Florida Medicaid Plan Must Cover Child’s Growth Hormone Care

Florida’s Agency for Health Care Administration wrongfully upheld a Medicaid plan’s refusal to pay for a child’s growth hormone treatment because it used predefined criteria to narrowly define what “medically necessary” care the child required, a state appeals court said.

The agency’s application of its criteria was inconsistent with Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment benefit for children, and thus shouldn’t have been dispositive in Q.H.'s appeal from Sunshine State Health Plan Inc.'s refusal to pay for her prescription Norditropin Flexpro, the Florida District Court of Appeal, Fourth Circuit said Wednesday.

Q.H.'s height dropped from the 45th percentile ...