AJC Article : State cant deny kids Medicaid services, judge says

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State can't deny kids Medicaid services, judge saysBy CRAIG SCHNEIDERThe Atlanta Journal-ConstitutionPublished on: 06/16/08

Georgia child health advocates hope a federal court decision will stop the state from denying medical services to children who receive Medicaid.

Advocates say the state has a long history of reducing or denying care ordered by physicians and paid for through the program that is jointly funded by the state and federal government.

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The decision last week by U.S. District Judge W. Thrash pertains to the case of a 13-year-old developmentally disabled girl, C. of sville in north Georgia. Her doctor prescribed 94 hours of private duty nursing care a week for her, but the state Department of Community Health approved only 84 hours.

The Atlanta federal judge found the state does not have the discretion to deny funding for services prescribed by a treating physician.

"The decision affirms that treating physicians, and not the state, should make those decisions," said the girl's attorney, Norris of the nonprofit Georgia Advocacy Office.

Norris said some 700,000 children in Georgia are eligible for Medicaid.

State DCH Commissioner Rhonda Medows asserted in court filings that the state has the discretion to limit the amount of treatment it must provide for a child covered under Medicaid.

The agency declined to discuss the case, saying it does not discuss ongoing or pending lawsuits. The agency did not respond to requests for comment on the assertion by advocates that it uses discretion to reduce services in numerous cases.

Pat Nobbie, deputy director of the Governor's Council on Developmental Disabilities, said the state has intervened to reduce services for hundreds, if not thousands, of children in recent years. She is hoping the court decision forces the agency to change its practices.

"Kids have been denied services they should have been getting," Nobbie said. "It's up to the physician."

Pam , the mother of the 13-year-old girl, expects the judge's decision will mean more hours of nursing care for her daughter. Her daughter, who is nicknamed Callie, is mentally retarded, blind and nonverbal.

said that the state has tried to reduce those nursing hours about 10 times over 10 years, forcing her each time to challenge the decision before agency officials.

"The stress of that is horrible," said. "Having a nurse in our home has kept Callie alive."