## Facts

- A certified class of low-income children alleged long-running noncompliance by the District of Columbia with Medicaid Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements.
- The parties resolved core claims through a 1999 settlement order/consent decree, under which the court retained jurisdiction to oversee compliance.
- The decree required the District to provide EPSDT services prescribed for class members and set procedures for enforcement, including a written notice and good-faith negotiation requirement before seeking judicial enforcement.
- The decree also contemplated that individualized benefits disputes would be handled through Medicaid’s administrative fair-hearing process rather than through direct motion practice in the class case.
- A class member child with autism (identified in the record as NHB) was prescribed applied behavioral analysis (ABA) therapy, which the District initially provided under EPSDT.
- After federal Medicaid authorities took the position that ABA therapy (as requested/described) was not covered, the District stopped providing ABA therapy to the child.
- Plaintiffs moved to compel the District to resume ABA therapy under the decree; in a 2005 order, the court denied relief, characterizing the request as individualized rather than systemic.
- Plaintiffs later filed a motion seeking reconsideration of the 2005 order and renewed efforts to obtain ABA therapy through enforcement or reinterpretation of the settlement order.

## Issues

1. Whether the consent decree authorized the court to compel the District to provide a specific treatment (ABA therapy) to a single class member as enforcement of the decree’s EPSDT provisions.
2. Whether the requested relief presented a systemic decree-violation suitable for court enforcement, or an individualized benefits dispute committed to administrative fair-hearing procedures.
3. Whether plaintiffs satisfied the standards for reconsideration of the prior 2005 order denying the motion to compel ABA therapy.
4. How subsequent federal Medicaid coverage determinations affected the District’s obligations under the decree’s EPSDT-service language.

## Decision

- The court denied plaintiffs’ motion for reconsideration of the 2005 order.
- The court reaffirmed that the decree was a structural remedy aimed at systemic compliance and did not convert individualized coverage disputes into class-case enforcement matters.
- The court held that disputes over whether a particular child is entitled to a particular service must proceed through Medicaid’s administrative fair-hearing framework rather than by motion to enforce the decree.
- The court declined to reinterpret or expand the decree to require case-specific coverage determinations for a single child’s requested therapy.

## Legal Principles

- Consent decrees are interpreted according to their text, structure, and remedial purpose; courts will not read structural program remedies to authorize individualized adjudication of benefits disputes absent clear decree language.
- A motion to enforce a consent decree must seek relief within the decree’s scope; it cannot be used to obtain new, individualized remedies not contemplated by the settlement’s enforcement design.
- Where a settlement channels individual benefits disagreements to administrative proceedings, parties generally must pursue those administrative remedies rather than litigate individualized coverage questions through the consent-decree court.
- Reconsideration of a prior order requires a recognized basis such as intervening change in controlling law, newly discovered evidence, or clear legal error; disagreement with the prior characterization of the claim is insufficient.

## Conclusion

The court refused to reopen its earlier denial of an order compelling ABA therapy for a single class member, holding that the consent decree’s EPSDT provisions were intended to address systemic compliance and that individualized service-coverage disputes must be handled through Medicaid’s administrative fair-hearing process rather than decree-enforcement motions.


Salazar v. District of Columbia, 560 F. Supp. 2d 6 (D.D.C. 2008)