At the age of 15, Maria developed a brain tumor for which she underwent surgery and radiation treatment. She had been a good student with lots of friends, but was unable to return to school, and had to take many medications resulting in damage to her body. Between her physical limitations and side effects of the medication, Maria gained a lot of weight. Eventually, her mother had to quit her job to care for Maria full time. Medicaid provided in-home care help as well, since Maria’s mother could not lift her. Maria and her mother lived on Maria’s SSI of $771 and savings from selling their home.
When Maria turned 19, the Social Security Administration reviewed her case and determined that she could work full time doing repetitive simple work where she would not be around people. Medicaid cut her home care hours in half because the adult standard for home care is more restrictive than for children. Medicaid also determined that medication she had been on for many years was no longer medically necessary. Maria had all new doctors because she could no longer see her pediatric doctors as an adult. Her new doctor tried repeatedly to get coverage for the medication, but was repeatedly denied.
An attorney with the Economic Advocacy and Community Health (EACH) Project at CCLA took Maria’s case and won the continuation of SSI benefits. At the hearing, an independent medical expert hired by Social Security testified that Maria continued to be disabled and that the medication she was being denied was, in fact, necessary for her health.
Finally, the denial of medication was reversed and Maria was able to obtain long-term care benefits, which increased her home health care hours.
Maria is one example of many clients we see who struggle with the loss of benefits and the reduction of health care upon becoming an adult.
*Names have been changed to protect the privacy of our clients.