Woman Fights Medicaid Denial for Disabled Sister's Lifesaving Care

Medicaid Coverage Denial

• 📌 Katherine St. Clair is fighting to restore Medicaid coverage for her sister, Lisa, who has severe cerebral palsy.
• ⚠️ Lisa's Medicaid provider, Community Health Choice, denied 30 hours a week of crucial protective supervision.
• 🎯 The stated reason for denial was that Lisa is never left home alone, a logic Katherine calls illogical.

Impact of Coverage Loss

• 😥 The reduction in coverage means Katherine is compensating by not sleeping to care for Lisa at night.
• 📉 This denial impacts care for a condition doctors once predicted Lisa wouldn't survive past age 12, yet she is now 51.

Systemic Issues and Appeals

• 🧩 Legal experts suggest the denial could stem from the managed care organization reinterpreting handbook rules or creating internal policies.
• ⚖️ Katherine has already faced initial appeal denials and a Medicaid fair hearing where the judge sided with the provider.
• ✊ Despite setbacks, she is committed to filing further appeals and becoming a voice for others without one.

Potential Resolution

• 💬 After questions were raised by the news outlet, Community Health Choice agreed to conduct another evaluation for Lisa's case.
• 🗣️ The healthcare provider stated a commitment to treating members with dignity and respect but declined to comment on the specific case.