Monday, April 10, 2006

Drain on Medicaid

The News & Observer

An illegal immigrant did not have an emergency medical condition when he received chemotherapy and Medicaid should not have covered his treatment, the state Supreme Court ruled Friday in reversing a lower court decision.

Medicaid only allows states to be reimbursed for Medicaid costs of illegal immigrants when medical treatment is deemed an emergency, according to court records.

The N.C. Supreme Court noted a doctor who testified that without treatment Guatemala native Hector Diaz's condition eventually would have been an emergency. But his condition didn't meet that threshold during chemotherapy, the doctor said.

Diaz's condition during chemotherapy "was stable and, therefore, he was no longer entitled to Medicaid coverage," the court said.

Court documents say that in October 2000, Diaz came down with a sore throat, nausea, vomiting, and other ailments that were later diagnosed as symptoms of leukemia. He was treated at Moses Cone Memorial Hospital in Greensboro beginning that month, including intermittent chemotherapy treatments through July 2002.

Diaz authorized the medical provider to seek Medicaid coverage, but the state Division of Medical Assistance approved coverage for only a portion of his medical care that didn't include chemotherapy.

The chief hearing officer of the N.C. Department of Health and Human Services approved the decision. Diaz appealed to the Guilford County Superior Court, which reversed the state agency's decision.

"Payment by Medicaid is not limited to emergency services; rather, Medicaid shall pay for all care and services as are medically necessary for the treatment of an emergency medical condition," the Superior Court ruled.

The state appealed to the N.C. Court of Appeals, which unanimously upheld the trial court ruling in favor of Diaz. The state's highest court reviewed the decision and on Friday ruled in favor of the state, sending the case back to the Court of Appeals.

posted by David at 7:25 PM :: Permalink ::