Teen Fights for Benefits as Medicaid Contractor Says No

By Christopher Flavelle and Charles R. Babcock - 2012-06-27T04:01:00Z

Melody and Steve Lancaster’s 16- year-old foster son, who’s paralyzed from the neck down, needed a mechanized ceiling lift to help him get into the bathtub or his favorite beanbag chair.

While Texas Medicaid officials had already paid as much as $13,000 for similar devices for others, the company that the state hired to look after the teenager’s health needs refused. Superior Health, a unit of Centene Corp. (CNC) that covers about 800,000 Texas Medicaid recipients, also rejected at least two other requests for lifts, state records show. The Lancasters’ foster son and another patient appealed, and won. The third case is pending.

“Superior is more concerned with its bottom line than the medical needs of these children,” said Peter Hofer, a lawyer with the advocacy group Disability Rights Texas who represented the teenager.

The October 2011 denial was based on Superior’s decision that the lift was a home modification not covered by its plan -- a determination a state hearing officer overruled in April, according to state records. Superior is committed to helping patients and is working with officials “to adjust our policies and procedures” on the lifts, said Sandy McBride, a Centene spokeswoman.

MORE...

http://www.bloomberg.com/news/2012-06-27/teen-fights-for-benefits-as-medicaid-contractor-says-no.html