Alabama Medicaid terminating care for 13 year old trached girl

geekgolightly, BSN, RN · Dec 8, 2004

AL Woman At Risk Over Medicaid Bureaucracy

by Dave Reynolds, Inclusion Daily Express

MOBILE, AL, Nov. 16, 2004 --The state's Medicaid Medical Director recently decided, based on medical records and nursing notes, that 13-year-old Lauren Rainey does not need the 10 hours of daily in-home nursing care she currently receives.

Lauren is deaf, and has asthma, an enlarged heart, scoliosis, and other medical conditions. She has a very small airway and relies on an oxygen machine and humidifying mist machine.

"That's why she is constantly suctioned," said her mother, Laura, who added that Lauren's airway has to be suctioned several times an hour to keep her from suffocating.

"She is always getting plugged up," she explained.

Medicaid's Dr. Mary McIntyre told a WPMI-TV reporter that only people whose medical conditions are worsening can be eligible for in-home nursing care. Laura's condition is stable.

"I have to make it (decisions on Medicaid clients) based on the medical information that is provided, the documentation that is submitted, and whether or not they actually meet the criteria," said McIntyre.

Lauren's doctor, Lawrence Sindel, said Medicaid officials clearly don't understand her situation or "they decided taking care of her is not worthwhile."

He explained that waiting for her condition to worsen could be fatal.

"I think if she were to get the flu, it would be very difficult to help her through that," Sindel told WPMI. "If she were to catch a pneumonia, it would be very difficult to help her through that. So the likelihood she could die is very high."

Lauren's family is currently appealing the state's decision.

Lauren's nurse, Carolyn Yates, said, "It's just sad. It's sad that our government can, you know . . . it's like throwing kids away."

In March of 2001, Nick Dupree, another Alabaman who uses a ventilator, launched a successful campaign to get Medicaid to pay for his in-home services after he turned 21, along with those of 29 other people in the same situation.

"Nick Dupree's Crusade Pays Off" (Inclusion Daily Express Archives)