In December of 2020, Anita started a Medicaid application for her two children, ages 13 and 15, while her 13 year-old child was still in the hospital, not able to breathe after contracting COVID-19. Anita was awarded the Medicaid Spend Down Program for both of her sons which is awarded to help with medical payments. The children were denied regular Medicaid and CHIP benefits because, according to HHSC, Anita’s income was too high to qualify for either. Anita was confused as to how she could make too much and be denied Medicaid and CHIP benefits when she was only receiving a disability income.  

A month later, Anita’s youngest son passed away from COVID-19. She contacted Lone Star Legal Aid’s Connecting Texas Kids to Coverage Unit for legal help appealing the decision made by HHSC. 

First, LSLA noticed she was only being granted Spend Down benefits for December when most of the grand amount of medical bills accrued during the time her youngest son was under inpatient care in January. They also noticed her living child was being denied Medicaid and/or CHIP benefits while Anita was surviving on a very low-income. Nothing seemed right about this denial.  

After investigation, LSLA learned that HHSC believed Anita was employed. LSLA drafted an appeal stating and proving information as to Anita’s only income, social security disability. Anita’s living son was finally approved for Children’s Medicaid benefits in June 2021.

*Name(s) have been changed to protect the identity of the client.