This is a case about whether South Carolina is required to provide proper therapy to children with Autism Spectrum Disorder (ASD) on Medicaid. On May 18, 2018, a child diagnosed with ASD and prescribed applied behavioral analytics treatment filed this putative class-action lawsuit in the United States District Court for the District of South Carolina. The plaintiff sued the Director of the South Carolina Department of Health and Human Services under 42 U.S.C. § 1983. Represented by private counsel, the plaintiff sought to enjoin South Carolina to provide him with necessary treatment. The plaintiff alleged that the agency that administers South Carolina’s Medicaid program violated his rights under Title XIX of the Social Security Act and several sections of the Medicaid Act, which provide that state Medicaid plans must provide “early and periodic screen, diagnostic, and treatment services” for eligible individuals with reasonable promptness. The case was assigned to Judge J. Michelle Child.

Approximately two and a half years before the filing of this lawsuit, the plaintiff was diagnosed with ASD and prescribed applied behavioral analysis treatment by a licensed physician. Applied behavioral analysis treatment is a widely accepted treatment for ASD, however, it requires regular and lengthy sessions with trained providers. After that treatment was authorized on November 10, 2015 by the South Carolina Department of Health and Human Services, the plaintiff was placed on a waiting list to receive applied behavioral analysis treatment, where he continued to remain almost three years later. The plaintiff’s mother had no way of affording this treatment other than through Medicaid. The plaintiff also alleged that over 1,000 other South Carolina children with ASD who received healthcare through Medicaid faced long waits for treatment. In his complaint, the plaintiff alleged that this was due to South Carolina’s low payments for the services in question under Medicaid, which led to a dearth of providers willing to accept patients like the plaintiff.

The defendant moved the court to dismiss the case on July 3, 2018. On July 24, 2018, the plaintiff filed an amended complaint, omitting the allegations that South Carolina’s Medicaid rates for the services in question were inadequate, but requesting the same relief. Since that point, the case has moved slowly with deadlines relating to amendments to pleadings, expert witnesses, and mediation being repeatedly adjourned. As of writing this summary, the case is still pending and Judge Childs has issued no substantive opinions or orders.

Jonah Hudson-Erdman - 09/15/2020


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