Opinion ID: 415223
Heading Depth: 1
Heading Rank: 5

Heading: The EPSDT Cutbacks and the Requirements of Federal Law

Text: 24 At the heart of the district court's opinion is its conclusion that the EPSDT cutbacks violate the requirements of federal law. The district court framed this difficult issue in the following manner: Does the state EPSDT program reasonably attempt to accomplish the purposes of the Act? The district court concluded that the cutback state EPSDT program did not reasonably attempt to accomplish the purposes of the Act and this Court agrees. 25 At the outset, it is noted that this Court ploughs no new ground when it exercises jurisdiction over this case. Well-established precedent requires this Court to determine whether Texas has complied satisfactorily with the requirements of federal law, requirements established by Congress--not this Court. See Bond v. Stanton, 655 F.2d 766 (7th Cir.1981); Rush v. Parham, 625 F.2d 1150 (5th Cir.1980); Curtis v. Taylor, 625 F.2d 645 (5th Cir.1980); Hodgson v. Board of County Commissioners, 614 F.2d 601 (8th Cir.1980); Philadelphia Welfare Rights Organization v. Shapp, 602 F.2d 1114 (3d Cir.1979), cert. denied, 444 U.S. 1026, 100 S.Ct. 689, 62 L.Ed.2d 660 (1980); Preterm, Inc. v. Dukakis, 591 F.2d 121 (1st Cir.1979). 26 Early precedent recognized Congress' power to fix the terms on which it shall disperse federal money to the states. Oklahoma v. Civil Service Commission, 330 U.S. 127, 67 S.Ct. 544, 91 L.Ed. 794 (1947). As the Supreme Court has noted, legislation enacted pursuant to the Spending Power is much in the nature of a contract: in return for federal funds, the states agree to comply with federally imposed conditions. Pennhurst State School & Hospital v. Halderman, 451 U.S. 1, 101 S.Ct. 1531, 1539, 67 L.Ed.2d 694 (1981). Hence, when a state voluntarily and knowingly accepts the terms of the federal-state contract, as Texas has done in the case sua sponte, it is required to fulfill its mandatory obligations under the contract. This is the quid pro quo. Id. 101 S.Ct. at 1539. Whether Texas has fulfilled its obligations is the critical inquiry. Such a determination necessarily requires this Court to ascertain the purposes behind the EPSDT legislation by delving into the Act's legislative history. 27 Medicaid was enacted in 1965 in an attempt to replace prior, less adequate medical assistance programs. For the first time, participating states were required to provide a minimum federally defined package of services that Congress considered essential. H.R.Rep. No. 213, 89th Cong., 1st Sess. 9-10, 70 (1965). Qualified recipients are entitled to this minimum package of mandatory services under 42 U.S.C. Sec. 1396a. 12 28 Among the categories of medical assistance services that states are required to provide under section 1396a(a)(10)(A) is EPSDT, which requires the participating state to provide: 29 such early and periodic screening and diagnosis of individuals who are eligible under the plan and are under the age of 21 to ascertain their physical or mental defects, and such health care, treatment, and other measures to correct or ameliorate defects and chronic conditions discovered thereby, as may be provided in regulations of the Secretary. 30 42 U.S.C. Sec. 1396d(a)(4)(B). In discussing this bill, then HEW Secretary John Gardner stated: 31 In low-income areas, we estimate that six out of every ten children who suffer from one or more chronic conditions are not receiving any treatment. 32