The Eleventh Circuit Court of Appeals has ruled that the Georgia Medicaid program must provide more than 21 hours of nursing care per week to a three-year-old boy with a rare metabolic disease. This decision comes after the child, referred to as L.W., faced life-threatening health risks due to inadequate nursing support. The ruling highlights the importance of ensuring that vulnerable children receive proper medical care under federal law.

The case began when L.W.'s mother, Katie Ward, sought additional nursing hours after moving to Georgia from Virginia, where L.W. received 96 hours of care weekly. After applying for increased nursing services through the Georgia Pediatric Program, L.W. was granted only 21 hours per week. This led to a legal battle over whether Georgia Medicaid was fulfilling its obligations under the Medicaid Act.

In May 2026, the Eleventh Circuit affirmed a lower court's decision that found Georgia was likely not providing adequate nursing services to L.W. The court emphasized that the Medicaid Act requires states to provide sufficient care to correct or ameliorate a patient's medical condition. This ruling is significant not only for L.W. but also for other children relying on Medicaid for essential health services.

Background

L.W. is a minor child diagnosed with a rare metabolic disorder that severely affects his ability to store and utilize glycogen, putting him at risk for hypoglycemia. To manage his condition, he requires constant monitoring and feeding through a gastrostomy tube (G-tube) every three hours. The disease can lead to severe complications, including lethargy, seizures, and death if not managed properly.

Before relocating to Georgia, L.W. and his family lived in Virginia, where he received comprehensive care, including 56 hours of private nursing services and 40 hours of Consumer Directed Care. Upon their move to Georgia in March 2023, L.W.'s mother applied for increased nursing hours, but the state's Department of Community Health approved only 21 hours per week. The decision was based on a review by Alliant Health Solutions, which determined that the hours allotted would meet L.W.'s needs.

In January 2024, L.W.'s mother requested an increase to 40 hours per week, supported by a letter from L.W.'s physician, Dr. Neena Champaigne, detailing the medical necessity for additional care. However, Alliant denied this request, stating that it did not demonstrate a change in L.W.'s medical condition. After another request for 100 hours was similarly denied, L.W.'s mother filed a lawsuit against the Commissioner of the Georgia Department of Community Health, claiming that the state was violating L.W.'s rights under the Medicaid Act and the Fourteenth Amendment.

The Ruling

The Eleventh Circuit's ruling focused on two main issues: whether Georgia could deny medically necessary care based on its policies and whether the lower court erred in determining that L.W. required more than 21 hours of nursing care. The court ruled that Georgia could not deny care simply because its policies were reasonable; the state must still meet federal requirements for adequate medical care.

In its opinion, the court stated, "Even if the policy is reasonable, the care that Georgia Medicaid provides must still meet the statutory standard." The court emphasized that the Medicaid Act requires states to provide sufficient services to correct or ameliorate patients' conditions, and therefore, L.W. was entitled to more nursing hours.

The ruling also noted that the district court had made several factual findings, including that L.W. required 24-hour supervision and that his parents could not provide the necessary care alone. The Eleventh Circuit affirmed the lower court's preliminary injunction that mandated Georgia to provide L.W. with at least 100 hours of nursing care per week.

Impact

This ruling has significant implications for L.W. and other Medicaid recipients in Georgia. It reinforces the requirement that state Medicaid programs must provide adequate care to meet the medical needs of children, particularly those with complex health conditions. The decision also establishes that Medicaid beneficiaries can challenge the adequacy of care on an individual basis, ensuring that their rights are protected under federal law.

The ruling underscores the importance of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program, which mandates that states provide necessary health care services to eligible children. This case may set a precedent for other families facing similar challenges in accessing adequate care through Medicaid, potentially leading to increased scrutiny of state policies and practices regarding nursing care and other essential services.

What's Next

Following the Eleventh Circuit's decision, Georgia Medicaid must comply with the ruling and provide L.W. with the ordered nursing care. It remains unclear whether the state will seek further appeals or adjustments to its policies in response to this ruling. However, the case highlights ongoing concerns about the adequacy of Medicaid services and may prompt further legal challenges from other families in similar situations.