On May 27, 1998 a group of seven children with intensive mental health needs who were eligible for Medi-Cal benefits filed suit against the California Department of Health Services in the Federal District Court for the Central District of California alleging violations of the Medicaid Act. They contended they were entitled under federal law to mental health benefits that were being denied to them, specifically Therapeutic Behavioral Services (TBS). They sought injunctive relief requiring that the defendant cover TBS.

On February 24, 1999 the district court (Judge William D. Keller) issued a preliminary injunction requiring that the defendant acknowledge that the Medi-Cal program covered TBS, implement procedures whereby plaintiffs could request TBS, and inform members of the putative class that they could request TBS. On May 4, 1999 the district court (Judge Keller) certified a state-wide class consisting of all current and future beneficiaries of the Medi-Cal Medicaid program under the age of 21 who were placed in a locked facility or a particular type of group home for the treatment of mental health needs, were being considered for such placement, or had undergone one or more psychiatric hospitalizations related the their disability in the previous two years.

On July 23, 1999 the defendant stipulated to judgment for the plaintiffs on all claims. Thereafter the dispute concerned the appropriate remedy as the parties were unable to reach an agreement as to several specific issues related to how TBS could be requested, how notification of the availability of TBS would work, how precisely assessments were to be conducted, the qualifications of assessors, and monitoring. On March 30, 2001 the district court (Judge Howard A. Matz) entered a permanent injunction resolving these issues, largely in favor of the plaintiffs.

The court continued to exercise jurisdiction over compliance with the terms of the injunction. On April 22, 2004 the court (Judge Matz) modified the permanent injunction to include additional remedial measures based on the finding that the defendant had not made TBS available to patients at an acceptable rate. On July 29, 2004 a plan to increase the usage of TBS was approved. These measures also included increased monitoring, and on December 29, 2004 a special master was appointed.

On February 28, 2006 the defendant moved for relief from all injunctions but the court (Judge Matz) denied this motion. The defendant appealed, but on October 2, 2006 the Ninth Circuit (Judges Konzinski, O'Scannlain, and Bybee) affirmed the district court. As of November 2010, the case remained open. The Special Master had filed a Seventh Report and a status conference was scheduled.

Michael Perry - 01/10/2011


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