Skubel v. Fuoroli

No. 96-6201 (2d Cir. May 13, 1997) ; Clearinghouse Number: 52222

Description

Regulation Limiting Medicaid Coverage for Home Health Care to Services Provided at Recipient’s Residence Invalidated

Abstract

The Second Circuit has affirmed the district court’s ruling invalidating 42 C.F.R. § 440.70(a)(1), which limited Medicaid coverage to home health services provided at the recipient’s place of residence. Plaintiff Medicaid recipients, children with severe medical conditions, require nearly constant nursing care; they can participate safely in educational and social activities in the community only if accompanied by a nurse. Citing the challenged regulation, defendant Connecticut Department of Social Services denied plaintiffs’ requests for Medicaid funding for nursing care outside their homes. Plaintiffs sought judicial review. The district court held that the regulation was an unreasonable interpretation of the Medicaid statute because, inter alia, it did not represent a reasoned decision in light of medical advances permitting disabled individuals to leave their homes. Defendant appealed. The court of appeals found no rational connection between the regulation and the purpose to be served by the statute governing home nursing services. The court noted that the restriction ignored the consensus among health care professionals that community access is not only possible but desirable for disabled individuals. Accordingly, the court affirmed the district court’s judgment as modified to expressly limit Medicaid coverage for home health nursing services to the number of hours of service to which a recipient would be entitled if such services were exclusively provided at the recipient’s place of residence.

Additional Information

Docket Date
1997-05-13 00:00:00+00:00

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