DeSario v. Thomas

No. 396cv646 (JBA) (D. Conn. Feb. 13, 1997). ; Clearinghouse Number: 51566

Description

Agency’s Categorical Exclusion of Air Conditioners, Humidifiers, and Air Purifiers as Durable Medical Equipment Violates Medicaid Law

Abstract

The district court has granted plaintiff Medicaid recipients’ motion for a preliminary injunction in this class action challenging the Connecticut Department of Social Services (DSS) policy of limiting Medicaid coverage for durable medical equipment to its exclusive list and categorically excluding coverage for air conditioners, humidifiers, and air purifiers, notwithstanding that it identifies such items as durable medical equipment. The court held that plaintiffs were likely to prevail on their claim that the state’s fee schedule violated federal law. The court noted that (1) DSS had no procedure for systematically, timely, or effectively updating the list as new equipment came on the market, and (2) DSS’s policies did not permit a recipient to demonstrate that an item not on the list, but medically necessary, so met the definition of durable medical equipment that it could be added to the list or otherwise considered for prior approval. The court held that DSS’s use of an exclusive list constituted an unreasonable restriction on the amount, duration, and scope of a covered service (i.e., home health service) and that DSS’s policy of excluding coverage for specified items of durable medical equipment improperly denied plaintiffs "meaningful access" to a mandatory package of Medicaid services. Although the court did not decide whether Medicaid law required coverage for all medically necessary services within a given coverage category, it held that states were not allowed to adopt a policy of refusing even to consider a recipient’s potential medical need for a particular item within an otherwise covered category of services. The court enjoined DSS from applying the challenged policy to named plaintiffs’ requests for durable medical equipment and ordered DSS to reconsider them. The court also certified a class; counsel note that they will be seeking to expand the preliminary injunction order to include the class.

Additional Information

Attorney Information
Plaintiffs represented by Shelley White, New Haven Legal Assistance Association, Inc. 426 State St., New Haven, CT 06510-2018 ((203) 946-4811); Sheldon Toubman, Sue Garten, Greater Hartford Legal Assistance, 80 Jefferson St., New Haven, CT 06106 ((860) 541 5000).
Docket Date
1997-02-13 00:00:00+00:00