G.D. v Colbert
Ohio Legal Rights Service (LRS) is engaged in active mediation of G.D. v Colbert, a class action lawsuit LRS filed against the Ohio Department of Job and Family Services (ODJFS). The case seeks to require the state to comply with federal laws related to the Early Periodic Screening Diagnosis and Treatment (EPSDT) program. LRS is co-counseling with Advocates for Basic Legal Equality (ABLE) to prosecute the case. ABLE is a non-profit regional law firm that provides civil legal assistance to low-income clients in 32 counties in Western Ohio.
On January 7, 2011, Federal Judge Michael H. Watson of the U.S. District Court for the Southern District of Ohio, Eastern Division, issued an order approving a Consent Decree in partial settlement of G.D. v Riley, formerly G.D. v Lumpkin. The terms of the Consent Decree were effective immediately and will benefit thousands of children in Ohio and their families seeking Medicaid information and services.
Under the terms of the Consent Decree, the director of the Ohio Department of Job and Family Services (ODJFS) will:
- modify administrative rules regarding notification of EPSDT services and the development of informational materials;
- modify managed care agreements to clarify managed care organizations' obligations under EPSDT;
- distribute periodic notifications about EPSDT;
- update information on websites about EPSDT; and
- conduct training and education for state EPSDT staff.
The partial settlement did not include the medical necessity issues in the lawsuit. In the January 7, 2011 Consent Decree, the parties agreed that this remaining issue would be addressed through cross motions for summary judgment, which were filed on March 11, 2011.
On March 11, 2011, LRS and ABLE asked the court to rule in favor of the Plaintiffs, Medicaid-eligible children, through summary judgment and find that Ohio’s definition of “medically necessary services” conflicts with federal laws regarding coverage of EPSDT treatment services and results in the denial of treatment services to which these children would be entitled under federal law. LRS asked the court to require the Ohio Department of Job and Family Services, the state Medicaid agency, to remedy violations of federal EPSDT law.
On July 6, 2012, LRS filed a response opposing a motion by the State to dismiss the case or to grant summary judgment in the State's favor. LRS argued the State's motion lacked merit and the definition of "medically necessary services" conflicts with federal EPSDT requirements.
On July 31, 2012, LRS filed a motion to certify a class of children eligible for Medicaid in order to ensure that any court ordered relief in this case would benefit all potential class members, which could be over one million. LRS along with co-counsel from ABLE are asking the court to appoint them as counsel for the class.
On March 26, 2013, the U.S. District court dismissed four of the five Plaintiffs and ruled that the remaining case does not provide enough evidence to answer the main legal question, which was whether Ohio’s rule of medical necessity conflicts with federal standards for medical necessity in the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Medicaid program for children. However, the court found that a Medicaid administrative hearing was not the appropriate entity to make a broad legal judgment on a broad legal issue. Therefore, the Plaintiffs had the right to bring their case to federal court.
Read more about Early Periodic Screening Diagnosis and Treatment (EPSDT) Program
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