Josh

By age two, Josh* met all his  developmental milestones, except speech and language development.  His pediatrician suggested Josh be evaluated by Pennsylvania's Early Intervention (EI) program, which provides services and supports to children with developmental delays and/or disabilities from birth to age five.  At Josh's EI evaluation, he was found eligible for speech therapy services based on his language delays. He began receiving speech therapy one hour per week, and his communication and language skills quickly improved.  Josh's family was thrilled, but they had no idea of the challenges still ahead.

When Josh turned three, Early Intervention decreased his speech therapy services significantly.  He could now only get speech therapy 45 minutes twice a month; and in the summer, just once a month.  Josh's family was heartbroken and feared his speech would decline and potentially lead to other delays or missed milestones down the road if not addressed properly at his young age.  The family could not afford to pay privately for the speech therapy Josh needed, so they applied for Medicaid (Medical Assistance) coverage, with the hopes that Medicaid could pick up the difference and help ensure Josh received the services he needed to thrive and develop with his peers.

The first challenge came when Josh’s Medicaid application was denied because the caseworker at the County Assistance Office failed to consider Josh's medical history and conditions.  They should have reviewed him under the category of eligibility known as PH-95. But because they failed to do so, his application was denied due to his family's moderate income.  This type of denial is all too common.  Josh's already overwhelmed parents were so discourged.  They did not appeal the denial.  But then one of Josh’s therapists told his parents about PHLP.   They called our Helpline to see if anything could be done.  We are so glad they did.  

After reviewing the Medicaid denial notice, we quickly realized that Josh’s medical history and conditions weren't considered when his application was reviewed.  By then, the appeal deadline had passed, but the family was still within the 60-day deadline to request Reconsideration (a process separate from the formal appeal process.)  PHLP requested reconsideration of the denial on Josh's behalf, and we pointed out that the caseworker had failed to consider Josh's medical history as they should have and thus, the denial was inappropriate.  The county caseworker agreed with us and reviewed the medical they already had one file, but had overlooked. Josh was approved for Medicaid immediately and his coverage went all the way back to the date of his original application!

Josh was recently evaluated at an outpatient speech therapy facility and is now receiving speech therapy twice a week for 30 minutes per session. These services would have been inaccesible for Josh without Medicaid.  His mom stated, "I’m so grateful that I was put in touch with PHLP and they helped my family navigate what was a foreign process to us.”
 
* Names have been changed