For nine months of the year, children spend most of the day in school, and when the bell rings for the final time in June, most cannot wait to be free from daily class schedules and spend most of their time just having fun. Many (but not all) get the chance to go to summer camp. PHLP worked hard to make sure that could happen for nine-year-old Ryan.
Ryan has cerebral palsy and traumatic brain injury. For nearly half his life he’s needed a home health aide to help him with basic tasks like getting dressed, using the restroom, and boarding the school bus. Ryan’s aide has been a consistent and necessary presence at home and school.
But one summer, Ryan’s Medicaid insurer terminated all his home health services, jeopardizing his participation at the summer camp he’s attended the past two years. The loss of Ryan’s aide meant he could not attend camp because there would be no one to meet the constant physical demands of his care. But without camp Ryan was faced with a bleak landscape of things to do and might have been limited to his house, not just on the occasional afternoon or weekend, but every single day. Moreover, Ryan’s parents were desperately worried about services when the school year started, since the insurer’s decision also meant no services in September.
Ryan’s family contacted PHLP for help challenging the insurer’s decision. Once involved, PHLP built a persuasive case to reclaim the home health aide hours by coordinating with Ryan’s physicians to prove the aide’s services are medically necessary. We also obtained an expedited hearing, since Ryan simply could not wait the normal timeframe of 1-3 months for a hearing without his aide. On the morning of the appeal hearing, before the judge even started the proceedings, the insurer agreed to overturn the denial and approve Ryan's aide. The very next day, Ryan was at summer camp!
Now, when Ryan’s teachers ask him what he did over the summer, he can say "I went to summer camp, I had a great time, and I made friends."