Q. I have heard that two significant Medicaid decisions have been issued by the federal district court of Georgia in the past few weeks. What are they?
A. The decisions are Moore v. Medows and Hunter v. Medows. Medicaid?s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements, which govern services for children and youth, are at issue in both cases. Both decisions were favorable to the child plaintiffs and are likely to have an impact that extends beyond those individuals or even the state of Georgia.
Medicaid?s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) provisions govern Medicaid services for children and youth under age 21. EPSDT requires that states cover services when necessary ?to correct or ameliorate? physical and mental illnesses and conditions, regardless of whether such services are covered for adults in the state Medicaid program.
According to the federal agency, states are not permitted to put dollar or hourly limits on EPSDT services, or other limits unrelated to medical necessity. But, they may place tentative limits on services; require prior authorization for services; and provide services in the most economic, yet equally effective, mode. In addition, states may exclude services that are unsafe or experimental.
There have been many EPSDT-related cases. 6 Many have involved the substance of what EPSDT requires. An increasing number have considered the procedural question of whether the EPSDT provisions are enforceable by individuals. Two district court cases from Georgia that were decided this month provide examples of each type. The Georgia Advocacy Office, Georgia?s P & A, is counsel for the plaintiffs in both of these cases.
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