Children Sue S.C. Over Medicaid Coverage for Autism Therapy

A lawsuit filed on behalf of a six-year-old autistic child who has been waiting two-and-a-half years for treatment under Medicaid says South Carolina’s provider reimbursement rates are so low that they violate federal law.

The case, on behalf of Z.M. and a class of similarly situated children, alleges that South Carolina’s Department of Health and Human Services has violated Medicaid’s mandates that care be available to “all individuals” who meet eligibility requirements, and that assistance be provided with “reasonable promptness.”

Because reimbursement rates for behavioral therapists in South Carolina are so low, the plaintiffs allege, few providers will work for ...