Medicaid Coverage Reinstated for Conroe Family After KHOU 11 Investigation

Medicaid Denial and Appeal

• 📌 A Conroe family faced the denial of critical Medicaid coverage for their disabled sister, Lisa, who requires around-the-clock care.
• ⚠️ Katherine Sinclair, Lisa's primary caregiver for nearly 20 years, found that 30 hours of protective supervision, vital for overnight assistance, were suddenly cut by their provider, Community Health Choice.
• 💡 The denial was particularly baffling as eligibility requirements and Lisa's condition had not changed, and there was a 12-year precedent for the care provided.

Partial Reversal and New Complication

• ⚡ Following KHOU 11's report and subsequent questions, Community Health Choice officials re-evaluated Lisa's case.
• 📉 While a partial reversal occurred, reinstating the 30 hours of protective supervision, another 10.5 hours from a different program were slated for removal, this time due to questions about feeding tube management.

Full Reinstatement and Media Impact

• 💬 Katherine Sinclair wrote to the Community Health Choice CEO, leading to a phone call where officials admitted potential confusion and miscalculation.
• ✅ By the end of the call, all of Lisa's at-home health assistance hours were fully reinstated, bringing immense relief to the family.
• 🚀 Katherine strongly believes that media attention from KHOU 11 was the catalyst that prompted the reversal and rattled walls within the provider.

Advice for Others

• 🤝 The family hopes their experience will empower others facing Medicaid denials to stand up and fight for their essential care.
• 📚 Their advice to others in similar situations is to find advocates to help navigate the appeals process and never give up.