Section 05

Litigation

Appendix 1. Recent Litigation on Children’s Behavioral Health Services

State	Federal Benefits/ Protections at Issue	Legal Remedy	Class Description (if applicable)	Implicated Behavioral Health Services	Required Mitigation Strategies
Alabama Alabama EPSDT Settlement, October 2017	• EPSDT	Settlement Agreement	No class; suit was brought by the Alabama Disabilities Advocacy Program and the Center for Public Representation.	• Intensive Home-Based Services	The state must: • Expand Intensive Home-Based Services for Medicaid-eligible children and youth with serious emotional disturbance or Autism spectrum disorder by eliminating existing service caps and requesting additional appropriations in the Governor’s budget; • Update its list of approved standardized screening tools to include the Pediatric Symptom Checklist; • Require behavioral health providers to conduct comprehensive behavioral health assessments or developmental screenings; and • Conduct outreach and education to providers and Medicaid recipients about EPSDT requirements and the state’s progress implementing the improvements described in the settlement agreement.
California Katie A. v Bonta, September 2011	• EPSDT	Settlement Agreement	Medicaid-eligible children who are 1) in foster care or are at imminent risk of foster care placement and 2) have a mental illness or condition, and 3) who need individualized mental health services in a home-like setting to treat their illness or condition. Mitigation strategies implemented as a result of the settlement agreement impact all Medicaid-enrolled children and youth.	• Intensive Home-Based Services • Intensive Care Coordination • Therapeutic Foster Care • Targeted Care Management • Rehabilitation Services	The state must: • Develop and disseminate a Medi-Cal Specialty Mental Health manual to instruct providers on the service array and service delivery of Intensive Care Coordination and Intensive Home-Based Services; • Amend California’s Medicaid authorities as needed to cover Therapeutic Foster Care and modify its definitions of Targeted Case Management and Rehabilitation services to reflect a Core Practice Model; • Develop and endorse trainings and other practice improvement protocols to support the Core Practice Model; • Establish a Data and Quality Task Force to track the use and outcomes of ICC, IHBS, and Therapeutic Foster Care services; • Improve data collection and matching methods to support the Core Practice Model; and • Provide guidance to counties and providers to implement requirements in the settlement agreement.
Colorado A.A. v Kim Bimestefer, February 2024	• EPSDT • ADA • Section 504	Settlement Agreement	No class, the class was never certified by the courts, but parties moved forward with the settlement agreement, citing “a mutual interest in seeing that services are delivered to Medicaid Members… consistent with state and federal law.” Mitigation strategies implemented as a result of the settlement agreement impact all Medicaid-enrolled children and youth.	• Intensive Behavioral Health Services	The state must develop and implement a system of care plan to deliver intensive behavioral health services to all Medicaid-eligible children, which will be overseen by an outside partner located at the University of Connecticut School of Social Work. The system of care plan must outline: • The full continuum of necessary mental health services (including Intensive Care Coordination; Intensive Home and Community-Based Services, and Mobile Crisis Intervention); • How Medicaid members will be identified and able to access services; • A standard assessment process; • A tiered approach to care coordination; and • A system for collecting data, tracking members, and monitoring outcomes.
Iowa P.A. v Iowa Department of Health and Human Services, January 2025	• EPSDT • ADA • Section 504	Settlement Agreement	Medicaid-eligible children 1) who have been determined by a licensed practitioner of the healing arts as having a serious emotional disturbance, not attributable to an intellectual or developmental disability, and 2) for whom there is an assessment that intensive home and community-based services are needed to correct or ameliorate their condition.	• Intensive Care Coordination • Intensive In-Home and Community Therapeutic Services • Mobile Crisis Intervention and Stabilization Services	The state must: • Develop, improve and strengthen Intensive Care Coordination, Intensive In-Home and Community Therapeutic Services, and Mobile Crisis Intervention and Stabilization Services to effectively meet their individual needs and maximize their success and development in the least restrictive setting; and • Develop a quality management and accountability structure that ensures ongoing quality assurance and systems improvement for children receiving Intensive Care Coordination, Intensive In-Home and Community Therapeutic Services, and Mobile Crisis Intervention and Stabilization Services.
Maine United States v. Maine Department of Health and Human Service, November 2024	• ADA	Settlement Agreement	No class; suit was brought via a United States Department of Justice investigation but all children eligible to receive behavioral health services from the Maine Department of Health and Human Services and who are at risk of an out-of-home placement are covered by the settlement agreement.	• Behavioral health services delivered in an out-of-home placement, emergency department, or Crisis Stabilization Unit	The state must: • Assess all children meeting criteria outlined in the agreement to determine their need for behavioral health services; • Provide access to care coordination services, including crisis planning and High-Fidelity Wraparound services; • Provide the full array and intensity of home- and community-based services, including crisis services and intensive in-home services (behavioral support services, therapy services, peer supports, respite, etc.) and establish MaineCare provider reimbursement rates for the costs of providing these services; • Support children and families to self-direct home- and community-based services; • Report the number of children whose individual service plans state that 1) the child or their family has chosen not to accept services in the family’s home or 2) the child needs one or more services that cannot be provided in the family’s home; • Convene quarterly meetings with providers to gather feedback on issues related to state policies, reimbursement, billing, service delivery, addressing unmet needs, and training staff; • Publish information and conduct outreach to children, families, and other stakeholders about home- and community-based services and how to access these services; and • Develop strategies to improve workforce training and recruitment, including rulemaking to outline expectations and desired outcomes from providers.
Massachusetts Rosie D. v Romney, February 2007	• EPSDT	Remediation Plan	Medicaid-eligible children with serious emotional disturbance (SED) who need in-home support services.	• In-Home Support Services	The state must: • Implement improvements to behavioral health screening and clear communication of new requirements about the use of standardized screening tools; • Design a statewide common assessment information gathering tool for statewide use, and train behavioral health providers in its appropriate use; • Plan, design, and contract for a service delivery network to deliver the crisis intervention and home- and community-based services described in the settlement agreement; and • Design and develop a web-based application to facilitate identification and monitoring of behavioral health service delivery to children with serious emotional disturbance.
Michigan K. B. v Michigan Department of Health and Human Services, December 2024	• EPSDT • ADA • Section 504	Settlement Agreement	Medicaid-eligible children with intensive mental and behavioral health care needs who experienced psychiatric hospitalizations and other institutional residential treatment settings, or involvement in the child welfare or juvenile justice system because they could not access the services they needed in their homes and communities.	• Intensive Care Coordination with Wraparound • Intensive Home-Based Services • Intensive Crisis Stabilization Services • Respite • Parent Support Partner • Youth Peer Support.	The state must: • Ensure access to intensive home and community-based services statewide for children with significant behavioral health needs; • Establish consistent, statewide screening, assessment, and referral processes so that children are identified and connected with services consistently and equitably; • Improve data collection and oversight to track services and outcomes; and • Implement continuous quality improvement measures to sustain progress.
New York C.K. v McDonald, January 2026	• EPSDT • ADA • Section 504	Settlement Agreement	Medicaid-eligible children with mental health conditions who have been determined by a licensed practitioner to require intensive home and community-based mental health services in order to correct or ameliorate their conditions while remaining safely at home and in their communities.	• Intensive Care Coordination • Intensive In-Home Services • Mobile Crisis Services	The state must: • Establish a multi-year plan to redesign Intensive Care Coordination, Intensive In-Home Services, and Mobile Crisis Services for Medicaid-eligible children, youth and families; • Develop an Implementation Plan that identifies specific steps the State will take to strengthen the required services; and • Assess performance on coverage, access, and quality of the required services.
Washington T.R. v Quigley, August 2013	• EPSDT	Settlement Agreement	Medicaid-eligible children now or in the future who have a mental illness or condition, have a functional impairment that substantially interferes with the ability to function in the family, school, or community setting, and who need intensive home and community-based services.	• Intensive Care Coordination • Intensive In-Home and Community Services • Mobile Crisis Intervention and Stabilization Services	The state must, among other requirements: • Provide Intensive Care Coordination, Intensive Home and Community-Based Services, and Mobile Crisis Intervention and Stabilization Services (collectively referred to as Wraparound with Intensive Services (WISe)) in Washington’s Medicaid program; • Provide WISe program and services, including Child and Family Teams; • Provide access to WISe program and services in accordance with the WISe Access protocol; • Amend or update the WISe Access Protocol over time; • Make descriptions or explanations of WISe easily accessible to youth, families, and other stakeholders, including on the state’s websites; • Build statewide capacity over five years to provide WISe services to all youth for whom WISe services would be necessary; • Conduct a screening for WISe services to children using the Child and Adolescent Needs and Strengths tool; • Establish a workforce development collaborative that operates independently and is co-led by youth and families, state systems, and partner universities; • Require Prepaid Inpatient Health Plans (PIHPs) to provide a Notice of Action that advises individuals of their due process rights when a PIHP denies, terminates, or reduces services or when there is a disagreement with specific treatment recommendations between the individual and the PIHP; • Develop and implement a quality assurance plan within three years that includes how the state will develop data-informed measures, address WISe-related data integration across state agencies, and how data and quality assurance tools will be monitored; and • Develop a WISe manual based on the National Wraparound Initiatives to direct and train PIHPs, providers, and state agencies on delivering WISe services.