New York State Medicaid Update - December 2013 - Important Notice
December 2013: Notice to Medicaid beneficiaries regarding Medicaid coverage of orthopedic footwear and compression stockings
On December 9, 2013, Judge Charles J. Siragusa ruled that the limitations on medically necessary orthopedic footwear and compression stockings applied as a result of April 1, 2011 amendments to New York Soc. Serv. Law § 365-a(2)(g)(iii) and (iv) can no longer be applied in Medicaid coverage determinations. (Davis v. Shah, W.D.N.Y., 12-CV-6134)
Effective December 9. 2013, the Medicaid program is returning to medical necessity criteria applied prior to the April 1, 2011 State law amendments.
- 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.
For additional information please refer to the Provider Communication "Medicaid Prescription Footwear and Stocking Benefit Update" located in the DME manual at eMedNY.org.
January 2013: Notice to medicaid recipients regarding medicaid coverage of orthopedic footwear and compression stockings
- January 2013: Important Notice to Medicaid Recipients Regarding Medicaid Coverage of Orthopedic Footwear and Compression Stockings is available in Portable Document Format (PDF, 193KB, 1pg.)
Davis et al. v. Shah is a lawsuit filed in federal district court in the Western District of New York. The case was filed on March 14, 2012 (case number: 12-CV-6134-CJS). On January 7, 2013, Judge Charles J. Siragusa has certified this case as a class action lawsuit on behalf of "All current and future New York State Medicaid recipients for whom Defendant has directly or indirectly failed to provide coverage for medically necessary orthopedic footwear and compression stockings as a result of New York Soc. Serv. Law § 365-a(2)(g)(iii) and (iv) and regulations and policies promulgated thereto." Judge Siragusa appointed the Empire Justice Center and the National Health Law Program as legal counsel for the class.
The case alleges that the New York State Department of Health is violating the Medicaid Act when it denies coverage of orthopedic footwear and compression stockings to Medicaid recipients whose doctors have prescribed these services as medically necessary for their health conditions. The lawsuit also alleges that the Department of Health has violated the Medicaid Act and United States Constitution by denying these services without giving you notice of the denial and an opportunity to contest the denial.
If you are a Medicaid recipient and you have been unable to get Medicaid to cover your doctor-prescribed orthopedic footwear or compression stockings, contact the Health Law Unit at the Empire Justice Center at (800) 724-0490.