Medicaid Reverses Decision after DLC Demonstrates That Grace’s Surgery Was Medically Necessary

Grace’s Story

When Grace Larsen was born, it was soon discovered that her hearing was impaired. As Grace grew, so did her love for cuddling with mom, adventures with her brother, coloring, playing with dolls and anything Cinderella. Maybe it was her father’s strong tenor voice or some genetic disposition that drew Grace to music. One thing she insisted on, she had to wear her hearing aids whenever she was awake.

When Grace was two, routine hearing tests showed that her hearing loss had progressed. She had severe/profound loss in one ear and moderate/severe loss in the other. The Larsens discussed their options with a specialist and chose to proceed with cochlear implants. The surgery was scheduled and other arrangements made. Then, only days before the surgery, the Larsens got the heartbreaking news that Medicaid wouldn’t cover the costs. Why? Grace’s speech wasn’t delayed enough yet to classify the procedure as “medically necessary”.

Lainee, Grace’s mom, expressed her frustration on Facebook. She mourned that those early years for developing speech would expire while Medicaid waited for Grace to be significantly behind her peers. One of Lainee’s Facebook friends recommended that she call the Disability Law Center. After discussing it with her husband Kevin, they decided to give it a shot.

Once Laura Boswell, Disability Law Center Attorney, reviewed Grace’s medical records she knew what course to take. She represented Grace in the hearing process. Laura demonstrated how the Grace Larsen after surgery medical records did indicate that the surgery was medically necessary and Medicaid reversed its decision. Within a few months of contacting the DLC, Grace had her implants. “They took care of everything” Kevin reports, “they submitted the information to Medicaid and we had an advocate there that was saying, ‘did you see this, did you notice that?’ ” The Larsens are grateful that Grace got her surgery when she did. “It was just a miracle to see that my daughter can progress. She talks, she sings, she pronounces better. We’re just so grateful.”