Maya is a 9-year-old Medicaid beneficiary born with cerebral palsy. She has been using a wheelchair for years, but as she has grown, her current wheelchair no longer properly fits her. The seat is too small, and the footrests could not be adjusted. It was clear to her mother, Jennifer, that she needed a new, properly sized wheelchair to maintain her mobility and comfort.
Jennifer reached out to Medicaid to get approval for a new wheelchair. It was becoming increasingly difficult taking Maya to her appointments because she was physically unable to use her current wheelchair. Jennifer was told that Medicaid would only cover a new wheelchair every 3 years. Since Maya had not had her current chair for 3 years, Jennifer had to prove that the chair was not growable.
Jennifer attempted to reach out to the company that originally custom-built Maya’s chair but was unable to get in touch with them. After countless phone calls, Jennifer was able to get an employee on the phone, but they refused to give her the information she needed. In a last ditched effort, Jennifer called Maya’s doctor. Unfortunately, even though the doctor agreed that Maya urgently needed a new wheelchair, Medicaid’s rigid guidelines left Maya’s family stuck without the help of the company that built the previous wheelchair. The doctor explained to Jennifer that he could connect her with CHESS Health Solutions, who did care management for the practice, and that they may be able to help.
Once CHESS reached out to Jennifer and learned of the situation, the Care Manager began to call Maya’s physical therapist, doctor, and wheelchair company, to figure out how to get Maya the new wheelchair she desperately needed. It took over 22 calls back and forth for the Care Manager to secure all the information necessary for Jennifer to prove that Maya’s previous wheelchair was not growable.
Finally, Jennifer gave Medicaid the proper information to get a new wheelchair approved. After months of waiting, Maya received the growable wheelchair she needed. Thanks to the dedication and persistence of the CHESS Care Manager, Maya can now go to her appointments and has gained a new independence that greatly improved her well-being.