A state may exclude certain medically necessary items from Medicaid coverage even though the items are included in the state's definition of durable medical equipment (DME).
The State of Connecticut excludes from the definition of DME covered in its Medicaid program certain items, such as humidifiers, air purifiers and air conditions. In another regulation, the state limits coverage for DME to items on a list. The district court enjoined both regulations, ruling that the state had no way to evaluate the medical necessity of items that fell under either exclusion, nor, in the case of the list, any systematic way of updating the list or any way for an individual to demonstrate that an unlisted item should be added.
The U.S. Court of Appeals for the Second Circuit reverses. Although acknowledging that its decision runs contrary to those of at least three other circuits, the Second Circuit relies on a Supreme Court decision, Beal v. Doe, 432 U.S. 438 (1977), that states my impose reasonable limits on their Medicaid coverage that are consistent with the objectives of a program. The court finds that Connecticut's definition of DME is nearly identical to the Medicare definition, and it also gives weight to the fact that the Health Care Financing Administration had approved it.
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