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Earlier this month, the mother of a 15-year-old boy, “Daniel”, called PHLP after learning her son’s residential treatment provider would discharge him because of inadequate insurance coverage. Daniel receives treatment for his autism at a Residential Treatment Facility (RTF). However, when Daniel’s insurance transitioned from Medicaid to Children’s Health Insurance Program (CHIP), CHIP's coverage failed to meet all his health needs. In particular, CHIP would not cover Daniel’s level of treatment. Therefore, the facility planned to release him, even though he was not ready to be discharged from that level of medical treatment.
PHLP immediately stepped in and reviewed Daniel’s situation. We determined that the Pennsylvania Department of Public Welfare (DPW) inappropriately terminated Daniel’s Medicaid coverage. DPW should have placed Daniel in a different Medicaid coverage category rather than send his case to CHIP. A few days after PHLP’s outreach to state officials, DPW corrected its mistake, reinstated Daniel’s Medicaid benefits and he continues to receive the important health treatment he needs.
