Georgia Medicaid
Eleventh Circuit orders Georgia to cover more than 21 nursing hours for child
L.W. needs constant glucose checks, tube feedings and quick intervention when his blood sugar drops. The Eleventh Circuit said the state has to cover care that fits that reality.
The court affirmed an order requiring Georgia Medicaid to provide more than 21 hours a week of private nursing for L.W., a three-year-old with a rare metabolic disease. Judges said the state’s limit did not satisfy Medicaid’s standard for care that can correct or improve a child’s condition.
- Georgia lost its bid to cap a medically fragile toddler’s home nursing at 21 hours a week.
- The court said Medicaid’s EPSDT rule requires care that actually helps a child’s condition.
- L.W. needs constant glucose checks, tube feedings and rapid response when his blood sugar drops.
- The ruling could matter for other families trying to keep sick children at home.
- A three-year-old Georgia boy with a rare, life-threatening metabolic disease will get more than 21 hours of private nursing care a week after the Eleventh Circuit said the state’s Medicaid program must meet his medical needs
A three-year-old Georgia boy with a rare, life-threatening metabolic disease will get more than 21 hours of private nursing care a week after the Eleventh Circuit said the state’s Medicaid program must meet his medical needs. L.W. needs constant glucose monitoring, tube feedings every three hours and fast help when his blood sugar drops, the sort of care that can quickly become impossible for a family to shoulder alone.
The fight was never just about a number on a schedule. For L.W. and his mother, Katie Ward, it was about whether a child with a fragile metabolism can stay safely at home when the state tries to draw the line at 21 hours.
What EPSDT requires
The court grounded its ruling in Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment program, or EPSDT, which requires states to provide private nursing services that are sufficient to correct or ameliorate a child’s underlying condition. Georgia argued it could still deny care under an otherwise reasonable policy. The judges rejected that argument, saying the federal standard controls the care a child actually receives.
The panel also said the district court did not clearly err when it found L.W. needed more than 21 hours of weekly nursing care. That leaves Georgia with an order shaped by the child’s medical reality, not by the state’s preferred cap.