From time to time, we like to invite guests to share their stories with us. Today’s guest blogger is Sylvie Derrien, an attorney with Statman Harris & Eyrich LLC, and Legal Contributor to Jasonsconnection.org.–Ed.
Access to health care is critical to a child’s healthy growth and development. If you have a child with a disability, access to adequate health care can be a challenge. For parents of children with severe mental illnesses and/or emotional or behavioral disorders, finding and navigating through the resources – informational, medical and/or financial, to help their children can be a daunting task. This can lead to children not being able to reach their full potential, being under treated, or being denied available resources altogether.
Under a federal program called “EPSDT,” Medicaid eligible children can receive a full range of health care benefits, including mental health and behavioral health benefits. EPSDT stands for Early Periodic Screening, Diagnosis, and Treatment. EPSDT can be a very powerful tool in assisting children under 21 with disabilities and their families to access some of the crucial services they need. However, despite this federal mandate, many states continue to fail to provide the required benefits resulting in significant harm to those young people, including exacerbation of their conditions, deterioration to the point of crisis, and unnecessary incarceration so that juvenile detention centers are becoming de facto mental health treatment programs for thousands of low income children.
Under EPSDT, federal Medicaid law requires each state must cover “necessary health care, diagnostic services, treatment and other measures…to correct or ameliorate defects and physical and mental illnesses and conditions” regardless of whether those services are covered under the state Medicaid plan for adults age 21 and over.
Also, under EPSDT, children with mental illnesses and/or emotional or behavioral disorders are entitled to receive home or community based mental health and behavioral services in the most integrated setting appropriate to their needs.
Therefore, if a health care or other related professional has diagnosed your Medicaid eligible child with a condition that requires that a recognized service, intervention, or course of treatment be provided in order to address or improve that condition, i.e., the services have been found to be “medically necessary,” he or she by law is entitled to whatever services their doctors have recommended for maximum improvement. This means that states cannot refuse to provide services based on whether or not they will “cure” a condition. This also means that states are not only required to pay for, but also provide, such services or ensure that they are provided.
THIS ARTICLE DOES NOT CONSTITUTE LEGAL ADVICE. IF YOU HAVE ANY QUESTIONS ABOUT LEGAL ISSUES CONTAINED IN THIS ARTICLE, YOU SHOULD SEEK THE ADVICE OF AN ATTORNEY.