## Facts

- A parents’ association and three Medicaid-eligible minor children with autism sought to continue receiving Applied Behavioral Analysis (ABA) therapy funded through Ohio Medicaid.
- The children received ABA from a community mental health provider, and licensed professionals recommended the therapy as medically necessary.
- Ohio amended Medicaid mental-health rules to cover only “rehabilitative” services, defined in a manner focused on restoring lost functions.
- State officials took the position that ABA for autism is “habilitative” (developing skills not previously possessed) and therefore would be excluded from coverage under the amended rules.
- Plaintiffs alleged the amendments would terminate or reduce ABA funding despite federal Medicaid requirements for beneficiaries under age 21.
- Plaintiffs sued state officials under 42 U.S.C. § 1983, alleging violations of the Medicaid Act’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) provisions, and sought a temporary restraining order (TRO) and preliminary injunction.
- The court ordered joinder of the federal agency responsible for administering Medicaid at the federal level and later denied the state’s motion to dismiss.

## Issues

1. Whether EPSDT requires Ohio Medicaid to cover medically necessary ABA for eligible children with autism when recommended by a licensed practitioner.
2. Whether Ohio may limit Medicaid mental-health coverage to “rehabilitative” services in a way that excludes medically necessary ABA, notwithstanding EPSDT’s requirement to provide care to “correct or ameliorate” a child’s condition.
3. Whether plaintiffs satisfied the requirements for a TRO and preliminary injunction (likelihood of success, irreparable harm, balance of harms, and public interest).

## Decision

- The court denied the state defendants’ motion to dismiss.
- The court granted a TRO and preliminary injunction.
- The court enjoined enforcement of the amended Ohio Medicaid rules to the extent they would terminate or reduce Medicaid funding for medically necessary ABA services for the plaintiff children pending further proceedings.
- The court found plaintiffs showed a likelihood of success because EPSDT obligations are broader than Ohio’s rehabilitative-only limitation.
- The court found irreparable harm because interruption of early intensive autism treatment risked serious, lasting developmental injury not remediable by later damages.
- The court found the balance of harms favored plaintiffs and the public interest favored compliance with federal Medicaid law and provision of medically necessary care to children.

## Legal Principles

- EPSDT requires states to provide Medicaid-eligible individuals under age 21 all necessary services listed in the Medicaid Act to “correct or ameliorate” physical and mental conditions, even if the services are not otherwise covered for adults.
- A state may not evade EPSDT obligations by adopting a narrower coverage definition (such as a rehabilitative-only standard) that excludes medically necessary treatment for children.
- EPSDT provisions may confer enforceable rights under 42 U.S.C. § 1983 when beneficiaries allege denial of services federal law requires.
- Preliminary injunctive relief may issue where plaintiffs show likely success on an EPSDT claim, irreparable harm from loss of medically necessary treatment, favorable balance of harms, and alignment with the public interest.

## Conclusion

The court preliminarily barred Ohio from implementing Medicaid rule changes that would exclude medically necessary ABA for children with autism, concluding that EPSDT’s mandate to provide services needed to correct or ameliorate a child’s condition likely required continued coverage and that the equities supported immediate injunctive relief.


Parents’ League for Effective Autism Servs. v. Jones-Kelley, 565 F. Supp. 2d 905 (S.D. Ohio 2008)