ROBERT IMRIE ASSOCIATED PRESS
A Rusk County nursing home resident won a fight with the state Tuesday to have Medicaid pay for his new, $14,000 power wheelchair.
A judge erred in upholding the state Department of Health and Family Services' refusal to pay for 58-year-old Gerald Trott's wheelchair, the 3rd District Court of Appeals said.
The state's denial was "premised on an incorrect interpretation of law," Judge Michael Hoover wrote for the three-judge appeals court.
At issue in the decision was a law about Medicaid regulations regarding wheelchairs for nursing home residents, and who should pay for the more sophisticated medical equipment not generally provided by nursing homes.
Medicaid is a federal program for low-income and disabled patients. The state contributes 40 percent of the money, and the federal government 60 percent.
Trott's attorney, Monica Murphy of the Wisconsin Coalition for Advocacy, said Tuesday's appellate decision was "wonderful" and could lead to more people in nursing homes getting power wheelchairs paid for by the taxpayer-funded Medicaid program.
According to court records, Trott suffers from multiple sclerosis, a progressive neurological disease.
He requested a new wheelchair to replace a six-year-old one he had been using. But he argued it could not be adapted to mount electronic accessories for such things as opening a door or turning on lights and television.
The older wheelchair also did not fit him properly due to weight gain and spinal deformities, court records said.
The state refused to pay for the wheelchair with Medicaid money, saying Trott failed to meet all the qualifications for receiving it and he failed to demonstrate the wheelchair was required for occupational or vocational activities.
A Rusk County Circuit upheld that decision.
But the appeals court
said Trott only had to meet one of the exceptions for getting the power
wheelchair under Medicaid, not two as the state said, and he met it.