STATE CANNOT REDUCE MEDICALLY NECESSARY HOME HEALTH COVERAGE UNDER MEDICAID.

In Anna C. Moore v. M.D. Rhonda Medows, No. 107-CV-631 TWT (D.C.N.D. Georgia-Atlanta Div. June 4, 2008), an action for declaratory and equitable relief brought by a 12 year old Medicaid patient under 42 U.S.C. §1983, the U.S. District Court granted Ms. Moore summary judgment against the State of Georgia which sought to reduce the number of home duty nursing hours afforded the plaintiff from 94 prescribed by her doctor to 84 hours a week as a cost cutting measure.

Ms. Moore suffered a stroke in utero, is severely disabled and suffers from a large number of chronic conditions including spastic quadriplegic cerebral palsy, refractory seizure disorder, mental retardation, gastro esophageal reflux disease, cortical blindness, dysphagia, bone cartilage disease, scoliosis, kyphosis and restrictive lung disease. The child does not have an easy life she suffers from,

severe physical disabilities including spinal deformities in two directions, she is blind and non-verbal, she has seizures that are difficult to control with multiple medications, she has difficulty swallowing even her own saliva, she has difficulties with breathing consistently, she is cognitively impaired, and she has a host of other physical manifestations and medical complications as a result of damage to her brain.

In other words she is just the candidate for a bureaucrat’s cutback of Medicaid benefits. In 1989, Congress passed amendments to the Medicaid  Act to broaden the healthcare provided to children. The amended act requires the states to provide “early and periodic screening, diagnostic, and treatment services” as needed “to correct or ameliorate defects and physical and mental illnesses. 42 U.S.C. § 1396d(r)(5). Citing Pittman v. Secretary, Florida Dept. of Health and rehabilitative Services, 998 F. 2d 887,889 (11th Cir. 1993), the court held that the 1989 amendments are mandatory and that the state has no discretion to deny funding for medically necessary treatment.