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P.G. v. Hamos

United States District Court, Seventh Circuit

January 24, 2014

P.G., by and through his mother, K.G.; A.K., by and through his mother, S.K.; M.L., by and through his mother,
v.
JULIE HAMOS, in her official capacity as Director of the Illinois Department of Healthcare and Family Services; MICHELLE R.B. SADDLER, in her official capacity as Secretary of the Department of Human Services; and THE ILLINOIS MENTAL HEALTH COLLABORATIVE FOR ACCESS AND CHOICE, Defendants.

OPINION

SUE E. MYERSCOUGH, District Judge.

This cause is before the Court on the Motion to Dismiss filed by Defendant The Illinois Mental Health Collaborative For Access and Choice (the Collaborative) (d/e 41). The Motion is GRANTED IN PART and DENIED IN PART. Plaintiffs A.K., by and through his mother, S.K; M.L., by and through his mother, V.L.; T.K., by and through her mother, L.S.; T.W., by and through her mother, M.R.; A.F., by and through her parents S.F. and M.F.; B.A., by and through her legal guardian, J.A.; and Sa.F., by and through her mother J.F., concede that they have failed to state a claim against the Collaborative. Therefore, those claims are dismissed. However, Plaintiff P.G., by and through his mother K.G., and Plaintiff C.S. have sufficiently demonstrated, at this stage of the litigation, standing to bring their claims against the Collaborative. The motion to dismiss the claims brought by P.G. and C.S. is denied.

I. FACTS ALLEGED IN THE COMPLAINT

Because Plaintiffs have conceded that Plaintiffs A.K., M.L., T.K., T.W., A.F., B.A., and Sa.F. failed to state a claim against the Collaborative, the Court will only recite the factual allegations relating to P.G. and C.S.'s claims against the Collaborative.

Plaintiffs P.G. and C.S. are Medicaid-eligible children (under age 21) with mental health disorders who allege they are not being provided with the treatment required by federal law. Plaintiffs filed suit against Julie Hamos in her official capacity as Director of the Illinois Department of Healthcare and Family Services; Michelle R.B. Saddler in her official capacity as Secretary of the Illinois Department of Human Services; and the Collaborative.

The Illinois Department of Human Services administers the Individual Care Grant Program, which is partially funded through Medicaid. Second Am. Compl. ¶ 87. The Individual Care Grant Program provides funding to parents of severely mentally ill children for approved clinical programs at residential placements or at community mental health agencies. Id . ¶ 86.

The Collaborative is an administrative services organization that oversees services and resources allocated to the Department of Human Services. Second Am. Compl. ¶ 64. Specifically, the Collaborative provides "outsourced administrative functions" to the Department of Human Services for the Division of Mental Health's Individual Care Grant Program. Second Am. Compl. ¶¶ 88-89.

On April 1, 2009, the Collaborative assumed responsibility for the community-based Individual Care Grant Program. Second Am. Compl. ¶ ¶ 94; see also ¶ 92 (as of April 1, 2009, residential and community-based services were processed through the Collaborative's billing system). However, beginning in fiscal year 2012, Individual Care Grant providers submitted all claims to the Department of Healthcare and Family Services for processing. Id . ¶ 95. Only Plaintiffs P.G. and C.S. have been accepted into the Individual Care Grant Program. Id . ¶¶ 112, 199.

Plaintiff P.G. is a Medicaid-eligible, 16 year-old boy who suffers from the following conditions: Psychotic Disorder, Not Otherwise Specified; Reactive Attachment Disorder, Inhibitive Type; and Oppositional Defiant Disorder. Second Am. Compl., ¶ 106. In July 2011, P.G. was accepted into the Individual Care Grant Program. Id . ¶ 112.

In August 2011, P.G. was admitted to Kemmerer Village, a community residential treatment facility in Assumption, Illinois. Id . ¶ 113. P.G.'s placement was funded by the Individual Care Grant Program. Id . ¶ 114. In January 2013, the Collaborative refused to authorize funding for P.G.'s placement at Kemmerer Village beyond January 31, 2013. Id . ¶ 115. On January 25, 2013, Jonna Tyler, a licensed clinical professional counselor, recommended that P.G. continue receiving residential treatment. Id . ¶ 117.

Plaintiff C.S. is a 19-year-old male diagnosed with Attention Deficit Hyperactivity Disorder, Combined Type; Bipolar Disorder, most recently with a Manic Episode with psychotic feature; and a history of Mild Mental Retardation. Id . ¶ 197. C.S. was accepted into the Individual Care Grant Program. Id . ¶ 199. In August 2012, the services C.S. received through the Individual Care Grant Program were abruptly terminated. Id . ¶ 200. C.S. attempted to appeal the termination of his Individual Care Grant services but he never received a response to his appeal. Id . ¶ 201. On March 15, 2013, Andrew Kim, M.D., recommended that C.S. receive residential treatment. Id . ¶ 202.

Counts I, V, and VI of the Second Amended Complaint are directed at the Collaborative. Count I alleges pursuant to 42 U.S.C. § 1983 that Defendants are violating the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) provisions of the Medicaid Act, 42 U.S.C. § 1396 et seq. Specifically, Plaintiffs allege that Defendants have failed to provide Plaintiffs with medically necessary services, including intensive home and community-based services, community residential services, and/or residential mental health services that Defendants are mandated to provide under the EPSDT provisions of the Medicaid Act.

In Count V, Plaintiffs P.G. and C.S. bring a claim titled "Administrative Review-Improper Promulgation of Rule" against Defendants Saddler and the Collaborative. Plaintiff P.G. alleges that the Collaborative's decision to deny P.G. funding for his placement at Kemmerer Village is a final administrative decision affecting P.G.'s rights. Second Am. Compl. ¶ 258. Similarly, Plaintiff C.S. alleges that the Collaborative's decision to abruptly terminate C.S.'s Individual Care Grant program benefits is a final decision affecting C.S.'s rights. Id . ¶ 259.

Plaintiffs P.G. and C.S. further allege, on information and belief, that the Collaborative used criteria other than those specified in 59 Ill. Admin. Code § 135.20 in deciding to deny Plaintiffs P.G. and C.S. further funding through the Individual Care Grant Program. Id . ¶ 260. They claim the Collaborative's decision to deny Plaintiffs P.G. and C.S. additional funding was made in reliance on criteria adopted by Defendants in violation of the Illinois Administrative Procedures Act. Id . ¶ 261. Moreover, according to P.G. and C.S., the ...


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