L.W. v. Commissioner of the Georgia Department of Communit

── L.W. v. Commissioner of the Georgia Department of Communit ── Court: Court of Appeals for the Eleventh Circuit Date: May 18, 2026 Category: NEW USCA11 Case: 24-12774 Document: 46-1 Date Filed: 05/18/2026 Page: 1 of 28 FOR PUBLICATION In the United States Court of Appeals For the Eleventh Circuit ____________________ No. 24-12774 ____________________ L.W., a minor child, by and through his mother and legal guardian, KATIE WARD, Plaintiff-Counter Defendant-Appellee, versus COMMISSIONER OF THE GEORGIA DEPARTMENT OF COMMUNITY HEALTH, Defendant-Counter Claimant-Appellant. ____________________ Appeal from the United States District Court for the Northern District of Georgia D.C. Docket No. 1:24-cv-01912-TWT ____________________ Before ROSENBAUM, GRANT, and BRASHER, Circuit Judges. BRASHER, Circuit Judge: USCA11 Case: 24-12774 Document: 46-1 Date Filed: 05/18/2026 Page: 2 of 28 2 Opinion of the Court 24-12774 This appeal is about whether federal law requires Georgia Medicaid to provide more than 21 hours of nursing care to a three- year-old boy (L.W.) with a rare, life-threatening metabolic disease. The Medicaid Act’s Early and Periodic Screening, Diagnostic, and Treatment program requires states to provide eligible patients with private nursing services that are sufficient to correct or ameliorate the recipient’s underlying medical condition. 42 U.S.C. § 1396d(r)(5). The district court held that Georgia was likely not providing adequate private nursing services to correct or amelio- rate L.W.’s condition and enjoined the state to provide him with additional care. This appeal raises two main questions. First, whether Georgia can deny medically necessary care if it does so based on an otherwise reasonable policy. Second, whether the dis- trict court committed clear error when it found that L.W. was due more than 21 hours of weekly nursing care under the statutory standard. We answer both questions “no.” Accordingly, we affirm. I. Under the Medicaid Act, the federal government provides financial assistance to states to provide medical care to eligible ben- eficiaries. The Act requires participating states to provide Early and Periodic Screening, Diagnostic, and Treatment (“EPSDT”) services to all Medicaid-eligible patients under the age of 21. 42 U.S.C. § 1396d(a). The EPSDT program covers four broad categories of services: screening, vision, dental, and hearing. Id. § 1396d(r). The program also includes a catch-all category that requires participat- ing states to provide covered patients with “[s]uch other necessary USCA11 Case: 24-12774 Document: 46-1 Date Filed: 05/18/2026 Page: 3 of 28 24-12774 Opinion of the Court 3 health care, diagnostic services, treatment, and other measures de- scribed in subsection (a) to correct or ameliorate . . . conditions dis- covered by the screening services . . . .” Id. Subsection (a), in turn, requires participating states to provide private duty nursing ser- vices. Id. § 1396d(a)(8). Georgia’s Department of Community Health administers the Medicaid program in Georgia. Georgia offers EPSDT services through the Georgia Pediatric Program (“GAPP”), which provides private nursing se