BANGOR – A class action lawsuit filed this week in U.S. District Court charges Maine’s top human services official with failing to follow federal Medicaid regulations in meeting the educational needs of the state’s disabled youngsters.
The suit, brought by an Oxford County mother on behalf of her young son and other children with behavioral, emotional or physical disabilities, was filed Tuesday by the nonprofit legal services organization Maine Equal Justice Partners, based in Augusta. Defendants are the state Department of Health and Human Services and its commissioner, Brenda Harvey.
The court document describes the primary plaintiff, “T.S.,” as a 21/2-year-old with autism and “multiple severe physical disabilities.” Other plaintiffs include Maine children from birth through age 5 who are eligible for Medicaid-paid “early intervention” services delivered through a special program of the state Department of Education.
According to the court filing, the Oxford County family requested early intervention services recommended by their child’s doctor in November 2007. The request was denied – not by the state’s Medicaid program, MaineCare, but by the quasi-public organization Child Development Services. CDS contracts to provide Medicaid-paid services to eligible Maine preschoolers with special needs through the Department of Education.
As an arm of the Education Department, CDS is not required to follow federal Medicaid eligibility guidelines or other Medicaid regulations, attorney Jack Comart of Maine Equal Justice Partners said Wednesday. Because its focus is on maximizing children’s educational potential rather than on broader health-related issues, he said, children who might be eligible for services under MaineCare are sometimes denied through CDS, which receives the bulk of its funding through the federal Department of Education.
As a contracted provider of Medicaid-paid services, Comart said, CDS should be held to the same standards as MaineCare. And as the federal Medicaid program’s administrative home in Maine, he added, DHHS and Commissioner Harvey should ensure that Maine children and their families have full access to MaineCare services available through the educational program.
“We want there to be an integrated system of services that MaineCare is paying for, so families don’t go from one agency to another, waiting for someone to take responsibility,” said Sarah Gagne-Holmes, executive director of Maine Equal Justice Partners. She stressed that her organization has made recent progress with DHHS on the Oxford County case and that she hopes the matter can be settled without going to court.
Harvey and DHHS are represented in the dispute by the Maine Office of the Attorney General. Assistant Attorney General David Loughran said Wednesday that the office does not discuss ongoing cases and declined to comment.
CDS state director Debra Hannigan said she was unaware of the lawsuit and could not comment on the proposed alignment between Medicaid eligibility and CDS eligibility guidelines. But she confirmed that the mission of her organization is determined by its funding for educational services. MaineCare, she said, is simply one of many public and private health insurers that pays for the services CDS delivers.
A court date has not been set.