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
(N.Y. Sup. Ct. N.Y. County 1991)

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,
441 U.S. 952 (1979)

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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