Pediatric Home Service protests insurer’s policy change 

SAINT PAUL, Minn. - Pediatric Home Service (PHS) planned to participate in a press conference at the state capitol on Dec. 17 to protest Medica’s decision to cap essential nursing coverage for medically complex children who also have supplemental coverage through Medical Assistance (MA). Medica has imposed a cap that will limit coverage for children who require 24-hour, in-home care to only 10 days of coverage per year, according to a media advisory. PHS says, on average, children covered under commercial insurance and MA through the company are authorized for anywhere from 100-168 hours of skilled-nursing services each week. “This is a draconian reduction that all but eliminates the child’s access to continuous, home care nursing support through their insurance,” the advisory states. “Medica’s new cap eliminates up to 99% of care and offers only a sliver of the are these medically complex children require.” Also planning to attend the event: 

• Families of medically complex children impacted by Medica’s policy; 
• Minnesota Home Care Association; and 
• State legislators. 

Medica has declined to respond to repeated requests for information from patients, their advocates and care providers, according to the advisory. Complaints filed by patient families with the state’s Department of Commerce have resulted in no action, it states. PHS says the consequences of the policy are severe: 

• Families cannot maintain safe home care with only a fraction of authorized hours 
• Hospitals face blocked discharges as children cannot safely return home 
• Parents are forced to abandon employment to replace skilled nurses 
• Children are unable to attend school if home care is unavailable to them 
• Costly increases in health care spending with the use of emergency care 
• Add costs to state Medicaid and taxpayers