Rosie D.
Reforming the Mental Health System in Massachusetts

About Rosie D.

The Rosie D. decision “provides the lightning rod of change for children with serious emotional disturbance.”

“The Time Is Now” Report

MSPCC and Children’s Hospital November 2006



Children across the Commonwealth of Massachusetts are being denied comprehensive and medically necessary behavioral health treatment that would enable them to receive services and supports at home and in their own communities instead of psychiatric hospitals and residential facilities.  Thousands of them are displaced from home and are detained in these institutions.  Hundreds more struggle at home without adequate supports, at high risk of repeating an endless cycle of institutionalization. 


The Rosie D. Complaint, filed in 2001, sought to redress these systemic wrongs, to challenge the State’s failure to provide timely diagnostic assessments and treatment as required by the federal Medicaid Act, and to enable children with psychiatric disabilities to receive appropriate home-based services so they can grow up in their own homes and attend local schools.


The Rosie D. Decision, issued January 26, 2006, found the Commonwealth violated the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) mandate of the federal Medicaid Act by failing to provide needed and timely services to children.  “The result of this failure is that thousands of Massachusetts children with serious emotional disabilities are forced to endure unnecessary confinement in residential facilities or to remain in costly institutions far longer than their medical conditions require,” said US District Court Judge Michael A. Ponsor.   The Court ordered the State to develop in-home services, including comprehensive assessments, case management, behavior supports and mobile crisis services.


The Rosie D. Remedial Plan, approved in February 2007 and finalized in July 2007, is a blueprint for the reform of the children’s mental health system in Massachusetts.  It provides the opportunity to develop an integrated system of coordinated services, including home-based services to all Medicaid-eligible children with serious emotional disturbance who need them.  The services must be available by June 2009.  A Court Monitor was appointed in the spring of 2007 to oversee the implementation of the Remedial Plan, mediate disputes between the parties, and ultimately determine compliance. 


The Rosie D. website seeks to provide a forum to enable all stakeholders in the children’s mental health system – children, parents and families, mental health professionals, child welfare and juvenile justice staff, human service providers, attorneys, advocates, academics, researchers, governmental officials and state agencies – to exchange information, ideas and resources about the restructuring of the system.  The website is designed to promote collaboration among all concerned persons, so that all children have a chance to obtain needed and timely community mental health services in their homes, with their families, and in their own communities.


See index at left for more information about the case history and home-based services.


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