From KHOU 11:
“A Montgomery County woman is fighting to restore critical Medicaid services for her sister, after a recent denial took away some of the in-home help they’ve relied on for years.
…For years, Lisa’s Medicaid plan covered over 100 hours of assistance from skilled nurses and home health aides, including 30 hours a week of protective supervision — in-home support for people with physical or cognitive impairments when caregivers are unavailable.
However, that benefit was suddenly denied in mid-February by Lisa’s new Medicaid managed care provider, Community Health Choice.
…Terry Anstee, an attorney with Disability Rights Texas, told KHOU 11 News that changes in coverage like this aren’t unusual, especially when patients switch managed care plans.
‘It could be that the managed care organization is reinterpreting the rules in the state’s STAR+PLUS handbook, or creating new internal policies,’ Anstee said.
Anstee advises families to appeal when they believe a denial is unfair, and notes that even if early appeals are denied, some cases can be ultimately overturned.”
Read the full article on KHOU.com.