Medically Fragile Children Denied Necessary In-Home Nursing

On April 28, 2022, Disability Rights New Mexico, alongside our litigation partners from New Mexico Center on Law and Poverty and private counsel, filed M.G. v. Scrase on behalf of all medically fragile children under the age of 21 who qualify to receive private duty nursing through the State’s Medicaid program. The suit was brought against the New Mexico Human Services Department (HSD) and the three Managed Care Organizations (MCOs) for the continued failure to provide medically necessary in-home nursing and to monitor the provision of these services across the state. Medicaid benefits for children under the age of 21 are funded through the federally mandated component of the Medicaid program called: Early Periodic Screening Diagnostic and Treatment (EPSDT). EPSDT requires that all medically necessary services be provided to Medicaid beneficiaries under the age of 21, and it requires an adequate network of service providers to ensure EPSDT services are accessible. The requirements of EPSDT are clearly spelled out in the federal law, and New Mexico’s own regulations describe services that must be provided to qualifying beneficiaries. The complaint alleges that the MCOs have breached their contract with HSD by failing to ensure private duty nurses are available for qualifying families. HSD has also failed in its duty to enforce the contract with the MCOs to the detriment of medically fragile children and their families.