ORDER GRANTING PLAINTIFFS’ MOTION FOR PERMANENT INJUNCTION

I. OVERVIEW

The following recitals incorporate “facts,” including dates, people’s ages and events alleged in the First Amended Complaint (“FAC”), to which the parties stipulated on March 30, 2000. With the parties’ consent, the Court has not modified those recitals to account for the passage of time since then.

A. Parties

B. This Action

C. Procedural History

D. Current Status of This Action (Plaintiffs Motion for Permanent Injunction)

E. Applicable Law — The Medicaid Act, 42 U.S.C. § 1396 et seq.

F. Burden of Proof

II. FACTUAL BACKGROUND

A. Medicaid and Medi-Cal Programs

1. Medicaid

2. Medi-Cal

3. Early and Periodic Screening Diagnosis and Treatment (“EPSDT”)

4. Therapeutic Behavioral Services (“TBS”)

B. Current Notices of Existing Medicaid or Medi-Cal Services

1. DHS’s Notices

2. MHPs’ Notices

3. DMH’s Notice of Availability of TBS.

III. STANDARD OF REVIEW UNDER THE MEDICAID ACT

A. “Due to concerns of comity and federalism, the scope of federal injunctive relief against an agency of state government must always be narrowly tailored to enforce federal constitutional and statutory law only.” Clark v. Coye, 60 F.3d 600, 603-04 (9th Cir.1995) (citation omitted) (reversing district court’s injunction prohibiting the implementation of a California Medicaid eligibility law). A district coux-t’s injunction must protect “the plaintiffs’ federal constitutional and statutory rights but ... not require more of state officials than is necessary to assure their compliance with federal law.” Id. If the injunction requires more of state officers than de manded by federal law, “[t]he district court will be deemed to have committed an abuse of discretion.” Id.

B. The district court reviews a state agency’s interpretation of a federal statute de novo. See Orthopaedic Hospital v. Belshe, 103 F.3d 1491, 1495 (9th Cir.1997). The district court must determine whether the state law and regulations implementing Medicaid are “consistent with federal law.” Id. at 1496 .

IV. THE PERMANENT INJUNCTION WILL BIND THE DEPARTMENT OF HEALTH SERVICES (“DHS”), THE DEPARTMENT OF MENTAL HEALTH (“DMH”) AND THE COUNTY MENTAL HEALTH PLANS (“MHPs”)

A. “Every order granting an injunction and every restraining order shall set forth the reasons for its issuance; shall be specific in terms; shall describe in reasonable detail, and not by reference to the complaint or other document, the act or acts sought to be restrained; and is binding only upon the parties to the action, their officers, agents, servants, employees, and attorneys, and upon those persons in active concert or participation with them who receive actual notice of the order by personal service or otherwise.” Fed. R.Civ.P. 65(d) (emphasis added).

“Rule 65(d) ‘is derived from the common-law doctrine that a decree of injunction not only binds the parties Defendant but also those identified with them in interest, in privity with them, represented by them or subject to their control.’ ” Class Plaintiffs v. City of Seattle, 955 F.2d 1268, 1280 (9th Cir.1992) (quoting Regal Knitwear Co. v. NLRB, 324 U.S. 9, 14 , 65 S.Ct. 478 , 89 L.Ed. 661 (1945)).

B. Under Medicaid, “[a] State plan for medical assistance must ... provide for the establishment or designation of a single State agency to administer or to supervise the administration of the plan ...” 42 U.S.C. § 1396a(a)(5).

C.It is undisputed that DHS “is the single state agency responsible for the administration of the Medicaid program” in California. JSF, p. 2. Therefore, DHS decides how to operate Medicaid, and DMH and the MHPs must comply with any decision of DHS, i.e., DMH and the MHPs are subject to the “control” of DHS in the administration of Medicaid.

V. INFORMING CLASS MEMBERS ABOUT EPSDT SUPPLEMENTAL MENTAL HEALTH BENEFITS AND TBS

A. Notice of EPSDT Supplemental Mental Health Services and TBS

1. Plaintiffs’ Position

“A state plan for medical assistance must ... provide for ... informing all persons in the State who are under the age of 21 and who have been determined to be eligible for medical assistance ... of the availability of early and periodic screening, diagnostic, and treatment services ...” 42 U.S.C. § 1396a(a)(43)(A).

B. Development and Distribution of a List of EPSDT Supplemental Mental Health Services

a. Under informing regulation 42 C.F.R. § 441.56 (a)(2)(ii), Defendant must effectively inform all EPSDT eligible individuals about “the services available under the EPSDT program and where and how to obtain those services.” As discussed above, Defendant has not effectively informed the Plaintiff class about the specialty mental health services available under the Medi-Cal system.

VI. TBS REQUEST FORMS, DENIAL NOTICES AND PRE-PLACEMENT CERTIFICATION FORMS

A. Direct Requests

a. EPSDT services include screening, vision, dental and hearing services. It also includes “such other necessary health care, diagnostic services, treatment, and other measures described in subsection (a) of this section to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the State plan.” 42 U.S.C. § 1896d(r) (emphasis added).

B. Written Denials

C. Certification That TBS Has Been Considered Before Institutionalizing a Class Member

a. TBS is provided to “children/youth with serious emotional problems who are experiencing a stressful transition or life crisis which, without adequate short-term support, puts them at risk of placement in an institution or group home RCL 12-14.” Draft Discussion. In other words, TBS is provided to children/youth to prevent placement in an institution or group home RCL 12-14.

VII. CHILDREN IN STATE HOSPITALS

A. About Metropolitan and Napa State Hospitals

B. Assessment of Whether Class Members at Metropolitan and Napa State Hospitals Would Benefit From TBS

C. TBS To Facilitate Transition

VIII. CONTINUING TBS BENEFITS PAST AGE 21

A. Providing TBS to Class Members Beyond Their Twenty-First Birthday If They Are In the Midst of Treatment

Plaintiffs have withdrawn this request.

B. Compensatory TBS to Class Members Who Have Been Wrongfully Denied this Mental Health Service

a. Defendant has agreed that judgment be entered against her on all claims in the FAC. Dec. JSR, p. 3. In the FAC, Plaintiffs allege (1) that Medicaid eligible children under age 21 have been denied mental health services to which they are entitled, (2) that Defendant failed to effectively inform children and their families of the mental health services to which they are entitled and (3) that Defendant failed to ensure that there are providers qualified and willing to provide the mental health services to which they are entitled. FAC, ¶¶ 74-76.

IX. ESTABLISHING MINIMUM PROVIDER QUALIFICATIONS AND MONITORING THE NUMBER OF PROVIDERS

A. Minimum Provider Qualifications

B. Monitoring Adequacy of Number of Providers

X. MONITORING THE MHPs’ PROVISION OF TBS TO CLASS MEMBERS, TAKING CORRECTIVE MEASURES WHEN NECESSARY, AND REPORTING TO PLAINTIFFS’ COUNSEL

A. Plaintiffs request that Defendant require reports from the MHPs on all new requests for TBS for class members (regardless of how such requests are made) and a breakdown of how many of these requests were approved or denied.

B. Plaintiffs request that Defendant require the MHPs to forward all the forms certifying that TBS was considered and deemed inappropriate for class members prior to their placement in Metropolitan State Hospital, Napa State Hospital or a RCL 12 facility or higher.

C. Plaintiffs request that Defendant require the MHPs to provide her with updated lists of the local mental health providers who are qualified and willing to assess and/or provide TBS to class members.

D. Plaintiffs request that Defendant require reports from the MHPs on the status of any training in TBS for interested parties within the county as well as any problems in evaluating or delivering TBS to class members.

E.Plaintiffs request that Defendant take appropriate corrective measures with regard to MHPs where either no class members or a disproportionately low number of class members have been approved for TBS.

XI. PROTECTIVE ORDER

This Order incorporates by reference the Protective Order Re: Confidentiality attached hereto as Exhibit A, the original of which shall be separately entered.

XII. CONTINUING JURISDICTION

The Court retains jurisdiction over the enforcement of this injunction for three years from the date it is entered. Should any part of this injunction become substantially unworkable or infeasible due to unforeseen circumstances, either party may move to modify the terms of this injunction.

XIII. FINDINGS OF FACT AND CONCLUSIONS OF LAW

All of the foregoing constitute the Court’s findings of fact and conclusions of law. To the extent that factual recitals also constitute legal conclusions and to the extent legal conclusions also constitute factual recitals, such recitals, findings and conclusions shall be so construed.

IT IS SO ORDERED.

. See Section I(2)(a) below for the definition of RCL. . Wraparound services are explained in the Factual Background section at Section 11(A)(4)(f) below.