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Update on Medicaid Prescription Footwear and Stocking Benefit

In an eMedNY communication on Wed., Dec.18, the Medicaid benefit for compression stocking and prescription footwear was changed based on a Mon., Dec. 9 ruling.

"Judge Charles J. Siragusa ruled that the limitations on medically necessary orthopedic footwear and compression stockings applied as a result of April 1, 2011 amendments to New York Soc. Serv. Law § 365-a(2)(g)(iii) and (iv) can no longer be applied in Medicaid coverage determinations. (Davis v. Shah, W.D.N.Y., 12-CV-6134)."

As a result of this ruling, effective Dec. 9, the Medicaid program is returning to medical necessity criteria applied before the April 1, 2011 state law amendments.

  • The criteria for coverage of medically necessary prescription footwear, shoe modifications and additions is no longer limited to diabetics, children under the age of 21, or for use as part of a lower limb brace.
  • The criteria for coverage of medically necessary compression and support stockings coverage is no longer limited to use during pregnancy or for treatment of open venous.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871