treatment requirement, and concluded that the defendants had interpreted the federal Medicaid law too restrictively. The court also denied the defendants' motion to dismiss the case and ruled that the plaintiffs had properly brought a claim under federal law for violations of their rights under Medicaid, that OLRS lawyers could represent the PLEAS association, and that the association has standing to sue as a plaintiff.
ODJFS and ODMH have appealed the case to the U.S. Court of Appeals for the Sixth Circuit. Judge Graham denied their request to stay the injunction during the pendency of the appeal, and also stayed the proceedings of the district court during that time. OLRS continues its work on this case to ensure that children with disabilities continue receiving needed services in inclusive settings.
