Medicaid Payment for Benefits Decision: Davis v. Shah

UNITED STATES DISTRICT COURT
WESTERN DISTRICT OF NEW YORK
__________________________________________
HARRY DAVIS, et al., Plaintiffs
-vs-
 
NIRAV SHAH, individually and in his official capacity as Commissioner of the New York State Department of Health, Defendant
__________________________________________
APPEARANCES
For Plaintiffs: Bryan D. Hetherington, Esq.
Geoffrey A. Hale, Esq.
Jonathan Feldman, Esq.
Empire Justice Center
One West Main Street, Suite 200
Rochester, New York 14614
 
Martha Jane Perkins, Esq.
Sarah Jane Somers, Esq.
National Health Law Program
101 E. Weaver Street, Suite G-7
Carrboro, North Carolina 27510
For Defendant: J. Richard Benitez, Esq.
Office of the New York State
Attorney General
144 Exchange Boulevard, Suite 200
Rochester, New York 14614

 

INTRODUCTION

This is an action brought by Medicaid recipients to challenge New York State?s decision to provide Medicaid payment for prescription footwear and compression stockings for certain medical conditions but not others. Specifically, Plaintiffs challenge New York State Social Services Law § 365-a(2)(g)(iii), which provides Medicaid payment only for prescription footwear ? used as an integral part of a lower limb orthotic appliance, as part of a diabetic treatment plan, or to address growth and development problems in children,? and Social Services Law § 365-a(2)(g)(iv), which provides Medicaid payment only for compression stockings ? for pregnancy or treatment of venous stasis ulcers.? Plaintiffs suffer from a variety of other illnesses that require the use of prescription footwear or compression stockings, for which New York?s Medicaid program previously provided coverage, but which are not covered by the above-quoted statutory provisions. Subsequent to Social Services Law § § 365-a(2)(g)(iii) & (iv) taking effect in 2011, Plaintiffs learned that their prescription shoes and compression stockings were no longer covered for their medical conditions, when they attempted to fill prescriptions for those items and were told by their medical suppliers that such items are now excluded from coverage. Prior to that, Plaintiffs had no notice of the change in coverage. Now before the Court is an application by three plaintiffs, Harry Davis (? Davis? ), Rita-Marie Geary (?Geary? ) and Patty Poole (?Poole? ) (collectively ?Plaintiffs? ), for a preliminary injunction directing the New York State Department of Health to pay for their prescription shoes and compression stockings pending a resolution of their claims. The application is granted.
 

———————————————————————-
Text has been truncated. For full publication text, download document.

Related Content

For almost 50 years, the National Health Law Program has fought to expand access to quality health care to low-income individuals and underserved communities. Today we are pleased to launch a newly designed website for our future work to make health care a reality for all people. Please take time to peruse our new site, and sign up for our email updates to learn about us, watch the work we do, and become engaged.

Continue to site