Chloe

Chloe is a 15-year-old who loves performing in her school’s theatre program and hanging out with friends — just like any teenager on the verge of turning 16. She also happens to navigate life with spina bifida, hydrocephalus, scoliosis, and several related conditions that require daily assistance and the use of a wheelchair or crutches to get around.

When Chloe’s family moved from New Jersey to Pennsylvania for her father’s job, they faced a challenge familiar to many families: figuring out an entirely new Medicaid system. Chloe needed home health aide services to help with her daily activities, and getting those services approved and maintained turned into an extended fight.

Chloe’s mom initially secured 56 hours per week of home health aide services through her Medicaid health plan. But when Chloe’s neurologist recommended an increase to 70 hours per week to meet her actual needs, the health plan approved only 65 hours — and authorized them for just one month, along with requests for additional documentation that had little to do with Chloe’s care.

That’s when Chloe’s mom called PHLP.

Our team reviewed Chloe’s situation. Even if the health plan’s decision not to approve the full 70 hours was appropriate, the one-month authorization was not. We helped the family file a grievance, which was successful — Chloe’s 65 hours per week were authorized for six months.

The one-month authorization from Chloe’s health plan might sound like a minor procedural issue, but for families like Chloe’s, it creates real harm. A one-month authorization means that every few weeks, a family must re-justify services their child clearly needs — gathering documentation, coordinating with providers, and waiting for approvals while worrying about a gap in care. For a child like Chloe, whose conditions are chronic and whose need for daily assistance isn’t going to change month to month, there is no clinical reason for such a short authorization period. It’s an administrative burden that falls entirely on families already managing complex medical needs.

One Family’s Experience Drives Statewide Change

PHLP was seeing this same pattern affecting other families, too. We raised the issue directly with the state’s Bureau of Managed Care Operations (BMCO), and after sustained advocacy, BMCO directed the health plan to stop issuing these short-term authorizations. One family’s experience helped drive a policy change that benefits families across the state.

Then, in December 2025, the health plan cut Chloe’s hours from 65 to 42 per week — without identifying any change in her condition. PHLP represented Chloe on appeal, and the reduction was overturned at external review. We also used Chloe’s experience to continue pushing BMCO for broader systemic accountability.

Chloe’s story is a reminder of what’s at stake when managed care organizations create unnecessary barriers to services that children need. It’s also a reminder that individual advocacy and systemic change go hand in hand — one family’s case can drive policy improvements that help families across the state.

“One family’s experience helped drive a policy change that benefits families across the state.”