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S.B., By and Through Her Father, W.B v. Julie Hamos

May 25, 2012

S.B., BY AND THROUGH HER FATHER, W.B.,
PLAINTIFF,
v.
JULIE HAMOS, IN HER OFFICIAL CAPACITY AS DIRECTOR OF THE ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES, DEFENDANT.



The opinion of the court was delivered by: Sue E. Myerscough, U.S. District Judge:

E-FILED Friday, 25 May, 2012 04:36:50 PM Clerk, U.S. District Court, ILCD

OPINION

This matter comes before the Court on Plaintiff's Verified Motion for Temporary Restraining Order (d/e 11) ("Motion"). For the reasons that follow, the Motion is GRANTED.

I. BACKGROUND On March 8, 2012, Plaintiff filed a four-count Complaint (d/e 1) against Defendant, Julie Hamos, in her official capacity as Director of the Illinois Department of Healthcare and Family Services. In Count I of the Complaint, Plaintiff alleges, pursuant to 42 U.S.C. § 1983, that Defendant is violating the federal Medicaid Act, 42 U.S.C. § 1396 et seq., because Defendant has failed and continues to fail to provide Plaintiff with medically necessary services that Defendant is mandated to provide under the Early and Periodic Screening, Diagnostic, and Treatment Services ("EPSDT") program of the Medicaid Act. Plaintiff also alleges, pursuant to § 1983, that Defendant is in violation of the Americans with Disabilities Act ("ADA") (Count II) and the Rehabilitation Act (Counts III and IV). Plaintiff seeks declaratory and injunctive relief in Counts I, II, and III and seeks damages in Count IV.

According to the Complaint, Plaintiff, S.B., is a Medicaid-eligible, 16-year-old girl who suffers from the following conditions: ADHD (Combined Type), Post-Traumatic Stress Disorder, Oppositional Defiant Disorder, Depressive Disorder, Sexual Abuse Victim, Sexual Abuse Perpetrator, and Mild Mental Retardation.

On April 30, 2011, Plaintiff was admitted to Lincoln Prairie Behavioral Health Center ("Lincoln Prairie") in Springfield, Illinois.

After her discharge from Lincoln Prairie, Plaintiff was directly admitted to Riverside Academy ("Riverside") in Wichita, Kansas, a psychiatric residential treatment facility. Blue Cross/ Blue Shield ("Blue Cross"), Plaintiff's private health insurance carrier, paid for her treatment at Riverside through April 2012. While at Riverside, Plaintiff attended school and participated in recreational activities.

Effective April 2012,*fn1 Blue Cross denied authorization for Plaintiff's continued treatment at Riverside. Plaintiff alleges that Blue Cross also denied authorization for treatment in a step-down residential treatment facility because Blue Cross alleged that such treatment is not a covered benefit.

Plaintiff alleges that, in a report dated February 27, 2012, Plaintiff's therapist at Riverside advised that Plaintiff should be placed in a "step-down facility closer to [the] primary care givers upon successful discharge from Riverside Academy." Pl.'s Mem. Ex. E. The Complaint also states that Mary Dobbins, M.D., recommended that Plaintiff receive residential treatment.*fn2

Plaintiff alleges that, although Defendant was made aware of Plaintiff's need to be placed in a step-down residential treatment facility on February 28, 2012, Defendant has not attempted to make arrangements or provide funding for Plaintiff to be placed in such a facility.

Plaintiff also alleges that she is currently unable to safely reside in her family's home. Plaintiff states that she is at risk for further hospitalization or "institutionalization" if she does not receive treatment in a step-down residential treatment facility closer to her family. Plaintiff states that, when in the hospital, she is unable to attend school or leave the hospital. Plaintiff also alleges that the cost of treatment at a step-down residential treatment facility is approximately one-third the cost of treatment as a psychiatric hospital.

Plaintiff asserts that she needs to be placed in a step-down residential treatment facility "for the maximum reduction of her mental disability and for the restoration of her to the best possible functional level." Pl.'s Mot. 2; Compl. ¶ 88. Plaintiff states that "[u]nless [she] receives the necessary intensive residential services, she will likely be at risk for many future hospitalizations." Compl. ¶ 89. Plaintiff also states that she requires residential treatment "to correct or ameliorate" her mental and behavioral conditions.

On May 22, 2012, Plaintiff filed the Motion for Temporary Restraining Order. Plaintiff seeks a temporary restraining order ("TRO") requiring Defendant to provide Plaintiff with Medicaid coverage for placement in a residential treatment facility found to be medically necessary, as required under the EPSDT provisions of the Medicaid Act. On the same day, Plaintiff filed a separate Motion for Preliminary Injunction (d/e 9), which the Court will consider at a later time.

On May 24, 2012, the Court held a hearing on the Motion for TRO. Counsel for Plaintiff and Defendant appeared in person. Plaintiff's father also appeared in person. The Court heard argument on the Motion. Plaintiff's counsel explained that Plaintiff is currently in Riverside but is scheduled to be discharged on May 25, 2012. At the conclusion of arguments, ...


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