In Massachusetts there is a Medicaid case pending at the First Circuit Court of Appeals, Rosie D. vs Baker concerning services like intensive care coordination (ICC). According to state standards in Massachusetts, these services are supposed to start within 14 days for children. This service is essential and is tied to receiving other services, such as occupational therapy. Currently the state of Massachusetts is arguing that timely Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements are met after diagnostics and a promise of treatment.
But when you look at the introduction of the law by President Lyndon B. Johnson, he states “The problem is to discover, as early as possible, the ills that handicap our children. There must be continuing follow-up and treatment so that handicaps do not go untreated.” There is a clear intent that necessary treatment for a diagnosis should be prompt. Congress further improved EPSDT provisions by clarifying and strengthening the states obligation to following EPSDT adding that “a comprehensive child health program of prevention and treatment, to systematically . . . [a]ssess the child’s health needs through initial and periodic examinations and evaluation, and [a]ssure that health problems found are diagnosed and treated early, before they become more complex and their treatment more costly.”
If Massachusetts is successful in their argument, then it would be accepted that a state can elect to not provide timely services and treatments for children 21 and younger. In a case like this, children and their parents may know that they need to receive treatment but have to wait for the state, or its managed care agents, to give the services. The long-term effects would likely affect occupational therapy services for children across the disability spectrum in a variety of populations like schools and outpatient therapy clinics for children who receive Medicaid services. Even if you don’t practice occupational therapy in Massachusetts, a successful argument could lead to other states adopting similar policies, which in turn could limit the occupational therapy services you provide.
