Court rules that developmental disabilities do not preclude physical impairment when evaluating eligibility for EDWP services

Topic: Medicaid Eligibility, Decided by: Judge Schroer 
Docket Number: 0000000 , Decision Date: June 30, 2023 
Attachment: Click here to download the decision. 

The Department of Community Health (DCH) denied an application for Medicaid’s Elderly and Disabled Waiver Program (EDWP) because the 30-year-old applicant’s primary diagnosis was cerebral palsy, which is categorized as a developmental rather than a physical disability. Accordingly, per DCH, the applicant’s diagnosis did not fall squarely within the waiver’s SOURCE criteria for those aged 64 and under. The Judge ultimately reversed this denial on the basis that developmental disability does not preclude physical impairment. In particular, the Judge noted there is no language in the EDWP waiver that excludes expenditures related to developmental disabilities.  The case was remanded to DCH so the applicant could “present documentation to prove that his disabilities are primarily physical.”

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