A federal district court grants a 22-year-old man’s motion for a temporary restraining order requiring the Georgia Department of Community Health to provide him with ongoing in-home nursing care after he aged out of a pediatric Medicaid program. Royal v. Reese (N.D.Ga., No. 1:14-cv-0025-WSD, Jan. 7, 2014).

Zachary Royal, a 22-year-old Medicaid beneficiary with spinal muscle atrophy, received 84 hours a week of in-home skilled nursing services from the Georgia Pediatric Program (GAPP) until his 22nd birthday on January 6, 2014. Once Mr. Royal’s GAPP benefits ended due to his age, he became eligible for services under the Medicaid Independent Care Waiver Program (ICWP). Claiming that he would not receive an appropriate level of skilled nursing care from ICWP, Mr. Royal maintained that he should be eligible for the state’s Comprehensive Supports Waiver Program (COMP) instead. Prior to Mr. Royal’s 22nd birthday, the Georgia Department of Community Health had determined that he was ineligible for COMP. (The opinion does not state why.)

Three days before his birthday, Mr. Royal filed a motion for a temporary restraining order asking the court to enjoin the Department from cutting back his nursing services once he turned 22 because the reduction in services made it likely that he would be hospitalized, in violation of the Americans with Disabilities Act and the Rehabilitation Act. At the hearing on Mr. Royal’s motion, both parties agreed that he would be eligible for at least 50 skilled nursing visits through ICWP, and Mr. Royal also admitted that he had not worked with the state to obtain those services prior to his birthday.

The U.S. District Court for the Northern District of Georgia grants Mr. Royal’s motion for a temporary restraining order but forces the state to provide only three visits a day from nursing assistants and two visits a day from a nurse until the matter is resolved. The court finds that “[i]n light of the serious nature of Plaintiff’s medical condition . . . Plaintiff may well suffer irreparable injury if some in-home, skilled nursing care was not provided now that Plaintiff has aged out of GAPP. Further, Defendants have acknowledged that Plaintiff is entitled to at least fifty (50) visits by a skilled nurse, and therefore granting Plaintiff limited relief in this regard does not present substantial harm to Defendants. The Court finds, in any case, that the threatened injury to Plaintiff if relief is not granted outweighs the harm the relief inflicts on Defendants.”

To read the full text of this decision, click here.


Georgia Court Grants TRO Allowing Man to Continue to Receive Services After Aging Out of Medicaid
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