Fourth Department — Medicaid: Godfrey v. Shah

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Appellate Division, Fourth Department

Medicaid

Request for Medical Device

Godfrey v. Shah
TP 11-01540
Transferred from Supreme Court, Erie County

Background: The petitioner commenced an Article 78 proceeding challenging the determination that denied her request seeking approval to purchase a Bantam Stander device with options. The petitioner is a 7-year old Medicaid recipient with multiple disabilities who is wheelchair-bound and unable to stand unassisted. The petitioner’s pediatrician and physical therapist requested approval of the device and the request was denied on the grounds that the petitioner had failed to establish that the device was the least costly medical device that would meet her medical needs.

Ruling: The Appellate Division annulled the determination and granted the petition. The petitioner had established at the hearing that the device was medically necessary as it would assist in her weight bearing activities, reflux bowel and bladder health, and increase her bone density. The petitioner had also established that there were no less costly alternatives that would provide the precise medical benefits while transferring the petitioner safely to and from her wheelchair. Moreover, the testimony of the physical therapist that the petitioner risks being dropped and injured without the use of the device was entitled to significant weight and could not be outweighed by non-medical personnel.

Diana M. Straube of Neighborhood Legal Services Inc. for the petitioner; Kathleen M. Treasure of the New York State Office of the Attorney General for the respondents