Opinion ID: 3047906
Heading Depth: 2
Heading Rank: 4

Heading: The Approach on Remand

Text: Here, the district court assumed that if each component of a given type of care falls within the State’s EPSDT obligations, this necessarily implies that that form of care itself must be funded and provided by the State as a single package.20 20 Plaintiffs themselves did not make this assumption; their motion for a preliminary injunction cited examples of states that provide wraparound and TFC by funding the individual components (while asserting that it is “highly preferable” for providers to bill wraparound and TFC as “a bundled package of services”). KATIE A. v. BONTÁ 3409 Under that assumption, because MediCal does not fund wraparound or TFC as distinct types of care, the district court concluded that the State was violating this obligation. [8] In analyzing the issue in this way, the court conflated a two-step analysis into one; as a result, it applied a legal interpretation of the Medicaid Act that is too sweeping. The court should have first determined whether the State is meeting its legal obligation under the EPSDT provisions to provide all individual health services that fall under the categories listed in § 1396d(a). Then, if it found that the State is failing to provide the individual health services effectively, the court should have determined whether the failure could only be remedied by ordering the State to fund the individual services as a single “bundle.” Rather than applying a legal rule that requires the State always to fund a coordinated bundle of services if the individual components fall under § 1396d(a), the court should have applied a legal rule that would allow the State to exercise its discretion as to how to meet its EPSDT obligation effectively to provide all the component services that fall under § 1396d(a). On remand, the district court should analyze plaintiffs’ likelihood of success on their Medicaid Act claims in this manner.