Class Action on Behalf of NY’s Medicaid
Eligible Children Requiring BH Services

April 4, 2022

Last week, several national disability rights organizations filed a class action lawsuit in federal court alleging that Medicaid eligible children in New York have been denied access to required services to address their mental illnesses.  Specifically, named Plaintiffs are Medicaid-eligible children with mental health conditions who 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.  Named Defendants in the case include DoH Commissioner Mary T. Bassett and SOMH Commissioner Anne Marie T. Sullivan.

(From the Complaint: ) Specifically, under the EPSDT provisions of the Medicaid Act, Defendants are required to provide or arrange for certain intensive home and community-based mental health services (“IHCB-EPSDT Services”) for Medicaid-eligible children for whom such services are a medical necessity. The required IHCB-EPSDT Services include: (a) Intensive Care Coordination – an assessment and service planning process conducted through a child and family team that coordinates services across multiple systems that serve the child and family, and manages all the care and services they need. This includes assessment and service planning, assistance in accessing and arranging for mental health services (including mobile crisis services), coordinating multiple mental health services, advocating for the child and the child’s family, monitoring the child’s progress, and transition planning, as required under 42 U.S.C. §§ 1396d(a)(13), 1396d(a)(19), and 1396n(g)(2). (b) Intensive, home-based behavioral services – intensive behavioral services and supports coverable as rehabilitation services as required under 42 U.S.C. § 1396d(a)(13), including individualized therapeutic interventions, provided on a frequent and consistent basis, that are designed to improve behavior and are delivered to children and families in the child’s home or any setting where the child is naturally located. (c) Mobile Crisis Services – intervention services that can respond to a child’s acute mental health emergency quickly and wherever needed coverable as rehabilitative services and targeted case management as required under 42 U.S.C. §§ 1396d(a)(13), 1396d(a)(19), and 1396n(g)(2).The suit also alleges that Defendants’ violations disproportionately affect LGBTQIA+ youth, youth from low-income families, and people of color who already face myriad struggles that harm their mental and behavioral health, including discrimination in all its manifestations.

Here’s a link to the Complaint filed 3/31/2022: