Colorado Medicaid Program Cannot Refuse Hot Tub for HIV-Positive Patient, Court Rules
The Colorado Court of Appeals ruled on Thursday that state Medicaid officials cannot "arbitrarily refuse" to purchase a physician-recommended hot tub for a man with HIV and arthritis, the Denver Rocky Mountain News reports. The patient, identified as T.L., appealed a state Medicaid decision that denied coverage for the hot tub in 1999 and subsequent rulings by an administrative law judge and state district court judge that sided with the state. T.L.'s doctor recommended the hot tub to treat his hereditary form of arthritis that causes chronic hip pain. T.L. also suffers from various HIV-related fungal skin viruses. Joel Hayes, T.L.'s attorney, said, "While many people think of a hot tub as a luxury, our client has a need for hydrotherapy because of his arthritis, and the HIV complications, which are pretty severe, make it impossible for him to use any kind of public facility for that therapy." The court ruled that the state must follow specific criteria and individually evaluate each request for a hot tub or other durable medical equipment on the basis of medical necessity. The case was sent back to the administrative law judge for a new review (Abbott, Denver Rocky Mountain News, 10/26).This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.