On October 31, 2001, the Center for Public Representation, the Mental Health Legal Advisors Committee, and a private law firm filed a class action under 42 U.S.C. § 1396 against the governor of Massachusetts in the U.S. District Court for the District of Massachusetts. The lawsuit was filed on behalf of Rosie D. and eight other Medicaid-eligible children, aged 6 to 15, who were hospitalized or at risk of hospitalization due to the lack of home-based services, and the class included tens of thousands of children in Massachusetts who were eligible for Medicaid (MassHealth) and had emotional, behavioral, or psychiatric disabilities. The plaintiffs alleged that the state had failed to provide medically necessary services as required under the federal Medicaid Act and that it had failed to inform parents and children that they were entitled to these covered services.
On December 19, 2001, the defendants filed a motion to dismiss. On March 29, 2002, the district court (Judge Michael A. Ponsor) denied the motion to dismiss and certified the case as a class action. The defendants appealed the denial of their motion to dismiss. On November 7, 2002, the U.S. Court of Appeals for the First Circuit rejected the State's appeal, holding that children had an enforceable right under the Medicaid Act to medically necessary treatment. Rosie D. v. Swift, 310 F.3d 230 (1st Cir. 2002).
On December 16, 2004, the defendants filed a motion for summary judgment. On March 25, 2005, the district court denied the motion for summary judgment, and the case headed for trial.
The case went through a six-week trial in the spring of 2005 before Judge Ponsor in the U.S. District Court for the District of Massachusetts. On January 26, 2006, Judge Ponsor handed down a 98-page decision that found that the Commonwealth violated the EPSDT provisions of the federal Medicaid Act by failing to provide home-based services to thousands of children across the state. The result of this failure is that thousands of Massachusetts children with serious emotional disturbance are forced to endure unnecessary confinement in residential facilities or to remain in costly institutions far longer than their medical conditions require.
As a result of the court judgment, the parties entered into negotiations to create a remedial plan. After six months of negotiations that failed to produce agreement, both sides presented separate remedial plans to the court. On February 22, 2007, Judge Ponsor approved a modified version of the defendants' Remedial Plan. The court's adopted plan sought to restructure the children's mental health system by incorporating intensive home-based services, including behavioral health screenings, assessments, case management, crisis intervention, and in-home therapeutic supports. The Plan, which had strict timelines, must be fully implemented by June 2009. The court also appointed a monitor to oversee the implementation, mediate disputes between the parties, and determine compliance with the Court's Order.
On January 16, 2009, the defendants filed a motion to modify the judgment and give them until July 1, 2010 to implement the plan. On February 27, 2009, the district court granted some extra time to the defendants, allowing them until December 1, 2009, to fully implement the remedial plan.
Both parties submitted periodical implementation reports on the remedial plan. On Nov. 29, 2011, Judge Ponsor partially granted the plaintiffs' motion to insure timely access to remedial services. The judge ordered the state to propose a new plan for standards governing enrollment in Intensive Care Coordination, and a new timetable for implementation of these standards. The Court also ordered that the state must appear before it every 60 days to report on its compliance progress.
Over the next few years, both parties continued to submit status reports, and Judge Ponsor proceeded to extend the monitor's role in six-month increments and endorsed the parties' agreement regarding the monitor's budget.
On December 22, 2014, Judge Ponsor approved a proposed order for attorneys' fees covering the period from July 1, 2013, through June 30, 2014, in the amount of $200,131.05. On December 21, 2016, a further $348,599.14 was approved for fees for the period between July 1, 2014, and June 30, 2016. On December 28, 2018, a further $340,553.01 in fees was approved for the period of July 1, 2016, through June 30, 2018.
On February 7, 2019, Judge Ponsor denied Defendants' Motion Regarding Substantial Compliance and to Terminate Monitoring and Court Supervision. He noted that, despite "persistent prodding from the court, Defendants are still grossly failing" to bring themselves in compliance with the remedial plan. Specifically, Defendants failed to demonstrate they could provide "reasonably prompt" care to a substantial portion of the plaintiffs, which is defined as offering an initial appointment fourteen days after initial contact. Citing this, and lack of effort at compliance, Judge Ponsor retained the court's power to continue its supervision.
On March 13, 2019, Judge Ponsor transferred the case to District Court Judge Richard G. Stearns.
Kristen Sagar - 03/14/2009
Andrew Junker - 12/04/2014
Edward Cullen - 03/21/2019
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