The district court improperly ruled that the state Medicaid agency had no discretion to determine the level of home health services to be furnished to a child with severe disabilities under the Medicaid early and periodic screening, diagnosis and treatment (EPSDT) requirements. The state must provide all services that are medically necessary, but the word of the patient's private physician is not controlling. Both the physician and the Medicaid agency have roles in the determination of the services needed to correct or ameliorate the child's condition, and 42 C.F.R. §440.230(d) specifies that the state may adopt reasonable methods of utilization control. The district court decision was reversed, and the case was remanded for further proceedings.
Moore v. Medows, 11th Cir., April 24, 2009
For more information on this and related topics, consult the CCH® Medicare and Medicaid Guide.
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