Court Reverses Cuts in Medicaid Coverage for Compression Stockings and Orthopedic Footwear

On December 9, 2013, the Hon. Charles J. Siragusa granted a plaintiff class of Medicaid recipients' motion for summary judgment, ordering a permanent injunction against the State's limits on orthopedic footwear and compression stockings.   Davis et al v. Shah (Case number: 12-CV-6134-CJS).  Download the court decision here.   Earlier, on January 7, 2013, the court had certified a class action.  The case challenges 2011 statutory changes that denied coverage of orthopedic footwear and compression stockings to all Medicaid recipients who did not meet one of a few limited exceptions.  In the decision, although the Court agreed with the state that compression stockings and orthopedic footwear were prosthetics and thus not mandatory home health services, the Court granted all of plaintiffs' other claims:  the statutory limitations on these services violate the federal Medicaid reasonable standards and comparability requirements, as well as the Americans with Disabilities Act and Constitutional due process protections.  As a result, the state will be prohibited from enforcing the 2011 MRT limitations on compression stockings and orthopedic footwear. 

Empire Justice Center and the National Health Law Program are representing the plaintiffs in the lawsuit.  Judge Siragusa had previously granted plaintiffs'motion for a preliminary injunction and required the Medicaid program to cover orthopedic footwear and compression stockings for the named plaintiffs.  

Following issuance of this decision, the State Dept. of  Health issued an eMedNY Update reverting to the system in place prior to the changes in April 2011.    Medicaid coverage for these items will no longer be restricted to a few narrow exceptions!

See Medicaid Prescription Footwear and Stocking Benefit Update - December 18, 2013 (PDF 161KB) and see

Medicaid Update December 2013 (see page 7), which states:

• The criteria for coverage of medically necessary prescription footwear, shoe modifications and additions is no longer limited to diabetics, children under the age of 21, or for use as part of a lower limb brace.
• The criteria for coverage of medically necessary compression and support stockings coverage is no longer limited to use during pregnancy or for treatment of open venous stasis ulcers

If you know of Medicaid recipients who have been unable to get Medicaid coverage for these services, please contact the Health Law Unit at the Empire Justice Center at 1-800-724-0490.

The class certification order also requires the state to inform Medicaid providers and suppliers of the availability of coverage for compression stockings and orthopedic footwear.  Here’s the link to the posting on the DOH website:  http://www.health.ny.gov/health_care/medicaid/program/update/2013/noticejan2013.htm.

The Empire Justice Center has posted the notice on its website here:  http://www.empirejustice.org/issue-areas/health/medicaid--related-programs/medicaid/medicaid-coverage-for.html#.UO8a36zheSc.