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  • Eligibility
  • Matt

    When No One Would Answer Their Calls, PHLP Stepped In

    Matt, a 29-year old with autism and significant functiona limitations, was losing his Medicaid, and yet his family couldn’t reach anyone at the local County Assistance Office (CAO) to get an explanation.  The 29-year-old Chester County resident had been on Social Security all his adult life. According to the CAO, a change in Matt’s income—brought about by his father’s retirement—made Matt ineligible for Medicaid. However, a Social Security representative told Matt’s family that as a “Disabled Adult Child,” his Medicaid coverage would continue indefinitely.  The family was unable to get anyone at the local welfare office to discuss the matter, and Matt’s Medicaid was scheduled to stop at the end of the week!
    Frustrated, Matt’s family reached out to PHLP.  We advised them on how to file a timely appeal and gave them eligibility information regarding “disabled adult children.” Armed with this information, the family filed an appeal and reasonably expected the welfare office to identify the mistake and correct the situation.  Two months later, the situation had still not been corrected and a fair hearing with an administrative law judge was coming up the following week!  And the county office remained unresponsive to their phone calls and voicemail messages.  Matt’s family reached back out to PHLP, which directly intervened by notifying the county administrator that because Matt was a “disabled adult child,” his recent income increase did not count toward his Medicaid eligibility.  The county administrator confirmed this with Social Security and, on the eve of the fair hearing, resolved the appeal by putting Matt in the proper eligibility category. 
    Even though Matt’s family knew the relevant rules, and pointed them out to the local officials, it took the intervention of a legal advocate to get the office to fix its error.   Matt’s family thanked PHLP for our knowledge of Medicaid rules and our advocacy.