This is a good day for 11-year-old Rachael Eaves. It's 1:30 p.m. and she's had only four minor seizures.

Bad days, which come about once a month, send her to the emergency room, including three times in April, once to remove her gallbladder.

A brain injury at birth left Rachael profoundly disabled, unable to speak or see much or even reposition herself for comfort. The brown-haired, brown-eyed girl, who weighs only 60 pounds, is fed through a tube and regularly has trouble breathing, digesting her food and maintaining safe body temperature.

She requires almost constant attention.

Rachael's mother, Michelle Eaves, said the stress has worsened since 2006 when the state reduced the number of hours it will pay for a home nurse, from 60 hours a week to 40. The nurse is paid through Medicaid, the program the state manages and funds with a mix of state and federal dollars. Eaves has filed an appeal with the state Department of Community Health and expects a ruling within weeks.

Ruling could ripple

Eaves is among many parents who hope a recent Atlanta federal court decision and a new state law will strengthen their chances of getting more state-paid care. She said since the cut in the nursing hours, Rachael has suffered more severe respiratory problems and infections.

Though the impact of the law and the court action is still unclear, both are hopeful signs to parents and child welfare advocates who have fought long battles with the state. The Eaveses are among hundreds of families whose children's medical services were cut by the state in recent years, advocates say.

They argue that Medicaid should pay for services a doctor orders. The state says it has discretion in those decisions.

A handful of similar battles over the Medicaid law are playing out across the nation, said Sarah Somers, an attorney with the National Health Law Program, an advocacy group.

Georgia, she said, has a reputation for resisting doctors' decisions on Medicaid services.

Georgia child advocates blame what they call a dollar-conscious, policy-driven state bureaucracy they say shortchanges children, violates their federal rights to health care and eventually harms their health.

Georgia Medicaid officials, for their part, deny that money drives their decisions; they say they focus on what the child needs. They say they have a responsibility to watch over state money funneled to Medicaid and that they serve as a check against fraud and the overuse of services.

"The busy physician may sometimes approve services without carefully considering the medical necessity or appropriateness of those services," said Will Battles, a spokesman for the Georgia Medical Care Foundation, which reviews Medicaid cases for the state.

The federal court ruling could have widespread implications, considering that some 700,000 children in Georgia are eligible for Medicaid, advocates say. The federal judge said that, in this case, the state does not have discretion to deny or reduce Medicaid services prescribed by the child's treating physician. Advocates welcomed the decision as a powerful precedent.

"So many advocates are rallying around this decision," said Joann Yoon, a child policy specialist for the advocacy group Voices for Georgia's Children. "It's a huge protection provided for children."

New law clarifies

The federal case has striking similarities to the Eaves case. The doctor for 13-year-old Anna "Callie" Moore, a developmentally disabled North Georgia girl, prescribed 94 hours a week of home nursing care, but the state approved only 84 hours.

Dr. Rhonda Medows, DCH commissioner, asserted in court filings that the state can limit the treatment provided a child under Medicaid. Medows declined through a spokeswoman to discuss the case for this article, saying the agency does not discuss ongoing lawsuits.

Meanwhile, a new Georgia law is intended to fix problems with state programs that, according to the wording of the law, "have made it difficult for children with disabilities ... to receive the services to which they are entitled."

The law largely focuses on clarifying the review and approval process for Medicaid services. Importantly, it clarifies that "medically necessary services" means services or treatments prescribed by a physician or other licensed professional.

In a statement, the state health agency said it is working to "perfect the review policies and procedures" to comply with the new state law.

The agency said it could not readily provide statistics on how often it denies or reduces services that doctors order for children.

Importantly, neither the court decision nor the new law prohibits the state from reviewing Medicaid services for these children, but rejections must now be explained in writing to a family.

Joshua Norris, an attorney with the Georgia Advocacy Office, which represented Rachael Eaves and Anna Moore, said he believes the state has been denying and reducing services due to cost considerations and wrong-headed policies.

"When they deny services, they better have a very good reason," Norris said.

Fighting a state decision can be tough. Michelle Eaves said the state letter that reduced her daughter's nursing hours didn't explain why. The contact number on the letter didn't work. Despite filing an appeal within 10 days, she said she had to wait a year and a half for a hearing.

"It gets so overwhelming," Eaves said. "You don't have the mental strength. It's a huge mental battle. I think Medicaid wants you to give up."

Advocates say they've seen other court decisions that raised hopes and resulted in little change.

At the Eaves home in Sandy Springs, Michelle Eaves, who has two other small children, is having to do everything herself. Two days a week, the state won't pay for a nurse. So she performs the breathing treatments that include running a tube down her daughter's throat to clear her airway.

Eaves admits she can't always spot the signs that something serious is brewing. Rachael has had pneumonia five times in two years, in part, her mother says, because a nurse was not present to identify respiratory problems early.

The muscular arms on the 4-foot-11 woman attest to her efforts lifting her daughter in and out of bed, onto the changing table and onto the stationary bike that automatically moves the pedals.

Her husband's insurance pays for most of Rachael's services, but the family has reached the maximum the insurance provides for home nursing.

For Michelle Eaves, it's enough to see her daughter smile and coo at her singing. Sometimes when she places Rachael in a swing, the child gets so excited she kicks her shoes off and squeals.

"She loves kisses and hugs," Michelle said. "This kid gets a lot of love."