Ninth Circuit EPSDT Decision

The Ninth Circuit reversed the issuance of a preliminary injunction mandating the provision of wraparound and therapeutic foster care services (TFC) to foster children under Medicaid’s Early and Periodic Screening Treatment Services (EPSDT) program. Nevertheless, the court’s decision upholds most of the district court’s reasoning and emphasizes the state’s obligation to provide EPSDT to children under the Medicaid statute. Katie A. v. Los Angeles County, 2007 WL 865509 (March 23, 2007).

The court noted that states must cover every type of health care or service necessary for EPSDT purposes that is allowable under the Medicaid statute, 42 U.S.C. § 1396d(a). The Ninth Circuit stated: “The EPSDT obligation is thus extremely broad.”  The defendants argued that wraparound services and TFC are not Medicaid-covered services and therefore were not provided.  The district court held that, since all the components of wraparound and TFC are within the EPSDT obligations, then wraparound and TFC are within the EPSDT obligations.  The district court issued a preliminary injunction requiring the state to provide wraparound and TFC services.

The Ninth Circuit held that the district court applied an erroneous interpretation of the Medicaid Act, and it therefore reversed the issuance of the preliminary injunction.  The appellate court explained: “[T]he [district] court should have examined whether all required component services under § 1396d(a) were already being supplied.  If all mandated services under § 1396d(a) are being supplied effectively, the State is not obliged to go further and package the services as wraparound and TFC.”  The court viewed wraparound services and TFC as a compilation of services, not as a distinct service.

Nevertheless, the court’s discussion of EPSDT made it clear that if the state does not provide each and every required service under EPSDT, then an injunction would be proper.  The court rejected numerous arguments by the defendants, including the argument that “federalism principles” required the court to give the state the widest latitude.  Importantly, the court rejected an argument that has been accepted in some other Medicaid cases, specifically that the Medicaid statute requires only that the state make such services available but does not require the state to actually provide such services.  The court stated: “Requiring the State actually to provide EPSDT services that have been found to be medically necessary is consistent with the language of the Medicaid Act.”

Thus, on balance, even though the reversal of the preliminary injunction was unfortunate, the decision includes a very helpful analysis of the Medicaid program.