March 31, 2022 by Natalie Cochran
LSLA Wins Appeal for 20-Month-Old Baby Denied Health Benefits Twice
Taylor was caring for her sister’s four children when the youngest, Cameron, just 20-months-old, was denied health benefits while the other three were approved. After submitting documents to prove to the Texas Department of Health and Human Services Commission (HHSC) that she was the caretaker of the child, HHSC denied the application again.
Taylor’s sister is a repeated drug abuser, so they mutually signed an Authorization of Non-Parent Care that would allow Taylor to take care of the 20-month-old child from March 2020 to March 2022.
Taylor applied for legal help with our Connecting Texas Kids to Coverage Project because HHSC denied Cameron Children’s Medicaid benefits in November 2021. Lone Star Legal Aid (LSLA) Staff Attorney, Elizabeth Green, called HHSC and asked why they denied Cameron again, and they responded that Cameron was currently active on another case. Green told HHSC that she submitted documents on behalf of Taylor showing proof that Cameron had been under the care of Taylor since he was only four months-old, and that she has temporary custody.
Green reached out to the HHSC State Appeals Worker, who stated that a statement is not sufficient to verify if the child lives in the home. Attorney Green argued that the submitted Landlord Verification form should qualify as sufficient proof, but the HHSC Representative clarified that Cameron is being denied because he is on newborn Medicaid, which is automatically applied after his biological mother was on pregnancy Medicaid, and due to the pandemic, Cameron has not been taken off those benefits. To certify Cameron under the client’s household, HHSC needed proof that Cameron is not living with his biological mother, but with his Aunt Taylor.
Green told Taylor to get documentation placing Cameron in her possession, due to the discrepancy between Cameron being on a HHSC account with his biological mother and his Aunt Taylor.
A hearing was set for March 2022. Attorney Green negotiated benefits with April, stating she was able to verify that Cameron’s biological mother has been in jail since September 2021. April was able to reverse the denial of Cameron’s benefits and his Medicaid and SNAP benefits were approved.
“I am very happy we were able to get all four children healthcare. Healthcare is vital to the wellbeing and growth of children,” Green said.
*Names have been changed to protect the client’s identity.
