Court Rules in Favor of State in Case Involving EPSDT
January 10, 2007
Court Rules in Favor of State in Case Involving EPSDT
The United States Court of Appeals for the Tenth Circuit ruled against the Oklahoma Chapter of the American Academy of Pediatrics (OKAAP) and 13 Medicaid-eligible children January 3, in a case that questioned whether the children are receiving the necessary health care services required by Medicaid, including Early and Periodic Screening, Diagnosis and Treatment (EPSDT). In their lawsuit, the OKAAP and a community organization had joined the parents in alleging that the Oklahoma Health Care Authority fails to provide Medicaid services, including EPSDT, with "reasonable promptness" and fails to set reimbursement rates for providers sufficient to assure Medicaid recipients of equal access to quality health care. A lower court had ruled that Oklahoma should conduct a study to determine an appropriate schedule of fees for services under Medicaid, to assure "reasonably prompt access to health care for the minor children," and should immediately adopt and implement new periodicity schedules for EPSDT. In reversing that decision, the appeals court said federal law does not oblige states to deliver any medical services and only requires them to pay promptly for the services that are provided. The appeals court then sent the case back to the lower district court with instructions to find in favor of the state. The ruling is online at http://www.kscourts.org/CA10.