This federal class action lawsuit on behalf of 600,000 Cook County children receiving Medicaid led to major improvements in the delivery of health care services to children in low-income families.
The class action lawsuit in Memisovski et al. v. Maram and Adam, originally filed in 1992, was brought on behalf of some 600,000 Cook County children receiving Medicaid. The suit charged that the State had not complied with the equal access provision of the Medicaid law, or with the requirement that the children receive preventive “early and periodic screening, diagnostic, and treatment services,” or EPSDT. HDA used the state’s own data to show the low level of care and demonstrated via analysis of reimbursement rates how the state discouraged doctors from serving this class. In a bench trial, the court rejected the State’s argument that plaintiffs had no enforceable rights, ruling that the State had failed to comply with the Medicaid Act under which they were “entitled to access equal to that of children with private insurance” and that the defendants had “violated their rights by failing to provide them with equal access to medical services.”
A subsequently negotiated consent decree listed multiple approaches, including higher reimbursement rates, to ensuring that children have access to and receive mandated health care services. The case resulted in broadly improved ways of delivering health care services to Medicaid-covered children in Illinois, leading ultimately to the creation of AllKids.