Federal lawsuit questions Medicaid's ability to deny care deemed necessary by doctor

Health officials from Florida, Georgia and Alabama this week argued in a federal appeals court in Atlanta that state Medicaid programs can cut treatments for children that a doctor has ordered as medically necessary, Florida Health News reports.

The case involves a child in Georgia whose home-health care was reduced from 94 hours per week to 84 hours per week by the state's Medicaid program. A U.S. district judge ruled that the state could not cut back on care that the doctor designated as needed. An appeal was filed by Georgia Department of Community Health Commissioner Rhonda Medows.

In an amicus brief filed jointly by Florida and Alabama, Florida Agency for Health Care Administration Acting General Counsel Justin Senior wrote that the original ruling "would essentially invalidate a Florida statute and prompt a drastic shift in Medicaid funds ... into unproven, unnecessary, ineffective, cosmetic, and dangerous treatments for persons under 21." He wrote, "Treating physicians ... cannot be trusted with this sort of discretion," adding, "When left to their own devices, they advocate for their patients and deem all manner of unproven, dangerous, ineffective, cosmetic, unnecessary, bizarre and controversial treatments as 'medically necessary'" (Florida Health News, 3/29).