Pa. Failed To Provide Medical Services, Lawsuit Charges

November 27, 1991 2 min read

A coalition of educators, health specialists, parents, and child advocates has filed suit against the State of Pennsylvania for failing to provide a comprehensive set of medical services for the state’s poorest children.

State officials have been dragging their feet in implementing a federally mandated set of medical benefits for children from poor and working-poor families, the coalition argues in a suit filed in U.S. District Court in Philadelphia this month.

Less than one-quarter of the more than 526,000 children and teenagers who are eligible for the program are actually receiving the benefits, the suit contends.

At issue are the 1989 federal amendments to the Early Periodic Screening Diagnosis and Treatment Program, which is part of the federal and state-funded Medicaid program.

Under the amendments, which went into effect last April, all children up to age 5 who come from families making less than 133 percent of the federally defined poverty level--or an income of about $18,000 for a family of four--are eligible for preventive and continuous health care.

The amendments also made children born after Sept. 30, 1983, whose families make less than the federal poverty level, or $13,400 for a family of four, eligible for the services until they reach their 18th birthday. Children between the ages of 8 and 21 who come from families that qualify for welfare and other cash-assistance programs are also eligible.

The amendments were one of a series of changes approved by the Congress in recent years expanding eligibility for Medicaid, in the process greatly increasing the cost of the program to the states.

Lack of Publicity Alleged

The suit, which is said to be the first legal action filed against a state for not enforcing all aspects of an E.P.S.D.T. program, charges that state officials have not properly publicized the program, have not recruited poor children for the expanded services, and have failed to properly inform doctors and state workers about the program.

It also alleges that the state does not pay doctors enough for treating E.P.S.D.T. patients.

Under the 1989 law, states must actively seek new enrollees for the early-screening program, provide complete medical exams to such children, and treat whatever medical conditions are found. The program includes regular vision and hearing screenings, immunizations, and blood-lead-level testing.

Nationally, only 22 percent of the 11.3 million children eligible for the services receive them, the American Academy of Pediatrics has estimated.

“Most states design and operate their children’s health-care system not to bring poor children and families in, but to deter their participation,” said Thomas K. Gilhool, a lawyer with the Public Interest Law Center of Philadelphia, one of eight legal organizations representing the children, teachers, parents, and community activists who filed the suit.

“They do so to save dollars,” said Mr. Gilhool, a former state secretary of education.

But Vicki Smink, a spokesman for the state public-welfare department, which administers the Medicaid program in Pennsylvania, said the state is making a real effort to tell poor families about the program. “We feel that we are indeed informing our clients about the availability of the E.P.S.D.T. program,” she said.

The suit’s claim that only 25 percent of eligible children are being covered is based on faulty data, she maintained.

Ms. Smink also noted that the state plans to increase fees for health-care providers by $50 million this year.

A version of this article appeared in the November 27, 1991 edition of Education Week as Pa. Failed To Provide Medical Services, Lawsuit Charges