Following years of glaring failures in Rhode Island’s behavioral health system for children and youth, Disability Rights Rhode Island, the American Civil Liberties Union of Rhode Island, and Children’s Rights today filed a class action lawsuit against the State for denying Medicaid-eligible children and youth their right to appropriate mental health care.
The lawsuit, filed in U.S. District Court, is brought on behalf of Medicaid-eligible children under the age of 21 whose behavioral health needs require intensive home and community-based services to allow them to live successfully at home with their families or caregivers. Without such services, these children routinely have been, and are at high risk of being, segregated from their communities while being unnecessarily placed in institutions. Plaintiffs are seeking to compel the Defendants to provide the children with medically necessary behavioral health services in a community-based setting as required under the law.
The state’s youth are facing a severe mental health crisis. In May 2022, Rhode Island pediatricians and psychiatrists declared “a state of emergency in child and adolescent mental health,” highlighting the “dramatic increases” in emergency department visits for mental health emergencies, including suicide attempts.
As detailed in the complaint, because of a lack of intensive home and community-based mental and behavioral health services, Medicaid-eligible children across Rhode Island are left to suffer as their mental health deteriorates. Without intensive services in their homes and communities, children with mental health disabilities are often unnecessarily placed in psychiatric hospitals, psychiatric residential treatment facilities, and other similar restrictive institutions for extended periods, where they are separated from their families and communities and fail to thrive.
The complaint alleges that the state’s failure to build an adequate behavioral health system for children and youth violates provisions of the Medicaid Act designed to provide children with appropriate mental health services, as well as two other key federal laws, the Americans with Disabilities Act and the Rehabilitation Act.
One of the named plaintiffs, 12-year-old J.L.A., is a triplet along with named plaintiffs J.S.A. and K.A., who loves basketball and watching football. Their mother repeatedly sought community-based behavioral health services in order to keep J.L.A. and his siblings at home safely. Despite these efforts, J.L.A. has cycled in and out of hospitals. In just over two and a half years, J.L.A. spent 403 days out of 594 – or 68 percent of that time – in out-of-home placement. In June, J.L.A. was once again admitted to the hospital for another six months.
The lawsuit notes that over 20,000 children on Medicaid in Rhode Island have a behavioral health disability. As far back as 2010, the National Coalition for Child Protection Reform called Rhode Island’s institutionalization rate for children among the “worst in the nation and vastly above the national average.” As of 2022, the state’s institutionalization rate was 50% above the national average. As of August 2024, around 80 Rhode Island children were placed in out-of-state residential psychiatric facilities – with some as far away as Idaho. Several of these facilities have been linked to abuse, understaffing, and even deaths. The number of children placed in out-of-state facilities has grown by 30% between 2022 and 2024. In that same period, the amount that the Rhode Island Department of Children, Youth, and Families has spent on such facilities ballooned by over 2000%, from $71,380 to $1.98 million.
A copy of the complaint and related material can be found here.
