Judge hears Medicaid arguments

KANSAS CITY, Mo. -- Attorneys for seven disabled Missourians tried Wednesday to convince a federal judge that Missouri's decision to stop paying for certain medical equipment is unfair and illegal.

U.S. District Judge Dean Whipple, who last week declined to issue a temporary restraining order blocking the cuts, said he would review testimony and court filings and hoped to decide next week whether to issue a preliminary injunction.

On Sept. 1, the state stopped using Medicaid funds to pay for such items as hospital beds, wheelchair batteries, breathing aids and cushions used to prevent bedsores. The cuts to durable medical equipment will affect about 340,000 adults in the Medicaid program.

They do not apply, however, to children or to those who are blind, pregnant or in nursing homes.

Attorneys for the plaintiffs argued again Wednesday that the exceptions amount to illegal discrimination based on diagnosis.

But assistant attorney general Victorine Mahon, representing the state Department of Social Services, said state law made payments for durable medical equipment through Medicaid optional, rather than mandatory. The state's decision to exempt some from the durable equipment cuts was an exercise of that option, she said.

"Durable medical equipment is not a required service for the categorically needy," Mahon said.

But by providing payment for some people's equipment expenses, the plaintiffs' attorneys said, Missouri had committed to paying such expenses for all who met federal Medicaid eligibility.

"Services available to the categorically needy must be equal in category and scope," attorney Jane Perkins said.

The state has also contended that its exception process allows patients, through their physicians, to apply for equipment that would not otherwise be covered.

George L. Oestreich, director of the pharmacy program for the Department of Social Services and head of its exception program, testified Wednesday that to his knowledge, only one of the seven plaintiffs had applied for equipment. That request was partially granted, he said, with the patient continuing to have his feeding tube paid for.

"This exceptions process is not alleviating the harm to people," Perkins countered in her closing argument. "They should not have to use an exceptions process."