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 and other state officials, 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 a lack of home-based services. The class they sought to represent 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 defendants 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 defendants’ appeal, holding that children had an enforceable right under the Medicaid Act to medically necessary treatment. 310 F.3d 230.

The district court issued an order compelling the defendants to produce requested documents for the plaintiffs on April 14, 2003. 256 F. Supp. 2d 115.

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. On January 26, 2006, the court issued a 98-page decision that found that Massachusetts had violated the EPSDT provisions of the federal Medicaid Act (requirements for “Early and Periodic Screening, Diagnostic, and Treatment” services) by failing to provide home-based services to thousands of children across the state. 410 F. Supp. 2d 18. The result of this failure was that thousands of Massachusetts children with serious emotional disturbance were forced to endure unnecessary confinement in residential facilities or to remain in costly institutions far longer than their medical conditions required.

As a result of the 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 plans to the court. On February 22, 2007, the court approved a modified version of the defendants’ plan. 474 F. Supp. 2d 238. 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’s strict timelines required full implementation by June 2009. The court also appointed a monitor to oversee the implementation, to mediate disputes between the parties, and to determine compliance with the court’s order.

On January 16, 2009, the defendants filed a motion to modify the judgment and to 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 November 29, 2011, the court partially granted the plaintiffs’ motion to insure timely access to remedial services. The court ordered the defendants 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 defendants must appear before it every 60 days to report on their compliance progress.

Over the next few years, both parties continued to submit status reports, and the court proceeded to extend the monitor’s role in six-month increments and endorsed the parties’ agreement regarding the monitor’s budget.

On February 7, 2019, the court denied the defendants’ motion to terminate monitoring. It noted that despite “persistent prodding from the court, Defendants are still grossly failing” to bring themselves into compliance with the remedial plan. Specifically, the defendants had failed to demonstrate they could provide “reasonably prompt” care to a substantial portion of the plaintiffs, which was defined as offering an initial appointment within fourteen days after initial contact. Citing this, and the defendants’ apparent lack of effort at compliance, the court retained its power to continue its supervision.

The defendants appealed this decision to the First Circuit on March 11, 2019. On March 13, the court denied the plaintiffs’ two outstanding motions, “in light of the general rule that…the filing of an appeal deprives a district court of the power to act substantively in a case until proceedings on appeal conclude.” The same day, the case was reassigned to Judge Richard G. Stearns.

On July 1, 2019, the district court granted the plaintiffs’ motion to extend the appointment of the court monitor, subject to the First Circuit’s ruling on appeal.

On May 4, 2020, the First Circuit reversed the judgment of the district court. It held that because the parties’ agreement had provided for the monitor’s appointment to conclude on December 31, 2018, the district court had improperly extended the monitor’s appointment. On remand, the plaintiffs should have the opportunity to show “good cause” to modify the agreement by extending the monitor’s appointment; the district court should analyze the question in light of Rufo v. Inmates of Suffolk County Jail. 958 F.3d 51

The First Circuit denied the plaintiffs’ motion for rehearing en banc (before the entire court, rather than the typical 3-judge panel) on June 17, 2020. As of August 2020, further proceedings are pending in the district court.

Kristen Sagar - 03/14/2009
Andrew Junker - 12/04/2014
Edward Cullen - 03/21/2019
Gregory Marsh - 08/10/2020


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