Urban v. Meconi

BERGER, Justice.

In this appeal, we consider whether the Delaware Department of Health and Social Services (DHSS) properly denied a claimant’s request for surgery under the Medicaid Early and Periodic Screening Diagnostic and Treatment (EPSDT) program. DHSS determined that the surgery was not the “least costly, appropriate, available health service alternative” 1 because the claimant would benefit from weight loss prior to surgery. The claimant’s treating physician determined that the surgery was medically necessary, after giving consideration to her weight. In addition, the claimant obtained…