K.B. v. Michigan DHHS: what the children’s HCBS settlement means for adult services

On August 28, 2025, a federal judge in Detroit approved a settlement requiring Michigan to make intensive home and community based services available to children with significant behavioral health needs, across the whole state, with a standardized way of deciding who qualifies. It is a genuinely good outcome for children. Your adult child got nothing from it. I want to be honest about that first, because what comes next is only useful if we start there.

What the case did

K.B. v. Michigan Department of Health and Human Services was a class action in the U.S. District Court for the Eastern District of Michigan, brought on behalf of Medicaid-eligible children with intensive mental health needs who were at risk of avoidable psychiatric hospitalization or of ending up in the juvenile justice system.

The legal theories were Early and Periodic Screening, Diagnostic and Treatment under the Medicaid Act, other Medicaid Act provisions, and the Americans with Disabilities Act.

The settlement, approved August 28, 2025, requires Michigan to provide intensive home and community based services statewide and to establish a standardized eligibility and assessment process.

Notice the shape of that remedy. Not “fund more slots.” Not “reduce the waiting list.” Make the service available across the state, and decide who qualifies the same way everywhere. Those are structural findings, and structural findings are the kind that travel.

The three things adults can actually use

One, the ADA integration claim does not have an age limit. EPSDT does. It is a children’s entitlement and it ends at 21, which is the exact cliff this website exists to describe. But the Americans with Disabilities Act integration mandate, and the Olmstead line of cases behind it, apply to adults in precisely the same terms. A case built partly on the ADA is a case whose reasoning survives a birthday.

Two, geographic unavailability is now a named problem in this state. The remedy in K.B. is statewide availability. That is a court and a state agreeing, in writing, that a covered service concentrated in a few counties is a defect requiring a fix. Every adult family in a rural county whose waiver covers a service no local provider will staff is describing the same defect. Same state. Same defect. Different age.

Three, inconsistent assessment is a problem Michigan has now conceded. The settlement requires a standardized eligibility and assessment process for children. When your adult child is assessed one way in one county and another way forty miles east, you can now point at what Michigan agreed was unacceptable for a different population and ask why the standard is different.

The argument that actually works, and the one that does not

I have watched families take a case like this into a meeting and lead with the wrong thing, so let me be specific.

The argument that does not work is entitlement by analogy. Walking in and saying a court gave children intensive services so your adult child should get them too will get you a polite explanation that the class was children and you are not in it. That explanation will be correct.

The argument that works is availability. It sounds like this: the waiver covers this service. My adult child is authorized for it. No provider in this region will staff it. That is not a waiting list, it is a covered service that does not exist where we live, and this state has already been ordered to fix exactly that defect for a different population.

The second version is narrow, factual, and documentable. It does not ask anyone to extend a settlement. It asks them to explain a specific gap between what is covered and what exists, which is a question with no comfortable answer.

Why the same court keeps showing up

Something worth noticing: the Eastern District of Michigan approved both the Waskul settlement covering self-determination budgets and the K.B. settlement covering children’s intensive services, within about seven months of each other.

That is not coincidence, and it is not a sign that Michigan is uniquely bad. It is a sign that in this state, the durable improvements to the disability service system in recent years have come from federal litigation rather than from the budget process.

I find that clarifying rather than depressing. It tells you where the leverage is. It tells you that documentation matters more than persuasion, because documentation is what a case is built from. And it tells you that organizations like Disability Rights Michigan and the legal aid groups behind these cases are not peripheral to the advocacy work. They are where the wins have actually come from.

It also means the next case will be built out of the files families keep right now. Somebody’s dated log of unfilled hours becomes an exhibit. That is not hypothetical. That is how both of these settlements happened.

Your practical next steps

This week. If your adult child is authorized for a service that no local provider will staff, write it down that way. Not “we are waiting.” A covered service, authorized, unavailable in this region, with dates. Send it to your supports coordinator and ask for written confirmation or correction.

This month. Request the provider network list for your PIHP region in writing, then call every provider on it that offers the service and log the answer with the date. Closed intake is a fact. A dated list of closed intakes is evidence.

If your adult child is under 21 right now. Use EPSDT while you still have it, and start the adult transition paperwork early, because the entitlement ends on a birthday and the replacement does not arrive automatically. Michigan Alliance for Families can help with the transition side at no cost.

When you talk to a legislator. Say that Michigan has now settled two federal cases in two years about the adequacy and availability of disability services, and ask what the plan is to fix the next one before it gets filed. That question has never once received a good answer, which is exactly why it is worth asking on the record.