Over the last two decades a series of Supreme Court decisions have eroded civil rights protections, leaving millions of Americans vulnerable to discrimination. The courts actions have narrowed the rules for bringing civil rights cases across the board, in employment, housing, the environment, and healthcare. In a case originating in New Jersey, the Supreme Court ruled that plaintiffs must now prove not only that racial discrimination exists, but that it is intentional… a standard that is nearly impossible to meet. In a case from Alabama, the courts exempted the states from civil rights law, preventing people from suing state governments, even when those governments are guilty of discrimination. In a third set of cases the courts have ruled that federal programs, like Medicaid, are actually not laws, but contracts, and as a result, people cannot enforce their rights to receive guaranteed services in federal court. One precedent setting case arose in Michigan:
Nurse addressing child: When you hear this sound right here, you’re going to raise your hand, okay?
In Detroit, as in cities and towns across the country, many low- income families fail to get the healthcare services promised by the state.
Ann Rudolph: My daughter Maiesha has a hearing problem… I first noticed the problem when she was six months old…
Nurse: You are set Maiesha…
Ann Rudolph: …when she was at the age at where she’s supposed to be trying to talk, she was sounding like a deaf person would talk. She’s an asthmatic as well, when she has an asthma attack, or have problem breathing she didn’t know how to communicate, she couldn’t tell you “I’m short of breath” or anything.
Ann and Maiesha Rudolph are among the one in a quarter million people in Michigan who are covered my Medicaid, the government funded health insurance program for low- income people. For all kids, early diagnosis of medical problems can make a critical difference, but those on Medicaid, like Maiesha, don’t always get the care they need. Blake Hammond and his mother Michelle are in the same bind.
Michelle Hammond: My son before he got diagnosed, it should have been clear that he had autism, or at least some kind of severe mental disorder…
Blake Hammond: Excuse me…
Michelle Hammond: … he’s hypersensitive to taste and smell, he’s hypersensitive to hearing…
Blake Hammond: Excuse me…
Michelle Hammond: …he has a four year old sibling, and… it’s hard to balance both of them…
Blake Hammond: Excuse me… you mean a four year old devil…
Michelle Hammond: Mmhmm… it’s hard to balance both of them… it’s an ongoing process, my whole day is filled with… him.
Dr. Bea Murray: It’s very hard for people who have Medicaid as their form of insurance to get the same sort of medical care that other children have… um, first there are only a small number of doctors or clinics or hospitals that will serve these people.
Dr. Teresa Holtrop: Okay, let’s, let’s finish up with the ADHD stuff…
Children on Medicaid are supposed to receive preventive health care through what’s called EPSDT, or Early Periodic Screening Diagnosis and Treatment.
Dr. Teresa Holtrop: The state contracts with the HMO providers, and then it’s up to the HMO providers to make sure that the EPSDT screening gets done… but they don’t do that because there’s nobody from the state really cracking down on it… Okay, that looks good…
Maiesha Rudolph did not receive early screening, as a result, her asthma and hearing problems are now more severe then they might have been.
Ann Rudolph: Even before she was six months old she had this problem with her hearing… Okay, open your mouth… I knew she had asthma and I told them that she did and they said “Well how do you know?” I said I have four other kids that are asthmatic, so I know!
Blake Hammond also did not receive an early diagnosis and his family didn’t get the services that would have helped them cope with his autism.
Michelle Hammond: The neurologist that he was seeing didn’t even diagnose him with autism and he’d been seeing with him for a year. I ended up going through Family Neighborhood Services because I was low- income and they were the ones that said he was autistic… and low and behold when I take it to the neurologist, then he agrees that he’s autistic but follows no treatment plan after that!
Dr. Bea Murray: The state has not made a commitment to these children, that they are going to provide the services that they said they were going to provide when they took the Medicaid money, and they don’t seem embarrassed by it or any way expecting chastisement for it… so I think they’re ignoring their responsibility under the law.
Michelle Hammond and Ann Rudolph joined with the group West Side Mothers. The group advocates for the rights of Medicaid recipients.
Ann Rudolph: I call West Side Mothers meeting to order, chairing the meeting is Ann Rudolph, I am the chairperson…
West Side Mothers saw just one option for making the state live up to its responsibility. They filed a class action law suit against Michigan.
Jennifer Clarke: The lawsuit alleges that the federal statute Medicaid requires that Michigan provide certain health services to children. The lawsuit alleges that Michigan is not doing that. So as a result the children in Michigan who are eligible for Medicaid aren’t getting the health care that they should be getting under the federal law.
For years West Side Mothers didn’t get the chance to bring their lawsuit into court, because the judge came up with a new and unusual theory.
Jennifer Clarke: What the theory was was that this particular law- Medicaid- isn’t really a federal law… um, he said it was more like a contract.
A contract, solely between the state of Michigan and the federal government… Medicaid recipients are not a party to that contract; therefore the West Side Mothers group had no right to sue. On the basis of this theory, the judge dismissed the case. Under the ruling, in Michigan, if children on Medicaid don’t receive the health services they are entitled to, they would have no legal recourse.
Dr. Bea Murray: I think if the courts aren’t available to correct things that are being done wrong to children then we don’t really have anywhere else to turn. The children don’t have the option to vote, and so their only recourse for fair treatment in this country is the courts, and if that’s closed off to them… they are, they’re lost.
Dr. Teresa Holtrop: Okay, face the door, now bend over and touch your toes…
Michelle Hammond: If you can’t sue the state… then what’s going to happen to the kids? The parents should have a right to sue them... they should have a right for their voices to be heard.
West Side Mothers appealed the case and won the right to go to court, but three years after they first filed suit, West Side Mothers is still waiting to have their case heard. Across the country similar tactics are being used to keep to keep people’s civil rights claims out of court.
Jennifer Clarke: The fact that we had to spend three years exploring a new theory of why poor peoples shouldn’t get to go to federal court is, it’s sad and it’s frustrating… so you have kids who could have been getting better who are still just continuing to get sick.
Ann Rudolph: They hurt my child, and in the long run she have to suffer for it, not the state, not the doctors, she have to suffer.