State must provide medical services to eligible children to improve or maintain a child’s health in the best condition possible.
Docket Number: ******* , Decision Date: May 28, 2013
Attachment: Click here to download the decision.
DCH could not reduce a GAPP recipient’s skilled nursing hours beyond what is medically necessary to ameliorate his condition. The Court gave great weight to the testimony of Petitioner’s personal physicians, who testified that a reduction in skilled nursing care would be hazardous to the child’s tenuous health. The Georgia Medical Care Foundation misconstrued the legal requirement “to correct or ameliorate” as requiring skilled nursing only if such care could improve the child’s medical condition. Contrary to this interpretation, both federal and state laws require nursing care where it is necessary to prevent a decline in the patient’s condition.