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J.E. v. Wong

United States District Court, D. Hawaii

August 12, 2016

J.E., through his parent SUZANNE EGAN, for themselves and on behalf of a class of those similarly situated; and the HAWAII DISABILITY RIGHTS CENTER, in a representative capacity on behalf of its clients and all others similarly situated, Plaintiffs,
v.
RACHAEL WONG, in her official capacity as Director of the State of Hawaii, Department of Human Services, Defendant.

          ORDER GRANTING, IN PART, AND DENYING, IN PART, PLAINTIFFS’ MOTION FOR SUMMARY JUDGMENT (ECF NO. 100) AND GRANTING, IN PART, AND DENYING, IN PART, DEFENDANT’S MOTION FOR SUMMARY JUDGMENT (ECF NO. 98)

          HELEN GILLMOR UNITED STATES DISTRICT JUDGE J.

         Plaintiffs J.E., through his parent, Suzanne Egan, and the Hawaii Disability Rights Center filed a Complaint alleging that the State of Hawaii, Department of Human Services, violated provisions of the Medicaid Act, 42 U.S.C. § 1396 et seq.

         Plaintiffs claim that the Department of Human Services has been precluding the state Medicaid program from covering Applied Behavior Analysis (“ABA”) as a treatment for autistic children and young adults, in violation of the Medicaid Act’s early and periodic screening, diagnostic, and treatment (“EPSDT”) services mandate. Plaintiffs also allege that the Department has failed to inform eligible persons that ABA is an available early and periodic screening, diagnostic, and treatment service.

         THE PARTIES FILED CROSS MOTIONS FOR SUMMARY JUDGMENT.

         Plaintiffs seek a declaratory ruling stating that:

(1) the State of Hawaii, through the Department of Human Services, violated the Medicaid Act by failing to cover ABA treatment pursuant to the EPSDT services mandate;

         Plaintiffs also seek an injunction:

(2) ordering the Department to include ABA as a covered treatment under the state Medicaid program for persons eligible for EPSDT services;
(3) compelling the Department to publicize the Medicaid program’s coverage of ABA treatment; and
(4) instructing the Department to submit a State Plan Amendment memorializing a policy that adds ABA treatment as a covered EPSDT benefit.

         Defendant seeks dismissal of Plaintiffs’ action as moot and declaratory judgment in its favor as to the following:

(1) the Department has always covered medically necessary autism treatment under Medicaid law;
(2) the Department does not have an obligation pursuant to the Medicaid Act to inform persons eligible for EPSDT services about ABA treatment; and
(3) the Defendant is not required to submit a State Plan Amendment to the Centers for Medicare and Medicaid Services that specifically memorializes coverage for ABA treatment.

         Plaintiffs’ Motion for Summary Judgment (ECF No. 100) and Defendant’s Motion for Summary Judgment (ECF No. 98) are each GRANTED, IN PART, AND DENIED, IN PART.

         PROCEDURAL HISTORY

         On September 5, 2014, Plaintiffs J.E. and the Hawaii Disability Rights Center (collectively, “Plaintiffs”) filed a Complaint. (ECF No. 1).

         On December 1, 2014, Plaintiffs filed their First Amended Complaint. (ECF No. 8).

         On June 19, 2015, the Magistrate Judge approved a stipulation by the parties for Plaintiffs to file a Second Amended Complaint. (ECF No. 42).

         On June 22, 2015, Plaintiffs filed a Second Amended Complaint. (ECF No. 44).

         On July 6, 2015, Defendant Rachael Wong, Director of the State of Hawaii, Department of Human Services (“Defendant”) filed a Motion to Dismiss Plaintiffs’ Second Amended Complaint. (ECF No. 46).

         On August 27, 2015, the Court denied Defendant’s Motion to Dismiss. (ECF No. 62).

         On December 10, 2015, Plaintiffs filed a Motion for Class Certification. (ECF No. 78).

         On February 10, 2016, Plaintiffs filed PLAINTIFFS’ MOTION FOR SUMMARY JUDGMENT and PLAINTIFF’S CONCISE STATEMENT OF FACTS IN SUPPORT OF PLAINTIFFS’ MOTION FOR SUMMARY JUDGMENT. (ECF Nos. 100; 101).

         On February 10, 2016, Defendant filed DEFENDANT RACHAEL WONG, IN HER OFFICIAL CAPACITY AS DIRECTOR OF THE STATE OF HAWAII, DEPARTMENT OF HUMAN SERVICE’S MOTION FOR SUMMARY JUDGMENT and SEPARATE AND CONCISE STATEMENT OF FACTS IN SUPPORT OF DEFENDANT’S MOTION FOR SUMMARY JUDGMENT. (ECF Nos. 98; 99). On the same date, Defendant also filed a Motion to Seal Exhibits 4, 7, 8, and 9. (ECF No. 97).

         On February 19, 2016, Plaintiffs filed PLAINTIFFS’ AMENDED CONCISE STATEMENT OF FACTS. (ECF No. 104). On the same date, Defendant filed DEFENDANT RACHAEL WONG, IN HER OFFICIAL CAPACITY AS DIRECTOR OF THE STATE OF HAWAII, DEPARTMENT OF HUMAN SERVICE’S FIRST AMENDED SEPARATE AND CONCISE ...


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