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Case Citation
Legal Case Name

S.D. Ex Rel. Dickson v. Hood Case Brief

Court of Appeals for the Fifth Circuit2004Docket #41165
391 F.3d 581 2004 WL 2584704

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Case Brief Summary & Legal Analysis

General Brief
4 min read

tl;dr: A state Medicaid agency unlawfully denied a child coverage for medically necessary incontinence supplies under the EPSDT program. The court affirmed that this denial violated the Medicaid Act and was actionable under 42 U.S.C. § 1983.

Legal Significance: This case affirms the broad scope of the Medicaid EPSDT mandate, requiring states to cover all federally permissible services necessary for amelioration, and confirms that such statutory entitlements create individual rights enforceable under § 1983.

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Case Facts & Court Holding

Key Facts & Case Background

S.D., a sixteen-year-old Medicaid recipient with spina bifida resulting in total bowel and bladder incontinence, was prescribed disposable incontinence underwear by his physician as medically necessary to ameliorate his physical and mental conditions and prevent infection. The Louisiana Department of Health and Hospitals (LDHH), the state Medicaid agency, denied S.D.’s claim for these supplies, asserting they were not medically necessary and were non-medical supplies not covered by Medicaid. The Louisiana State Medicaid Plan excluded ‘diapers’ from coverage for the general adult Medicaid population under its optional home health care services but did not explicitly exclude them for Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) recipients. S.D. was a qualified EPSDT recipient. Before moving to Louisiana, Virginia’s Medicaid program had provided S.D. with these supplies. S.D. sued LDHH under 42 U.S.C. § 1983, seeking injunctive and declaratory relief. The district court granted summary judgment for S.D., finding the EPSDT provisions created an enforceable right and that LDHH violated the Medicaid Act. LDHH appealed.

Court Holding & Legal Precedent

Issue: Did the Louisiana Department of Health and Hospitals unlawfully deny a Medicaid recipient’s claim for medically prescribed disposable incontinence underwear under the Medicaid Act’s EPSDT program, and if so, did this denial deprive the recipient of a federal statutory right enforceable under 42 U.S.C. § 1983?

Yes, LDHH unlawfully denied S.D.’s claim in violation of the Medicaid Act’s Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum. Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore

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IRAC Legal Analysis

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Legal Issue

Did the Louisiana Department of Health and Hospitals unlawfully deny a Medicaid recipient’s claim for medically prescribed disposable incontinence underwear under the Medicaid Act’s EPSDT program, and if so, did this denial deprive the recipient of a federal statutory right enforceable under 42 U.S.C. § 1983?

Conclusion

This case reinforces the comprehensive nature of the EPSDT benefit, limiting state Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud

Legal Rule

Under the Medicaid Act's EPSDT program, 42 U.S.C. § 1396d(r)(5), states must Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum. Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco labori

Legal Analysis

The court first determined the scope of the EPSDT mandate under 42 Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum. Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum. Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum. Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum. Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum. Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do

Flash-to-Full Case Opinions

Flash Summary

  • The Medicaid Act’s EPSDT program requires states to provide any medically
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proid

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