Our client, Autumn, is a minor who never received notice if her Children’s Medicaid was renewed for the new year. Her mother renewed her benefits along with her other young daughters. One daughter received renewal, while Autumn did not receive a response. Texas Health and Human Services (HHSC) told Autumn’s mother that her case would be escalated, but they never heard anything back.
There are two benefit programs for children. Children’s Medicaid is a health care program for children in low-income families. There is no cost to receive services. Children’s Health Insurance Program (CHIP) is a health care program for children without health insurance whose families earn too much to get Medicaid but cannot afford health insurance.
To be eligible for Medicaid or CHIP, a child must be age 18 or younger (in some cases, children with disabilities aged 19 and 20 can get Medicaid). They must also be a Texas resident and a U.S. citizen or qualified non-citizen. CHIP fees vary based on your income. If your child is eligible for CHIP, your enrollment fee and co-pay will be based on your family’s income. Enrollment fees are $50 or less per family per year.
Autumn did not receive a response from HHSC in time for her doctor’s appointment, so her mother had to pay out-of-pocket. Six months later, Autumn was still not approved for renewal, and her mother was never notified of their decision.
LSLA Staff Attorney Channing Guidry helped our young client and her mother file an appeal. HHSC delayed approval on this case for three months before LSLA stepped in. Guidry was able to obtain a hearing. Since HHSC failed to act within the deadline, Autumn was finally approved for Children’s Medicaid, dating back to the initial application.
The client’s mother was extremely grateful and happy that her daughter had been approved for Children’s Medicaid.
“The client’s mother had been going back and forth with HHSC for three months just to obtain a decision (approval or denial) when she contacted us for assistance. HHSC’s failure to provide any decision had the mother and her daughters in limbo regarding their healthcare, with her having to pay out-of-pocket costs. The process was a bit arduous for the client and me as it was six months between applying for benefits and receiving official approval from HHSC. I filed an appeal, represented the client at the hearing, and received a decision on the spot (a rare occurrence for HHSC; the agency is prepared to defend its action). Ultimately, I am happy that the issue was resolved, however it is a travesty on the part of HHSC that the issue could not have been resolved sooner for our client.” Channing Guidry said.
Lone Star Legal Aid (LSLA) is a 501(c)(3) nonprofit law firm focused on advocacy for low-income populations by providing free legal education, advice, and representation. LSLA serves millions of people at 125% of federal poverty guidelines, who live in 72 counties in the eastern and Gulf Coast regions of Texas, and 4 counties in Southwest Arkansas. To learn more about Lone Star Legal Aid, visit our website at www.LoneStarLegal.org.
Media contact: media@lonestarlegal.org