Client Spotlight: Preserving In-School Pediatric Care for the Medically Frail
Five-year-old Kyler lives with seizure disorder, autism, and developmental delays. Every day he attends school and relies on his private duty nurse, who ensures that he receives his medications and is kept safe during his near-daily seizures. Kyler’s seizures are so severe and frequent that he often requires immediate emergency medical attention that only his nurse can provide. Without that nurse, it would not be safe for Kyler to attend school. So when his Medicaid Managed Care Plan (Insurer) terminated Kyler’s nursing care, even though there was no improvement in Kyler’s medical condition, his mother contacted PHLP.
To challenge the Insurer’s denial, PHLP gathered strong supporting documentation from Kyler’s doctors and nurses demonstrating his need for in-school nursing. At trial, PHLP called experts who testified that nursing services remained medically necessary for Kyler, and his condition did not warrant their termination. The Judge agreed and ordered the Insurer to continue supports during the school day.
Since trial, Kyler is still doing well in school. His mom told PHLP, “Your work on this case will never be forgotten and always be appreciated! I cannot thank you and your team for your hard work and dedication!” PHLP staff feels privileged to do this work, and are committed to fighting for children like Kyler.
Securing Health Coverage for Immigrants: Resources Available!
Securing health care coverage is daunting, but there are additional barriers facing immigrants.
"Nina," a pregnant woman who is a lawfully present immigrant in Pennsylvania, was in a bind after she received conflicting information about her eligibility for health insurance. She was told by the Pennsylvania Department of Public Welfare (DPW) that she was not
eligible for Medicaid due to her immigration status. However, the Federal Health Insurance Marketplace told her that she did not qualify for “private” coverage on the Marketplace because she was eligible for Medicaid. Nina was unsure how to get the care she needed. She was stuck with contradictory information and denied through both paths to coverage!
Women’s Law Project
in Pittsburgh reached out to PHLP on Nina’s behalf. Our staff quickly realized that DPW incorrectly found Nina ineligible for Medicaid, and PHLP helped Nina appeal the denial – successfully! Our friends at Women’s Law Project say they “can’t thank [PHLP] enough; you were the only people who understood the complexities of the way Medicaid works (or doesn’t work) for immigrants.”
Nina is excited and optimistic about her pregnancy, now that she knows she has access to the medical care she needs. PHLP was glad to have provided guidance to help her secure care.
The following resources provide more guidance on immigrants accessing health care: