Landmark Settlement Agreement Reforms Michigan's Medicaid Behavioral Health System for Children and Young Adults

Strategic Insights -

Michigan's Medicaid behavioral health system for children and young adults under age 21 will undergo sweeping reforms following a federal court's approval of a landmark settlement agreement. The agreement, which resolves a class action lawsuit, requires the state to provide medically necessary mental health services to Medicaid-eligible children with intensive mental and behavioral health care needs. The reforms aim to ensure timely access to intensive home and community-based services, establish a standardized eligibility and assessment process, and track the adequacy of services and outcomes.

Key Takeaways:

  • The settlement agreement requires the Michigan Department of Health and Human Services (MDHHS) to make comprehensive systemic reforms, including ensuring statewide timely access to medically necessary intensive home and community-based services, establishing a standardized eligibility and assessment process, and improving data collection and oversight.
  • The agreement establishes a five-year target date for implementation of the systemic reforms, during which children with mental health disorders remain entitled to medically necessary mental health care.
  • The class action lawsuit, filed in 2018, alleged that Michigan violated the Medicaid Act's Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) mandate and other federal laws, including the Americans with Disabilities Act, Section 504 of the Rehabilitation Act, and Due Process guaranteed by the US Constitution.
  • The settlement agreement requires the state to demonstrate the capacity to provide medically necessary mental health services before exiting from monitoring and supervision by Class Counsel and the Court.
  • Co-counsel Gerard Mantese stated that the goal of the case was to help people struggling with obtaining medical care under the Medicaid system, and he is confident that the settlement will provide needed care to tens of thousands of families.

Statistics:

  • The settlement agreement affects children and young adults under age 21 with mental health disorders.
  • The class action lawsuit, filed in 2018, has resulted in a five-year-long process to reform Michigan's Medicaid behavioral health system.
  • The agreement has a five-year target date for implementation of the systemic reforms.
  • Tens of thousands of families are expected to benefit from the settlement.

Sources:

  • Mantese Honigman, P.C.
  • SOURCE Mantese Honigman, P.C.