5-year-old needs new wheelchair, but Colorado Medicaid program keeps denying mom’s requests

DENVER — Sarah Allen is an army of one. She’s a single mother taking care of her five-year-old son Aidan  and he needs a new wheelchair. “He’s delayed developmentally so he’s not the age he would be cognitively and physically,” she said.

She is Aidan’s 24-hour-a-day care giver. Food, clothing, medical, education, there’s always something to do. “It’s definitely challenging, you lose out on a lot of sleep. You don’t have as much help, and we really don’t have any family so that presents challenges, too.“

Aidan is growing, and needs a new wheelchair.  What should have been fairly easy, has turned into a stressful, difficult thing to accomplish. Why won’t Medicaid OK a new wheelchair for Aidan?  “He needs a wheelchair. He’s needed a new wheelchair for a long time, his current one is about four years old.”

She’s been denied four times by Health First Colorado, the state’s Medicaid program.

Allen thinks it’s all because of the wording in the chair’s description. It uses the word stroller. “They’re claiming that it’s a stroller and not a pediatric manual wheelchair, even though the codes are for a pediatric manual wheelchair.”

A spokesperson for the state’s Department of Health Care Policy and Financing said this specific case could not be discussed due to federal privacy laws, adding “when a service is requested, the Department reviews that request for duplication of services and medical necessity when approving or denying the request.”

Editor’s note: This story has been updated from it’s original version to include a response from the state.

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