LAS VEGAS (KLAS) — A Las Vegas valley mom faces a hurdle as she tries to get medicine for her child. It’s due to a change in how Medicaid covers certain prescribed medicines and it’s impacting other families, as well.
You may remember Joel’s story. Paula Cheney adopted Joel and has dedicated her life to caring for him. Their story touched valley residents so much, a handicapped van was donated along with funds for Joel’s care.
But now Paula and Joel face another challenge which is happening to other families. Paula Cheney called the I-Team because she knows this is an issue affecting other parents, patients and families. There’s been a change for medication that was covered by insurance, now making it more of a challenge to get the needed prescriptions.
While that’s being sorted out, people like Joel are waiting and suffering.
He has already had a life of challenges. Joel suffered one beating as an infant and a second as a toddler which left him disabled. While his biological mother went to prison for child abuse, foster parent Paula Cheney adopted him.
“I make sure that he has the best that I can offer, that I can get,” Cheney said.
Part of that includes multiple medications for the 10-year-old.
“This is for the muscles … keep the muscles relaxed,” Cheney said. “This is the one that will keep him from throwing up.”
She says two years ago doctors finally found the right mix of medication. Joel takes three compounded medicines which are specifically mixed by a pharmacist. They’ve been covered by Medicaid. But when Cheney tried to pick up refills for June, she says her doctor’s office said the medicine was approved but Medicaid had not approved it.
Without coverage, the cost for all three medicines would be $252 per month.
I-Team Reporter Vanessa Murphy: “This is a little boy; the system failed him once.”
Paula Cheney: “Once?”
I-Team Reporter Vanessa Murphy: “Do you think the system is failing him again?”
Paula Cheney: “Absolutely.”
The I-Team reached out to Nevada Medicaid. Their response: Starting June 3, all compounded medication needed pre-authorization.
Somehow that process wasn’t working for Joel.
The I-Team also talked to Joel’s pharmacist who said it’s not just Medicaid either. Patients using other insurance are facing the same challenge.
“This is not just about Joel,” Cheney said. “This is about all the other Joel’s out there because I know there’re others out there. Mothers that are having the same issue.”
Cheney has made call after call to the state and to Assemblyman Tom Roberts.
Then on Thursday after he stepped in and after the I-Team inquired about the issue, Cheney says a Medicaid representative called saying the medication should be approved for the next refill.
“Why are they making them jump through all these hoops when they’ve already done what you say they’ve got in place for them to do, to make sure they get the benefits from this program,” Cheney said.
You may remember a former prosecutor, now judge, created a GoFundMe page to get Joel and Paula a handicapped van. More than $60,000 was raised. A local family ended up donating the van. Cheney is trying not to use that money. She is in her 70s and will not always be able to care for Joel. The money is in a trust fund for his future needs. A small withdrawal was made from that fund to pay for that medicine that was not yet approved by Medicaid.