## Facts

- Louisiana participates in Medicaid and administers its program through the Department of Health and Hospitals (DHH), headed by Secretary David Hood.
- Plaintiffs, a certified class of Medicaid recipients under age 21, were placed on Louisiana’s MR/DD waiver waiting list, which is intended to fund community-based services as an alternative to institutionalization.
- After class certification, partial settlements, and partial summary judgment resolving other claims, one issue remained for trial: whether federal Medicaid law required Louisiana to provide community-based psychological and behavioral services to class members diagnosed with autism.
- Plaintiffs presented expert evidence that behavioral and psychological interventions improve functioning in children with autism, are essential to teaching daily skills and reducing problem behaviors, and for many children are medically necessary and not replaceable by other services.
- The evidentiary record on the necessity and effectiveness of these psychological/behavioral services was unrebutted.
- The parties tried the remaining issue on a documentary record (exhibits and depositions).

## Issues

1. Whether the Medicaid Act, including EPSDT, required Louisiana to provide medically necessary community-based psychological and behavioral services (including services delivered by licensed psychologists) to Medicaid-eligible children with autism in the plaintiff class.
2. Whether the asserted Medicaid obligations created enforceable rights for beneficiaries such that the state’s failure to provide the services could be remedied under 42 U.S.C. § 1983.

## Decision

- The court found for the plaintiff class on the remaining claim.
- The court held Louisiana must provide community-based access to medically necessary psychological and behavioral services for eligible children with autism, consistent with EPSDT and applicable Medicaid requirements.
- The court rejected the argument that coverage of psychiatric services satisfied the state’s obligation, crediting evidence that psychiatrists generally do not provide the specific behavioral treatments shown effective for autistic children.
- The court treated the EPSDT-related obligations at issue as enforceable through § 1983 and ordered relief requiring provision of the services subject to appropriate medical-necessity determinations and program requirements.

## Legal Principles

- A state may choose whether to participate in Medicaid, but once it participates it must comply with federal Medicaid statutes and regulations.
- EPSDT requires participating states to furnish eligible individuals under 21 medically necessary care and services covered by the Medicaid Act to correct or ameliorate physical and mental conditions.
- If a requested service fits within a covered Medicaid service category and is medically necessary for an EPSDT-eligible child, the state must provide it even if it is not otherwise provided to adults under the state plan.
- Coverage of a different provider type or service (e.g., psychiatry) does not satisfy EPSDT if it does not supply the medically necessary treatment required to address the child’s condition.
- EPSDT obligations may confer individual rights enforceable by Medicaid beneficiaries under 42 U.S.C. § 1983, permitting injunctive relief to remedy noncompliance.

## Conclusion

The court concluded that EPSDT obligated Louisiana Medicaid to make medically necessary psychological and behavioral treatment available to eligible children with autism and that beneficiaries could enforce those obligations under § 1983, warranting court-ordered relief to secure access to the required services.


Chisholm v. Hood, 133 F. Supp. 2d 894 (E.D. La. 2001)