Memisovski v. Maram

No. 92 C 1982 (N.D.Ill. filed June 27, 2005); Clearinghouse Number: 53827

Description

Parties Settle Class Action Challenging Illinois's Failure to Provide Timely EPSDT Services to Medicaid-Eligible Children in Cook County

Abstract

The parties settled this class action challenging defendant Illinois Department of Public Aid’s and Illinois Department of Human Services' failure to ensure that all eligible children in Cook County, Illinois, had access to pediatric care and services as available to the general population with private or other public health insurance. Plaintiffs alleged that defendants violated the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) provisions of the federal Medicaid Act, 42 U.S.C.§§ 1396 et seq., by failing to provide specified preventive, primary, and diagnostic pediatric services timely to Medicaid-eligible children in Cook County. The district court held that the rates paid by Illinois Medicaid were insufficient to entice medical entities to provide services to Medicaid patients. The court held that defendants failed to inform Medicaid-eligible children of the availability of EPSDT services and that defendants did not establish a Medicaid program for timely providing all EPSDT services to all Medicaid-enrolled children. Under the terms of the settlement provisionally approved by the district court, defendants will increase provider rates to ensure that more physicians and dentists are willing to participate in the EPSDT program. Additional incentives for physicians who achieve goals of providing regular, consistent well-child care will improve the overall quality of care that EPSDT-eligible children receive. Payments to Federally Qualified Health Centers will be increased. The adjustments are to encourage these centers to be proactive in providing children with the full slate of well-child services, including immunizations and well-child doctor visits. Recipients will continue to receive informational notices, with some enhancements for better communication. Defendants agreed to report progress quarterly on the settlement’s implementation to plaintiffs’ counsel. Illinois will fund a study on the Medicaid-eligible children’s access to specialty care.

Additional Information

Attorney Information
Plaintiffs represented by John Bouman, Sargent Shriver National Center on Poverty Law, 50 E. Washington St., Suite 500, Chicago IL 60602(312.263.3830 ext. 250); Stephanie F. Altman, Thomas Yates, Health and Disability Advocates, 205 W. Monroe St., 3d Floor, Chicago IL 60606 (312.223.9600); Frederick H. Cohen, Daniel P.Shapiro, Christine A. Miller, Hillary Levitt Dunn, Goldberg Kohn Bell Black Rosenbloom & Moritz Ltd., 55 E. Monroe St., Suite 3700, Chicago IL 60603 (312.201.4000).
Docket Date
2005-06-27 05:00:00+00:00
Attorney Email
johnbouman@povertylaw.org