The state of Louisiana isn’t providing children on Medicaid with adequate mental-health services, according to a lawsuit filed Thursday by the Southern Poverty Law Center on behalf of five children.
The suit, filed in the U.S. District Court in Baton Rouge, argues that the state has violated federal laws in failing to offer children intensive mental health services, instead relying on psychiatric institutions and the juvenile justice system to stabilize children in crisis.
States that accept federal funds from Medicaid must provide children with early screening for mental health problems so that they can be diagnosed and treated as quickly as possible, according to the Centers for Medicare and Medicaid. That includes mobile crisis teams and intensive outpatient services, known as wraparound services, that allow children to be treated in their own community and home, federal guidelines show.
In Louisiana, children on Medicaid have few options when they experience a mental health crisis, according to the lawsuit. Children should have access to professionals trained in crisis prevention to deescalate a situation and prevent parents from seeking law enforcement as a last resort. In many rural areas, there are no such centers or programs, or they have long waiting lists.
“The … option they have is to call 911, which can result in getting juvenile justice involved,” said Victor Jones, senior supervising attorney for the SPLC. “The other option is to have the child institutionalized.”
Sometimes, that means a child as young as six is put into an ambulance and driven to a hospital hundreds of miles away from their home, he said.
The lawsuit is the latest filed by the SPLC, a civil rights watchdog group, against the Louisiana Department of Health for allegedly not meeting requirements outlined in the Medicaid Act and other federal laws. The group filed in partnership with the National Health Law Program, the National Center for Law and Economic Justice, the Advocacy Center of Louisiana and O’Melveny & Myers LLP.
In 2010, the SPLC sued the state of Mississippi on behalf of children on Medicaid on similar grounds, arguing that the state discriminate against children with mental illness by separating them from their families for treatment and fails to provide federally mandated services. That case has dragged on for almost a decade.
“These lawsuits can take decades,” said Jones. “Relief isn’t always around the corner.”
The Louisiana Department of Health declined to comment, citing pending litigation.
A shortage of doctors in the state has meant long wait times that allow mental health episodes to escalate to crisis situations, when a child is likely to hurt themselves or others, according to advocates for the mentally ill. Most of Louisiana’s parishes have no psychologists or psychiatrists, according to data from the U.S. Centers for Disease Control and Prevention.
According to the 2015 data, the most recent year available, 21 of 64 parishes also lacked a practicing pediatrician.
“Louisiana has a severe lack of providers right now,” said Anthony Germade, the executive director of National Alliance on Mental Illness in Louisiana. “A lot have a long waiting list — as long as a couple of months. For someone having a crisis, that doesn’t help much.”
Health care cuts dating back to the Jindal administration have chipped away at mental health services in the state. “A lot of places with clinics or crisis centers closed,” said Germade, who estimated higher education and health care received almost $1 billion in cuts under that administration.
Medicaid expansion in 2016 provided coverage for another 430,000 Louisiana residents in the first year and opened the door for more federal funding, but the state still struggles to get providers to accept Medicaid.
The obstacles to mental health treatment for children can culminate in an increased risk of incarceration and more trouble in school, including higher drop-out rates, research shows. Children who don’t receive treatment are six times more likely to have health, financial, legal and social problems as adults, according to a study published in JAMA Psychiatry.
One of the children involved in the suit, referred to only as C.C., is a 13-year-old girl who lives in Houma. According to the lawsuit, C.C. received an ever-evolving set of eight diagnoses over the years with behavioral symptoms like violent outbursts, destroying property and running away from home. While on Medicaid, the 13-year-old has been institutionalized three times at hospitals up to 300 miles away from home, spending over 100 days at a time at a psychiatric institution.
The four other children named in the suit had similar issues and difficulties getting care.
Louisiana is at the bottom of national rankings for the overall well-being of its children. The state was ranked 49 of 50 states for overall child well-being in a 2019 report from the Annie E. Casey Foundation that draws on poverty, education and health data.