On March 25, 2010, this class-action lawsuit was filed in the United States District Court for the Southern District of Indiana against the Secretary of the Indiana Family and Social Services Administration (FSSA) and the Director of the Office of Medicaid Policy and Planning of FSSA. The named plaintiffs were minor Medicaid recipients with serious disabilities who had been receiving medically-necessary therapies, paid for by the State's Medicaid program and administered by the FSAA. The FSSA had denied the named plaintiffs and others similarly situated individuals continued access to these therapies. It cited two provisions of the Indiana Administrative Code, one of which limited the provisions of these therapies to two years unless patients demonstrated significant progress to a "higher functional state," and the other which generally prohibited all "maintenance therapies," i.e. therapies designed to prevent deterioration rather than improve a patient's condition. The plaintiffs filed suit pursuant to 42 U.S.C. § 1983 and argued that the FSSA's refusal to provide the therapies unlawfully violated Title XIX of the Social Security Act, 42 U.S.C. § 1396, et seq. (the "Medicaid Act" or the "Act"), which require states that participate in Medicaid to provide early screening, physical therapy and related services, and preventative services, respectively.
The plaintiffs sought preliminary and permanent injunctive relief to enjoin the defendants from refusing or limiting Medicaid coverage for therapies recommended or prescribed by a Medicaid recipient's physician, and preventing the enforcement of both of the contested provisions of the Indiana Administrative Code. The plaintiffs also sought legal costs and attorneys' fees.
On September 20, 2010, the parties filed a joint stipulation, wherein the defendants agreed to provide the named plaintiffs with funding for their therapies while the case awaited its final outcome. This was in lieu of a preliminary injunction.
On October 1, 2010, the plaintiffs, upon order from the court, filed a document clarifying their claim that the FSSA had violated federal Medicaid law. The following day the plaintiffs filed an amended complaint integrating these changes.
On November 22, 2010, the Judge Jane Magnus-Stinson certified the plaintiff class. The class was defined as: "Any and all persons in Indiana who are or will be enrolled in the Medicaid program and who are or will be under the age of twenty-one (21) who have been or will be denied coverage for physical therapy, occupational therapy, respiratory therapy, and/or speech pathology (“therapies”), or who have had or will have coverage for these therapies otherwise limited, which denial or limitation is based upon 405 IAC 5-22-6(b)(6) and/or 405 IAC 5-22-6(b)(7), notwithstanding the fact that a physician acting within the scope of his or her practice under Indiana law has or will recommend and/or prescribe these therapies for the Medicaid recipient." A.M.T. v. Gargano, 2010 WL 4860119 (S.D. Ind. 2010).
On February 10, 2011, the Court granted summary judgment in favor of the plaintiffs, issuing a permanent injunction preventing the defendants and their successors from limiting or denying coverage for prescribed physical, occupational, or respiratory therapy, and/or speech pathology, for any person under 21 enrolled in the State's Medicaid program when such denial or limitation was based upon the two disputed provisions of the Indiana Administrative Code (405 I.A.C. 5-22-6(b)(6) and (b)(7).) The Court denied the plaintiffs' request for attorneys' fees and costs. A.M.T. v. Gargano, 781 F. Supp. 2d 798 (S.D. Ind. 2011)
On February 23, 2011, the plaintiffs filed a motion to amend the final judgment and for attorneys' fees and costs. On June 9, 2011, they withdrew this motion, "the parties having resolved the matters without the necessity of Court intervention." The docket reflects no further litigation activity after June 10, 2011, and the case is now closed.
Alex Colbert-Taylor - 08/07/2013
Eva Richardson - 06/08/2020
compress summary
