L.W. v. Commissioner of the Georgia Department of Community Health

Holding: The Eleventh Circuit affirmed the preliminary injunction, holding that Georgia Medicaid must provide sufficient nursing care to correct or ameliorate the plaintiff's condition and that the district court did not abuse its discretion in granting the injunction without a bond.
Standard: Medicaid Act EPSDT standard; preliminary injunction factors
Vote: Affirmed by a majority opinion; a concurring opinion agreed with the judgment but expressed concern about the majority's broader ruling on state policies.
Practical effect: The ruling confirms that Medicaid recipients can challenge the specific amount of care provided on an individual basis, even if the state's general policies are reasonable, ensuring that federal statutory standards for medical necessity are met in practice.

L.W. v. Commissioner of the Georgia Department of Community Health

May 18, 2026 ·1:24-cv-01912-TWT ·Published ·BRASHER · By Aisha Johnson

The Eleventh Circuit affirmed a preliminary injunction requiring Georgia Medicaid to provide a three-year-old boy with a rare metabolic disease more than twenty-one hours of weekly nursing care. The court held that a state cannot deny medically necessary care based on a reasonable policy if the care provided fails to meet the federal statutory standard.

Background

A three-year-old boy with a rare metabolic disease requiring constant glucose monitoring and feeding via a gastrostomy tube applied for increased nursing care under Georgia’s Medicaid program. The state approved only twenty-one hours of care per week, while the child’s physician and mother argued that significantly more hours were medically necessary to prevent death. The district court granted a preliminary injunction requiring the state to provide at least one hundred hours of care, which the state appealed.

The court’s reasoning

The court affirmed the district court’s decision, holding that the Medicaid Act requires states to provide care sufficient to correct or ameliorate a patient’s condition regardless of whether the state’s underlying policy is reasonable. The court found no clear error in the district court’s factual determination that twenty-one hours was insufficient given the child’s medical needs and the unsustainable burden on his parents. The court also rejected the argument that the plaintiff needed to exhaust state administrative remedies before filing a Section nineteen eighty-three claim.

What it means going forward

The ruling confirms that Medicaid recipients can challenge the specific amount of care provided on an individual basis, even if the state’s general policies are reasonable, ensuring that federal statutory standards for medical necessity are met in practice.