LINCOLN — A lawsuit filed Friday claims that Nebraska Medicaid illegally denies coverage for children with severe behavioral and mental health problems.
The suit was filed on behalf of two young boys, identified only by their initials, S.L. and K.D.
It challenges a state policy that bars coverage of certain types of treatment, and it asks the court to order coverage.
The Nebraska Appleseed Center for Law in the Public Interest and the National Health Law Program filed the case in Lancaster County District Court.
Kerry Winterer, CEO of the Nebraska Department of Health and Human Services, and Vivianne Chaumont, Nebraska's Medicaid director, were named as defendants.
“When HHS denies necessary services to these children, their problems often worsen over time, an effect that has far-reaching consequences for them, their families and the community,” said Jane Perkins, legal director at the health law program.
Becky Gould, Appleseed's executive director, said the policies force families to make heartbreaking choices. In some cases, families wind up giving up their children to the state to get the services needed.
“Every Nebraska child should have the support they need to grow up to be healthy and productive,” she said.
Kathie Osterman, an HHS spokeswoman, said officials had not yet seen the petition and couldn't comment.
According to the petition, S.L. is a 3-year-old who lives with his parents and siblings in Sarpy County. He runs away, eats objects such as sponges and toys, slaps and bites himself, hits others, destroys property and licks electrical sockets.
Three different psychologists recommended outpatient treatment to address his aggression and other behaviors.
Each time, Nebraska Medicaid refused to authorize coverage. His parents were instead offered five sessions intended to help people deal with stress.
The other boy, K.D., is 4 years old and lives with his mother and two siblings in Lancaster County. His behavior includes screaming, twirling, throwing tantrums, pinching, biting and banging his head.
A psychologist diagnosed him with autism, among other conditions, and recommended applied behavioral analysis, a treatment aimed at reducing the effects of autism. Medicaid denied the request.
According to the suit, Medicaid issued the denials because the treatment recommended for both boys was considered behavioral management, which is not covered under state Medicaid regulations.
It also denied care because the boys' symptoms are related to autism and developmental disabilities, which also are not covered under state regulations.
The suit claims that the denials violate federal Medicaid laws requiring that children be provided with care needed to correct or reduce mental health problems.
It also claims the denials violate laws barring discrimination against the disabled.
Parents and providers packed a public hearing concerning the Medicaid policies last fall.
Many raised concerns that the policies bar coverage of effective behavioral treatments and coverage for children with autism and other developmental disabilities.
At the time, Chaumont, the state Medicaid director, said Medicaid pays for mental health treatment but not behavioral modification. Children with autism and developmental disabilities can get mental health treatment but not treatment for the autism itself, she said.
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