Alina
When Alina looks at you, you see a quiet teen with soft brown eyes. But if you look more closely, her eyes reveal a lack of focus that is very concerning.
Alina’s family moved to Connecticut two years ago, when her Mom took both girls and escaped the extreme domestic violence they’d been living with. Alina’s stepfather beat both the girls and their mother and Alina had been raped repeatedly.
Alina’s history of abuse and the domestic violence she continually witnessed, contributed to her ongoing seizures and auditory hallucinations. Alina’s doctor, a pediatrician at Connecticut Children’s Medical Center (CCMC), was very concerned. Alina was so emotionally disabled that she could not attend school on a regular basis and needed her mother’s constant care. Years of violence had left the mother with disabling trauma, making it very difficult for her to find full time work.
Alina’s doctor was looking for a way to help the family and called the Center’s Medical-Legal Partnership. The mother’s application to the Department of Social Services (DSS) had been denied and Alina’s application for disability from the Social Security Administration (SSA) had been rejected. We contacted DSS and explained the family’s need for assistance.
Our successful legal advocacy helped Alina’s family receive emergency assistance. At Alina’s SSA disability hearing, we submitted evidence of Alina’s psychiatric impairments. Alina’s educational records documented significant learning disabilities exacerbated by her psychiatric condition. As the day of the SSA hearing approached, we were concerned about the stress Alina’s mother would suffer when she testified to the domestic violence, sexual abuse and psychotic episodes that led to the application for disability. Fortunately, the Court ruled in favor of the appeal based on submitted documentation and Alina’s mother did not have to testify.
Alina’s physical and emotional challenges continue, but she’s moving in a positive direction. We recently helped Alina find an appropriate educational setting and we continue to carefully monitor the family’s progress.
Marco
With the bravado only an eleven year old can muster, Marco decided his wheelchair could navigate the pile of rocks at the bottom of the hill. Gaining speed as he approached, Marco hit the rocks and was dumped onto the roadway. The story could have a simpler resolution if Marco had been on a bicycle, but Marco suffers from Spinal Muscular Atrophy Type II – he has no lower body strength and only limited motion in the top half of his body. A broken wheelchair was only the latest problem for Marco and his mother, Millie.
Marco’s medical problems meant that Millie had to carry him when he had to use the bathroom or the shower. While not a perfect system, this worked when Marco was little, but he now weighs almost 100 pounds. This past summer, Millie fell when lifting Marco and they both wound up in the emergency room.
Marco receives ongoing care from the Connecticut Children’s Medical Center Orthopedic Department. Clinicians recommended installation of a lift system in the house – a track installed on the ceiling that allows the user to sit in a sling and navigate through relevant rooms – to prevent further danger to Marco and Millie.
To the dismay of the family and Connecticut Children’s Orthopedic Department, the request for the lift system (durable medical equipment) was denied by Millie’s Medicaid/HMO insurance carrier. Marco’s orthopedist called the Center’s Medical-Legal Partnership for help. We spoke extensively with the clinicians and the family to assess the insurance denial and secure this important equipment for the family. Connecticut’s legal standard for such equipment is medical necessity, defined as “health care provided to correct or diminish the adverse effects of a medical condition.”
After taking pictures, making diagrams and gaining a new appreciation for the practical as well as legal definition of medical necessity, we filed an Appeal of Denial with the State of Connecticut Department of Social Services. Within days, an attorney from the Medicaid HMO agreed to discuss a resolution for the family.
Marco has many hurdles to face, including a future spinal fusion. Some challenges will be eased with the installation of the newly-approved lift equipment that will make his life, and his mother’s, easier and much safer.
