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.
DRNM filed the Jackson lawsuit in 1987 to help people with intellectual and developmental disabilities who were institutionalized in state facilities in Los Lunas and Fort Stanton. After a long trial we were able to convince the federal court that the residents deserved better treatment. Eventually the State realized that it could not provide legally adequate treatment within the institutions. By 1997 the institutions had closed and New Mexico fully committed to a comprehensive community-based system without discrimination for everyone who qualified for the Developmental Disabilities Waiver. The parties spent the next 25 years in the struggle to improve this community-based system. On April 29, 2022 the court finally dismissed the case. While we were unable to achieve all the outcomes we hoped to see implemented for the class members, this case was a remarkable success for some of New Mexico’s most vulnerable citizens, and the impact of the Jackson lawsuit will live far beyond the 35 years the case remained active.