PHLP Helps 13-Year-Old Katie Stay in School with Her Aide
For children with chronic disorders such as cerebral palsy, which affect a person's ability to move and maintain balance and posture, the support of one-on-one aides is critical to remaining safe at school. Katie, a 13-year-old from Luzerne County with cerebral palsy, has relied on an aide during the school day and when riding the bus to and from school. Katie’s aide is paid for by Medicaid, the insurance program created to support children with complex medical conditions.
But recently, Katie’s Medicaid Managed Care Plan (Insurer) notified her family that they would terminate Katie’s helper, even though there was no improvement in Katie’s functioning or change in her personal care needs. Her Insurer simply concluded that these services were no longer necessary and that educational aides in Katie’s classroom should meet her needs.
Fortunately, Katie’s family contacted PHLP.
We advised Katie’s mother to appeal the Insurer’s denial immediately so that Katie could keep her personal care aide until her legal rights were exhausted. Then we gathered support from Katie’s school, her doctors, and her nurses to demonstrate her continued need for personal care assistance. All understood that there is no cure for cerebral palsy and that medically necessary treatment includes the type of in-school support already in place. Presented with testimony and documentation, Katie’s Insurer overturned the denial.
Katie’s mother could not be happier or more relieved now that Katie, with her aide by her side, can safely continue attending school.
To help clients like Katie, consider donating to PHLP today.