## Facts

- A certified class of Massachusetts Medicaid-eligible children under 21 with serious emotional disturbances (SED) sued state officials responsible for administering the MassHealth (Medicaid) program.
- The children alleged systemic failures to provide federally required Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, including medically necessary home- and community-based services.
- Trial evidence showed many class members needed comprehensive assessment, an individualized clinical plan, and trained care coordination to implement and monitor treatment.
- The Commonwealth did not provide, or provided inadequately, intensive home-based supports and care coordination for large numbers of class members.
- As a result, many children were hospitalized or at risk of hospitalization, and some experienced unnecessary placement or prolonged stays in residential or institutional settings.
- After a six-week bench trial, the court issued a post-trial decision addressing liability under specific Medicaid Act provisions, with remedies to be addressed later.

## Issues

1. Whether Massachusetts failed to provide EPSDT-eligible children with SED all medically necessary services required to “correct or ameliorate” their conditions, including intensive home-based services and care coordination.
2. Whether Massachusetts failed to furnish required Medicaid services with “reasonable promptness” under 42 U.S.C. § 1396a(a)(8).
3. Whether Massachusetts violated the Medicaid “equal access” provision, 42 U.S.C. § 1396a(a)(30)(A).
4. Whether Massachusetts violated the managed care requirements in 42 U.S.C. § 1396u-2(b)(5) in connection with its delivery of services to class members.

## Decision

- The court held Massachusetts liable for violating EPSDT by failing to provide class members medically necessary services to correct or ameliorate their conditions, including intensive home-based services and care coordination.
- The court held Massachusetts liable for violating the Medicaid Act’s “reasonable promptness” requirement due to systemic delay and non-provision of required services.
- The court rejected the claim that Massachusetts separately violated the “equal access” provision.
- The court entered judgment for the plaintiff class on liability as to EPSDT and reasonable promptness, with remedial proceedings to follow.

## Legal Principles

- Once a state participates in Medicaid, it must comply with federal Medicaid requirements as a condition of receiving federal funds.
- EPSDT requires coverage of medically necessary services for Medicaid-eligible individuals under 21 to “correct or ameliorate” conditions identified through screening, and this obligation extends to home- and community-based services when medically necessary.
- The principal statutory limit on EPSDT treatment coverage is medical necessity, making the EPSDT entitlement broad.
- Medicaid assistance must be furnished with “reasonable promptness”; systemic inability or failure to arrange necessary care can violate this requirement even if services exist on paper.
- States retain discretion in plan design and administration, but that discretion does not permit the absence of an adequate mechanism to deliver medically necessary EPSDT services to eligible children.
- The “equal access” provision addresses provider availability and access in relation to the general population and does not automatically establish liability for all EPSDT implementation failures.

## Conclusion

The court found that Massachusetts’s Medicaid program failed, on a systemic basis, to deliver medically necessary EPSDT mental health services—including intensive home-based supports and care coordination—to children with SED with reasonable promptness, establishing liability under the Medicaid Act while rejecting a separate equal-access violation and leaving remedies for later proceedings.


Rosie D. v. Romney, 410 F. Supp. 2d 18 (D. Mass. 2006)