State Sued on Health Programs for Kids

A class-action lawsuit seeking to improve healthcare for poor children in Cook County is scheduled to go to trial this week -- 12 years after it was filed.

The suit contends that Illinois has violated federal law by failing to ensure that poor children receive appropriate preventative medicine, from immunizations to tests for lead in their blood.

The reason, according to the suit: Doctors refuse to treat patients whose care is paid for by the government’s Medicaid program because reimbursement rates are low and the state is often late in paying its bills.

The case is significant because it could compel Illinois to spend millions of additional dollars on Medicaid, the federal-state health program for poor people. But lawyers who filed the suit argued that the state could face much larger medical bills unless it improved children’s Medicaid programs.

“Most children are not receiving basic care,” said Fred Cohen, the lead lawyer arguing the case. “Providing preventative child care is, in the long run, much cheaper than not providing that care and then dealing with later health problems.”

The defendants in the case, the Illinois departments of Public Aid and Human Services, declined to comment because the case was about to go to trial. Opening arguments are scheduled for Monday in U.S. District Court in Chicago.

The suit was filed in 1992 on behalf of about 600,000 poor children in Cook County.

Federal law requires that children covered by Medicaid receive regular vision, dental and hearing screenings, along with immunizations and other needed medical services. The law requires that at least 80% of Medicaid-eligible children receive at least one service a year.

But most states have fallen short of that goal, according to advocates for the poor. In 1998, only nine states met or exceeded the goal, according to the National Health Law Program, a nonprofit law firm that works on behalf of the poor.

That opened the door to dozens of lawsuits nationwide in which poor people sued to force their states to provide the promised benefits.

Illinois, Michigan, North Carolina and other states argued that they were shielded from such lawsuits because individuals could not sue to require Medicaid to deliver services. But federal appeals courts rejected those arguments.

“We have a responsibility to provide access to these services under federal law,” said David Parrella, director of the National Assn. of State Medicaid Directors. “It’s quite a powerful legal argument.”

In 2000, a federal judge ruled that Texas’ system for administering preventative health care for children was badly flawed and ordered the state to make improvements. In 1997, a federal judge appointed an outside monitor to oversee improvements in the Medicaid program in Washington, D.C.

After lawyers filed the Illinois suit, state officials acknowledged management problems in children’s Medicaid programs, especially in urban areas such as Cook County.

The state asked the court to put the suit on hold while it tried to fix the system.