Eleventh Circuit orders Georgia to cover more than 21 nursing hours for child

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.