Home » Justice Update » Justice Timed: Home care hours restored for double amputee
“Mary” is a 56-year-old double amputee living with HIV. More than a decade ago, she was injured in a fall, and an infection spread to both of her legs. Double amputation was the only way to get the infection under control.For many years, Medicaid paid for her in-home care, eight hours a day, seven days a week. In January 2019, a managed care company took over her Medicaid services. Her ongoing care needs were scheduled to be reviewed every six months. The review included an in-home assessment. No changes were recommended in the first four reviews. The trouble started in November 2020, when the reviewer called and said he was sick and didn’t want to come to her house because of COVID concerns. Instead of rescheduling the appointment, the review was submitted without the in-home assessment. The managed care company claimed she refused the in-home assessment and cut her home care hours in half.Mary filed a grievance. Fearful about how she would manage without full-time assistance, she asked her doctor for help. He told her to call us.Knowing that Mary desperately needs uninterrupted care, we advocated with the managed care company. We requested that her hours not be cut, while we appealed the decision. In the end, we were able to settle the matter with the managed care company’s legal department, and Mary’s benefits were restored. Despite her struggles, Mary can continue to live in her own home.