Level of disability and eligibility for services. The trial court acted within its discretion when it reversed the Medicaid agency's denial of an application for home- and community-based waiver services; the criteria for the waiver program specified that an applicant must have developmental disabilities that are severe enough to require the services of an intermediate care facility (ICF) The applicant had cerebral palsy and a seizure disorder, which were among the diagnoses required, but the agency determined that his impairments were not severe because he was ambulatory, used language to express himself and could perform some activities of daily living. Under state law, the trial court considers both the facts and the law independently when reviewing an agency decision.
The state Supreme Court must uphold the trial court's determination unless it is plainly wrong. The expert testimony established that the applicant could not button clothes, tie shoes, comb his hair, or manage his finances and that he needed prompting to perform self-care activities such as brushing teeth, and his capabilities were about average for someone with similar diagnoses. His need for training and supervision was severe enough that he would require 24-hour care if he did not live with his mother. Therefore, the trial court's decision was supported by the evidence and was not clearly wrong. Wysong v. Walker, W. Va., Oct. 14, 2009, ¶303,145.
For more information on this and related topics, consult the CCH® Medicare and Medicaid Guide.
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