Client Spotlight: PHLP Secures In-Home, Overnight Nursing for 3-Year-Old with Seizure Disorder
For many children with significant health needs, in-home overnight nursing care is essential during day and evening hours. Working parents simply cannot provide the medically necessary round-the-clock care. Families need help!
“Mason” is a child who benefits from such care. In-home nursing care has kept him with his family. A three-year-old from Allegheny County, Mason is developmentally delayed and has a seizure disorder so severe that he had part of his brain removed to control his seizure activity. His health insurer, a Medicaid Managed Care Plan (“the Plan”) provided overnight nursing to monitor his condition so that Mason’s parents, who both work full-time, could rest.
Their sleepless nights began when the Plan denied overnight nursing services, maintaining that they were no longer medically necessary. However, Mason’s parents feared that their son was still at risk of seizures during the night, and his doctor shared their fears. Mason’s parents went through three levels of appeal
with the Plan on their own to fight for overnight nursing, and they lost at each level.
Resolved to maintain their son’s safety, Mason’s parents contacted PHLP. Agreeing to represent them at their Fair Hearing, PHLP prepared additional materials to strengthen the case and convinced the treating neurologist to participate and testify at the hearing. In the end, the administrative law judge ordered the Plan to continue overnight nursing hours for Mason. PHLP’s assistance made the difference and resulted in a win for Mason and his parents, who can now rest assured that their son is safe.
PHLP Comments on the Harmful Impacts of Pennsylvania's Proposal to Restructure Medicaid
In December 2013, the Department of Public Welfare (DPW) released a draft application to the federal government called Healthy Pennsylvania
to significantly change its Medicaid program. This month, PHLP commented on Healthy Pennsylvania
In short, PHLP was encouraged by the Administration’s proposal to expand Medicaid coverage to half a million uninsured adults, but deeply disappointed because elements of Healthy Pennsylvania
—e.g., work requirements and premiums—create significant barriers to coverage, for both current and future consumers, and render existing Medicaid coverage less effective.
The comments PHLP authored or supported can be found below: