Pennsylvania Health Law Project: Helping People in Need Get the Health Care They Deserve

Client Spotlight: The Value of In-Home Nursing for Kids 

For parents of children with significant special health care needs, in-home nursing is essential, allowing parents to sleep, work, and perform basic household tasks knowing their child is safe.  
So when a Medicaid Managed Care Insurance Care Plan (Insurer) denied in-home nursing for 6-year-old Brody, his parents contacted PHLP. Brody is diagnosed with Lesch-Nyhan Syndrome (LNS), a rare genetic disorder which leads to physical and mental disabilities. Because of his disorder, Brody requires constant care to remain safe and healthy at home.

The Insurer’s refusal to provide in-home nursing was particularly egregious because the same type and amount of care had been approved just a few months earlier, and there was no change in Brody’s condition!
PHLP immediately challenged the Insurer’s denial and sought a fair hearing. Our advance preparation included reviewing Brody’s voluminous medical records about the severity of his condition and coordinating testimony from his parents and doctors to prove in-home nursing was “medically necessary.” That preparation made a difference. On the eve of trial, the Insurer reversed its position and agreed to authorize all the requested hours. Brody once again has the care he needs.
When Brody was diagnosed with LNS at just 9 months old, his doctors said he would have an “impossible life.” But due to the dedication of Brody’s parents, his doctors, and his nurses, Brody flourished. It is our privilege to be counsel for families like Brody’s.
We’re also tickled by Brody’s mother’s post to other parents: “I have to say, our [PHLP lawyer] kicked BUTT!!! … [W]e are so pleased with what she has done for us. She pretty much took control of the conversation and told the insurance company exactly what we needed and why we needed it.” 

Getting More Kids Covered: PHLP To Train Professionals in Family Courts, Pediatric Offices & Legal Aid Programs

Pennsylvania has a history of providing health insurance coverage to children in moderate- to low-income families. This coverage, through either Medicaid or the Children’s Health Insurance Program (CHIP), is free or subsidized for some at low-cost. 

However, a small but significant percentage of eligible children are not enrolled.  This is harmful.  We’re working to change that thanks to a recent grant from the federal government

Beginning this fall, PHLP will travel across the state to train family serving professionals about
  1. the availability of children’s health insurance,
  2. how to inform families about coverage options, and
  3. where to refer families who need assistance applying for or renewing their coverage. 
Some of the background papers for the targeted professional groups are posted on PHLP’s web site and can be found here: [Family Courts] [Legal Services Programs]. 

Join us in Harrisburg at the PA Health Access Network's 5th Annual Conference

PHLP will attend and present at the Annual Conference of the PA Health Access Network (PHAN) on September 22-23 at the Crowne Plaza, 23 South 2nd Street, in Harrisburg. State and federal officials, health care advocates, and policy experts will gather to hear the latest on key federal health reforms. Workshops topics include:
  • How The New Health Insurance Marketplace Will Work In Pennsylvania
  • Enrolling Pennsylvanians In The New Marketplace
  • Rules For Determining Eligibility For Premium Tax Credits As Well As Medicaid & CHIP
  • Understanding Essential Health Benefits
  • Becoming A Certified Application Counselor
To register visit PHAN’s website or click here.  
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The Pennsylvania Health Law Project is a nationally recognized expert and consultant on access to health care for low-income consumers, the elderly, and persons with disabilities. PHLP engages in direct advocacy on behalf of individual consumers while working on the kinds of health policy changes that promise the most to the Pennsylvanians in greatest need.
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