KANSAS CITY, Mo. (CN) – Missouri cannot deny Medicaid coverage for disposable diapers to incontinent adults, a federal judge ruled.
U.S. District Judge Nanette K. Laughrey granted summary judgment to a group of adult Missourians who sued under the Americans with Disabilities Act.
The plaintiffs said spent between 2 and 43 percent of their monthly income on the diapers and the denial of Medicaid coverage created financial hardship. One plaintiff said she reused to use diapers because of the cost.
“As a preliminary matter, the Court notes that Defendants admit to the entirety of
Plaintiffs’ statement of uncontroverted material facts, and offer no additional facts for the Court’s consideration,” Judge Laughrey wrote. Laughrey already had issued a preliminary injunction.
“Defendants’ only argument against the merits of plaintiffs’ claim is that Missouri’s waiver programs are sufficient to prevent forced institutionalization,” the judge added. “Plaintiffs, as Medicaid recipients, are ‘categorically needy.’ Prior to the court’s preliminary injunction order, plaintiffs who did not receive support through a waiver program, struggled to pay for their incontinence supplies through a combination of donations from charities and family members. …
“The court notes that only one of the four plaintiffs currently receives coverage under a waiver program, despite persistent requests to state agencies and their Medicaid case managers by the non-receiving plaintiffs. Indeed, defendants have failed to rebut plaintiffs’ evidence, and fail to show the court that (1) each plaintiff is eligible for a waiver program, and (2) there are available slots in the waiver programs for each plaintiff. Additionally, continued coverage offered under waiver programs are not guaranteed, and there are caps on enrollment. Due to these reasons, defendants have failed to show that waiver programs are a viable alternative to institutionalization.”
The plaintiffs ranged from ages 23 to 49 and were all low-income, disabled and suffered from incontinence. Their doctors said that disposable diapers were necessary to prevent infections that could lead to sepsis and even death.
Before the ruling, Missouri covered incontinence only between the ages of 4 and 20. Residents 21 or older who were institutionalized were covered, as were those who qualified for an exception, which was judged on a case-by-case basis.
Ronald Levy, the director of Missouri’s Department of Social Services, and Ian McCaslin, director of the state’s HealthNet Division, were the defendants.