“PHLP agreed to represent John to prove that the insurer was wrong; that his PAS remains medically necessary and should not have been reduced.’
“34-year-old John has a Traumatic Brain Injury (TBI). He’s been able to live at home for the past 11 years because of the services and supports he receives through his Medicaid Waiver. One of those essential services is receiving 131 hours per week of Personal Assistance Services (PAS), a service that ensures his personal care needs are met including assistance with activities of daily living (e.g., dressing, bathing, eating).
“John and his mother contacted PHLP after his Community HealthChoices (CHC) insurance plan, which is responsible for the amount of in-home services, reduced his PAS by one-third to just 84 hours per week. This reduction happened even though there had been no change in John’s condition or need for care. His mother was truly scared and unsure of how she would continue caring for John at home, which both wanted. Their greatest fear — his placement in nursing home (institutional) care — seemed on the horizon.”