Meyers by Walden v. Reagan

• Decision Date: 04 November 1985
• Docket Number: 85-1071,Nos. 85-1070,s. 85-1070
• Citation: 776 F.2d 241
• Parties: , Medicare&Medicaid Gu 34,993 Jeanne MEYERS, by her next friend, Helen WALDEN, Appellee, v. Michael V. REAGAN and Donald Kassar, Appellants. Jeanne MEYERS, by her next friend, Helen WALDEN, Appellant, v. Michael V. REAGAN and Donald Kassar, Appellees.
• Court: U.S. Court of Appeals — Eighth Circuit

Page 241

776 F.2d 241

11 Soc.Sec.Rep.Ser. 206, Medicare&Medicaid Gu 34,993

Jeanne MEYERS, by her next friend, Helen WALDEN, Appellee, v. Michael V. REAGAN and Donald Kassar, Appellants.

Jeanne MEYERS, by her next friend, Helen WALDEN, Appellant, v. Michael V. REAGAN and Donald Kassar, Appellees.

Nos. 85-1070, 85-1071.

United States Court of Appeals Eighth Circuit.

Submitted June 11, 1985.

Decided Nov. 4, 1985.

Eleanor E. Lynn, Des Moines, Iowa, for the appellant.

Thomas Krause, Sioux City, Iowa, for the appellee.

Before McMILLIAN and FAGG, Circuit Judges, and WOODS, ^* District Judge.

FAGG, Circuit Judge.

Michael Reagan is the Commissioner of the Iowa Department of Human Services (Department). At the time the complaint was filed, Donald Kassar was the Chief of the Department's Bureau of Medical Services. The Department is responsible for the administration of the Medicaid program within the state. Reagan and Kassar appeal from the district court's order of summary judgment requiring them to furnish an electronic speech device for a Medicaid recipient, Jeanne Meyers. Meyers cross-appeals from the district court's refusal to require Reagan and Kassar to furnish Meyers a more sophisticated speech device. We reverse the district court's order of summary judgment because we find that a factual issue remains regarding which speech device is appropriate for Meyers under Iowa's Medicaid plan.

Jeanne Meyers is a mentally retarded adult with a speech handicap who lives at a residential care facility in Iowa. She is a recipient of federal supplemental security income which entitles her to benefits under Iowa's Medicaid program. See 42 U.S.C. Sec. 1396a(a)(10)(A)(i); 42 C.F.R. Sec. 435.120; Iowa Code Sec. 249A.3(1)(a). Upon the recommendation of a speech pathologist, Meyers' doctor prescribed for Meyers a HandiVoice 110, an electronic device that transmits speech. Meyers requested that the Department furnish the device under the state's Medicaid program. The Department denied the request on the basis that electronic speech devices are not covered under the state's program.

Meyers then brought this action claiming that her statutory right to Medicaid benefits had been violated. After a more expensive device, the Vois Model 130, with additional features became available on the market, Meyers amended her complaint requesting that the court, in the alternative, order that Reagan and Kassar furnish her with a Vois Model 130. Meyers then filed a motion for summary judgment.

Attached to her motion were affidavits from her physician and speech pathologist expressing their beliefs that an electronic speech device is a necessary and reasonable form of treatment for Meyers' condition. Reagan and Kassar resisted the motion, claiming that there were genuine issues of material fact yet to be resolved. They submitted an affidavit of Donald Herman, the current Chief of the Bureau of Medical Services, who stated that a less expensive and sophisticated speech device such as the Vocaid could adequately meet Meyers' needs and that the Department would furnish a device in the price range of the Vocaid.

Upon granting Meyers' motion for summary judgment, the district court enjoined Reagan and Kassar from denying coverage of all electronic speech devices under Iowa's Medicaid plan and ordered them to pay the costs for the HandiVoice 110. In an amended judgment, the court denied Meyers' request for the Vois Model 130 holding that "the additional functions of the Vois Model 130 substantially exceed the requirements of [Meyers'] present condition." The court did not discuss whether the Vocaid was sufficient to meet Meyers' needs.

Medicaid is a program of federal assistance designed to help participating states provide medical assistance to needy persons. Harris v. McRae, 448 U.S. 297, 301, 100 S.Ct. 2671, 2680, 65 L.Ed.2d 784 (1980). The primary goal of Medicaid is to provide medical assistance to these individuals and to furnish them with rehabilitation and other services to help them "attain or retain capability for independence or self-care." 42 U.S.C. Sec. 1396. To achieve this goal, Congress requires participating states to provide financial assistance in a number of general categories of medical treatment. 42 U.S.C. Secs. 1396a(a)(10)(A), 1396d(a)(1)-(5), (17). The participating state may also elect to provide other optional medical services listed in Title XIX of the Social Security Act. See 42 U.S.C. Sec. 1396d(a)(6)-(16), (18).

Iowa's Medicaid plan includes the optional service of "physical therapy and related services." 42 U.S.C. Sec. 1396d(a)(11); Iowa Code Sec. 249A.2(6). "Related services" includes professional assistance for individuals with speech, hearing, and language disorders. See 42 C.F.R. Sec. 440.110(c)(1). A recipient with a speech disorder is entitled to "diagnostic, screening, preventive, or corrective services provided by or under the direction of a speech pathologist * * *, for which a patient is referred by a physician. It includes any necessary supplies and equipment." Id.

Reagan and Kassar argue that because a state has broad discretion in determining the extent of medical services it offers under its Medicaid plan, see Beal v. Doe, 432 U.S. 438, 444, 97 S.Ct. 2366, 2370, 53 L.Ed.2d 464 (1977), Iowa could properly exclude electronic speech devices from coverage under its plan. We disagree. Once Iowa chose to offer ...