Suit says state funded intensive therapy for some kids, not others. Ruling sends child's case back for more hearings
A Ramsey County judge has ruled that Minnesota's Medicaid program has been "inconsistent" in paying for intensive autism treatment for some children while denying it to others.
But the ruling stops short of ordering the state to cover the treatment for a low-income child, identified as T.O., who is at the heart of the case.
The judge sent the issue back to an administrative law judge for further proceedings.
Amy Dawson, the lawyer representing T.O., had sued the state and HealthPartners for refusing to cover the child's bills for Applied Behavior Analysis (ABA) therapy. Dawson argued the state routinely paid those bills for more affluent families under a Medicaid program for disabled children, but refused it to low-income children like T.O., who was enrolled in a Medicaid managed-care program.
"This court finds it inconsistent," wrote District Judge Robert Awsumb in a ruling issued Monday. "If the services provided truly are the same, then why are some covered and some not?"
Awsumb noted that the Minnesota Department of Human Services, which runs the Medicaid program, did not appear at a January hearing on the case "to answer these and other questions."
A Star Tribune report Monday disclosed that the state Medicaid program has paid millions of dollars to ABA providers in recent years, including $13.4 million last year for more than 350 children, while asserting the therapy had never been a covered service. The vast majority of those receiving it at state expense are children from families above the poverty line.
The Department of Human Services declined to comment on the court ruling Tuesday, saying it will be "reviewing the order to determine next steps." HealthPartners also declined to comment, noting the case "will continue to work its way through the process."
Dawson said she's "very pleased" by the ruling. "I have absolute faith that justice will prevail," she said. "The court's decision has put this case on track to help put an end to the disparity currently faced by low-income children who have autism in Minnesota."
Autism diagnoses in children have soared in recent decades, and parents face a bewildering variety of therapy choices. Some treatments can cost up to $100,000 per year, and many states have faced growing demands to help pay the bills. The child in the lawsuit, who is now 4, eventually got his treatment covered by Medicaid after switching out of a managed-care program.
Maura Lerner • 612-673-7384