Key Medicaid Decisions Re: DME Coverage
Medicaid cases that challenged denials of specific items of DME, as well as cases that address key Medicaid rules related to DME coverage.
Case Name |
Citation |
Equipment / Service |
Awarded? |
A.M.L. v. Dept. of Health |
863 P.2d 44 (Utah App. 1993) |
Breast reduction surgery |
Yes |
Alexander L. v. Cuomo |
154 Misc.2d 945, 588 N.Y.S.2d
85 |
Clozapine (drug) |
Yes |
Baker v. Commonwealth of Pa. Dept. of Pub. Welfare |
502 A.2d 318 (Pa. Commw. 1985) 6 |
Bariatric Wheelchair |
Yes |
Beal v. Doe |
432 U.S. 438 (1977) |
Abortion services |
Yes |
Bell v. Agency for Health Care Admin. |
768 So. 2d 1203 (Fl. App. 2000) |
Use of Exclusive List; non-listed insulin pump |
Yes; use of exclusive list is prohibited. |
Blue v. Bonta |
121 Cal.Rptr.2d 483, 99 Cal App. 4th 980 (Cal App. 2002) |
Stairway Elevator |
Yes |
Bowers v. Thompson |
No. 89-2-00553-8 (Wash. Super. Ct. Thurston County Oct 15, 1990) |
DME Coverage standards, generally |
--- |
Brisson v. Dept. of Soc. Welfare |
702 A.2d 405 (Vt. 1997) |
Eyeglasses |
Yes |
Bristol v. R.I. Dept. of Human Servs. |
1997 WL 839884, C.A. No. 95-6605(R.I. Super. Ct. Jan. 30, 1997) |
Incontinence Supplies |
Yes |
Burnham v. State of Wash., Dept.of Soc. & Health Serv. |
63 P.3d816 (Wash App. 2003) |
Service dog |
Not DME |
Curtis v. Taylor |
625 F.2d 645 (5th Cir. 1980) |
In patient hospital days |
--- |
Davis v. Shrader |
687 N.E.2d 370 (Ind. App. 1997) |
Orthopedic shoes |
Yes |
DeSario v. Thomas |
139 F.3d 80 (2nd Cir. 1998), cert. granted, decision vacated, and remanded sub nom. Slekis v. Thomas, 119 S.Ct. 864 (1999) |
DME generally; reliance on exclusive list of covered DME |
Exclusive lists prohibited |
Dexter v. Kirschner |
984 F.2d 979 (9th Cir. 1992) |
Organ transplant |
--- |
Doe v. Minn. Dept. of Pub. Welfare |
257 N.W.2d 816 (Minn. 1977) |
Sex re-assignment surgery |
Yes |
Ellis v. Patterson |
859 F.2d 52 (8th Cir. 1988) |
Organ Transplant |
--- |
Esteban v. Cook |
77 F.Supp. 2d1256 (S.D.FL. 1999) |
Wheelchairs |
Yes |
Fred C. v. Texas Health & Human Servs. Comm'n. (I) |
988 F. Supp. 1032 (W.D. Tex. 1997), vacated and remanded per curiam, 117 F.3d 1416 (5th Cir. 1997)(Table) |
AAC Device / SGD |
Yes |
Fred C. v. Texas Health & Human Servs. Comm'n. (II) |
988 F.Supp. 1032 (W.D.Tx. 1997), affirmed, per curiam, 167 F.3d 537 (5th Cir. 1998)(Table) |
AAC Device / SGD |
Yes |
Granato v. Bane |
74 F.3d 406, 413 (2d Cir. 1996) |
Access to home health care |
Yes |
Hern v. Beye |
57 F.3d 906 (10th Cir. 1995), cert. denied, 516 U.S. 1011 (1995) |
Abortion Services |
Yes |
Hope Medical Group for Women v. Edwards |
63 F.3d 418 (5th Cir. 1995) |
Abortion Services |
Yes |
Hunter v. Chiles |
944 F.Supp. 914 (SD FL) 1996 |
AAC Device/ SGD |
Yes |
Jeneski v. Myers |
163 Cal. App. 3d 18, 209 Cal. Rptr. 178 (1985) cert. denied, 471 U.S. 1136 (1985) |
Prescription drugs |
Yes |
Johnson v. Minn. Dept. of Human Serv. |
565 N.W.2d 453 (Minn. App. 1997) |
Stand up wheelchair |
Yes |
Kerr v. Holsinger |
2004 WL 882203 (E.D.KY. Mar 25, 2004) |
Eligibility for long term care |
Supremacy Clause |
Kirk v. Denning |
370 N.W.2d 113 (Neb. 1985) |
Periodonture treatment |
Yes |
Lagowski v. Whelan |
TP 99-770 (App. Div. 4th Dept.) 2000 |
AAC Device / SGD |
Yes |
Ledet v. Fischer |
638 F. Supp. 1288 (M.D. La. 1986) |
eyeglasses |
Yes |
Marsh v. Commonwealth, Dept. of Pub. Welfare |
409 A.2d 926 (Pa. Commw. 1979) |
Laboratory test |
Yes |
McCoy v. Dept. of Health & Welfare |
127 Idaho 972, 907 P.2d 110 (1995) |
Gastric by-pass surgery |
Yes |
Meusberger v. Palmer |
900 F.2d 1280 (8th Cir. 1990) |
||
Meyers v. Reagan |
776 F.2d 241 (8th Cir. 1985) |
AAC Device / SGD |
Yes, but as SLP equipment |
Mitchell v. Johnston |
701 F.2d 337 (5th Cir. 1983) |
Dental Procedures |
Yes |
Morgan v. Dept. of Health & Welfare |
120 Idaho 6, 813 P.2d 345 (Idaho 1991) |
Weight loss program |
Yes |
Myers v. State of Mississippi |
3:94 CV 185 LN (S.D. Miss. June 23, 1995) |
AAC Device / SGD |
Yes |
Nichols v. Office of Medical Assistance Programs |
15 P.3d 578 (Or.App. 2000) |
Air flotation bed and pressure-reducing mattress |
Yes |
Ohlson v.Weil |
953 P.2d 939 (Colo App. 1997) |
Body brace |
Yes |
Pinneke v. Preisser |
623 F.2d 546 (8th Cir. 1980) |
Sex re-assignment surgery |
Yes |
Planned Parenthood of Houston v. Sanchez |
__ F.3d ___, 2005 WL 579912 (5th Cir. 2005) |
Abortion services |
Supremacy Clause |
Preterm, Inc. v. Dukakis |
591 F.2d 121 (1st Cir.), cert.
denied, |
Abortion services |
Yes |
Rickaby v. Wis. Dept. of Health |
297 N.W.2d 36 (Wisc. App. 1980) |
Wheelchair for NF resident |
Yes |
Roberts v. Brian |
98 Cal. Rptr. 50, 489 P.2d 1378 (Calif. 1971) |
1:1 Attendant Care |
Yes |
Rodde v. Bonta |
357 F.3d 988 (9th Cir. 2004) |
ADA challenge to Medicaid treatment exclusions |
Yes |
Rush v. Parham |
625 F.2d 1150 (5th Cir. 1980) |
Sex re-assignment surgery |
No |
Ruth v. Kizer |
10 Cal.Rptr. 2d 274, 8 Cal. App. 4th 380 (1992) |
Oxygen and portable oxygen equipment |
Yes |
S.D. v. Hood |
2002 WL 31741240 (E.D.LA.2002) affirmed, 391 F.3d581 (5th Cir. 2004) |
Incontinence Supplies |
Yes |
Sanders v.KS Dept. of Social & Rehab. Services |
317 F.Supp. 2d 1233 (D. Kan. 2004) |
CV Vest |
No |
Simpson v. Wilson |
480 F. Supp. 97 (D. Vt. 1979) |
Eyeglasses |
Yes |
Smith v.Rasmussen |
249 F.3d 755 (8th Cir. 2001) |
Sex Reassignment Surgery |
No |
T.L. v. Colo Dept. of Health Care Policy & Financing |
42 P.3d 63 (Colo. App. 2001) |
Hot tub |
Cannot be excluded by list |
Trott v. WI Dept. of Health & Family Serv |
626 N.W.2d48 (WI App. 2001) |
NF Power Wheelchair |
Yes |
Visser v. Taylor |
756 F. Supp. 501 (D. Kan. 1990) |
Clozapine |
Yes |
Weaver v. Reagen |
886 F.2d 194 (8th Cir. 1989) |
AZT |
Yes |
Webster v.Dept. of Children &Families |
852 So.2d 363 (FLA App. 2003) |
Computer software |
No |
White v. Beal |
555 F.2d 1146 (3d Cir. 1977) |
Eyeglasses |
Yes |
Will T. v. Taylor |
3:95 CV 2901A (JEC) (N.D.GA 2000) |
AAC Devices / SGDs |
Yes |
Worthington v. Idaho Dept. of Health & Welfare |
No. 69458 (Idaho D. Ct. 2d Jud. Dist. Nez Perce County Feb. 20, 1992) |
Breast reconstruction following mastectomy |
Yes |
Zatuchi v. Dept. of Public Welfare |
784 A.2d 242 (Pa. Commnwlth 2001) |
Wheelchair lift equipped van |
No |
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