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Case Name Z.M. v. Baker PB-SC-0007
Docket / Court 3:18-cv-01370 ( D.S.C. )
State/Territory South Carolina
Case Type(s) Public Benefits / Government Services
Case Summary
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 ... read more >
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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Issues and Causes of Action
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Issues
Benefit Source
Medicaid
Defendant-type
Hospital/Health Department
Law-enforcement
Disability
Mental impairment
General
Government Services (specify)
Public benefits (includes, e.g., in-state tuition, govt. jobs)
Plaintiff Type
Private Plaintiff
Causes of Action 42 U.S.C. § 1983
Medicaid, 42 U.S.C §1396 (Title XIX of the Social Security Act)
Defendant(s) Director
Plaintiff Description South Carolina residents a) receiving health benefits insured by Medicaid; b) professionally diagnosed with ASD; c) prescribed or recommended applied behavioral analysis treatment as being medically necessary by a physician ; d) recipient of an Authorization Letter by South Carolina Department of Health and Human Services for analysis therapy; and e) not currently receiving analysis therapy after attempting to apply for such services.
Class action status sought Yes
Class action status granted Pending
Filed Pro Se No
Prevailing Party None Yet / None
Public Int. Lawyer No
Nature of Relief None yet
Source of Relief None yet
Filed 05/18/2018
Case Ongoing Yes
Additional Resources
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  See this case at CourtListener.com (May provide additional documents and, for active cases, real-time alerts)
Court Docket(s)
D.S.C.
09/01/2020
3:18-cv-01370
PB-SC-0007-9000.pdf | Detail
Source: PACER [Public Access to Court Electronic Records]
General Documents
D.S.C.
05/18/2018
Complaint for Declaratory and Injunctive Relief [ECF# 1]
PB-SC-0007-0001.pdf | Detail
Source: PACER [Public Access to Court Electronic Records]
D.S.C.
07/24/2018
Amended Complaint for Declaratory and Injunctive Relief [ECF# 14]
PB-SC-0007-0002.pdf | Detail
Source: PACER [Public Access to Court Electronic Records]
show all people docs
Judges Childs, Julianna Michelle (D.S.C.) show/hide docs
PB-SC-0007-9000
Plaintiff's Lawyers Jackson, J. Derrick (South Carolina) show/hide docs
PB-SC-0007-0001 | PB-SC-0007-0002 | PB-SC-0007-9000
Ward, Tobias Gavin Jr, (South Carolina) show/hide docs
PB-SC-0007-0001 | PB-SC-0007-0002 | PB-SC-0007-9000
Defendant's Lawyers Wlodarczyk, Damon C. (South Carolina) show/hide docs
PB-SC-0007-9000

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