A New Jersey appeals court overturns the state Division of Medical Assistance and Health Services’ denial of a woman with disabilities’ request for a motorized wheelchair to help her get around a nursing home, finding that it is medically necessary and not equipment that a nursing home would typically provide as part of its per diem services.  M.S. v. Division of Medical Assistance and Health Services (N.J.Sup.Ct.App.Div., No. A-4816-13T3, Jan. 14, 2016).

M.S. suffers from multiple disabilities and is partially paralyzed as a result of a stroke.  She receives care in a nursing home through New Jersey’s Medicaid program.  Since M.S. can control only one side of her body, the nursing home provided her with a manual one-arm wheelchair to get around the facility and participate in activities.  The wheelchair caused increased pain in M.S.’s shoulder and limited her mobility in the nursing home.  M.S. submitted a request for a motorized wheelchair to the Division of Medical Assistance and Health Services.

The Division rejected M.S.’s request because it determined that the wheelchair was included as part of the per diem rate paid to the nursing home, but an administrative law judge (ALJ) overturned the Division, agreeing with the nursing home director and M.S. that the chair was medically necessary and was not routinely used in the nursing home and therefore was not covered by the per diem charges.  The Division overruled the ALJ’s determination and M.S. appealed.

The New Jersey Superior Court, Appellate Division, reverses and remands the case back to the Division.  The court finds that “[t]here is no evidence in the record that power wheelchairs are routinely used or essential to the facility’s services . . . [t]hus, the requested power wheelchair was not excluded by [the Medicaid statute], and may be covered if ‘required due to the medical need of’ petitioner.”  (The court agrees with the ALJ that the wheelchair is medically necessary.)  However, the court remands the case for further inquiry into whether it is more cost effective for the nursing facility to provide an attendant to move M.S. around the facility instead of providing her with a wheelchair.

To read the court’s decision, go to:  http://law.justia.com/cases/new-jersey/appellate-division-unpublished/2016/a4816-13.html