SD ex rel. Dickson v. Hood

The Early and Periodic Screening Diagnostic and Treatment (EPSDT) services program, established by the Medicaid Act, was designed to provide medical care to Medicaid-eligible individuals under 21 years old. The Medicaid Act mandated that states submit a plan detailing the EPSDT services it will provide and defined EPSDT services as any healthcare necessary to treat physical and mental illnesses, regardless of whether the services are covered under the state plan. In 2002, EPSDT-eligible SD (plaintiff) submitted a medical-assistance claim to the Louisiana Department of Health and Human Services (LDHH) (defendant) for the cost of disposable incontinence underwear, which his doctor determined was necessary because of his bowel and bladder deficiencies. LDHH denied the claim on the grounds that underwear is not an item that is medically necessary and therefore is not covered by Medicaid and that the item was not a service listed in the state plan. SD appealed the decision to an administrative law judge who ruled in favor of LDHH, concluding that diapers were excluded from coverage under the plan. SD filed a 42 U.S.C. § 1983 claim. The district court ruled in favor of SD on the ground that an EPSDT-eligible individual is entitled to any service to treat physical and mental illnesses, regardless of whether the service is listed in the state plan. LDHH appealed.