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PEDIATRICS

heart murmur. She had initially been diagnosed with Down Syn- autism spectrum disorder, and under federal law, Medicaid is re-
drome, but her karyotype did not show a trisomy. A geneticist sug- quired to cover necessary medical treatment. Yet in Texas, and in
gested that a chromosomal microarray could help him to make the only a handful of other states, Medicaid does not cover ABA for
diagnosis but the child’s Medicaid health plan denied coverage for children with the disorder. Children in these states have had to sue
the test. The child’s mother filed a request for a fair hearing and to get coverage that should be guaranteed by federal law.
MLAF assisted by helping her and the geneticist prepare their tes-
timony. Ultimately, the health plan covered the test and the child re- While many physicians can have a complicated relationship with
ceived the care that she needed. attorneys, this is one area where practitioners from both disciplines
While MLAF provides services to one client at a time, the results can work together for the same patient/client. As a strong ally to
of their work can be wide reaching. Due to assistance from MLAF, pediatricians, a partnership with Medical-Legal Assistance for Fam-
as well as ongoing advocacy by the geneticist referenced above, ilies provides a multidisciplinary team that can address a child’s di-
Medicaid health plans in San Antonio now cover chromosomal mi- rect and social determinants of health. For more information please
croarrays for children when medically necessary. While that girl had contact Susan Zinn from Medical-Legal Assistance for Families at
to fight to get care, similar children in the future will benefit from 210-704-8730.
her efforts.
Additionally, MLAF has filed suit in the federal court in San An- Darren Donahue, JD is a former practicing attorney and
tonio to obtain Medicaid coverage for applied behavioral analysis third year medical student at UT Health San Antonio.
(“ABA”) for Texas children with autism spectrum disorder. ABA is
the most recommended and sole evidence-based treatment for

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