Family In Need of Medical Supplies Left Without Medicaid for Months

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WESLACO – A family in need of medical supplies told us they've been waiting on Medicaid for months.

Medicaid helps qualified people with medical supplies. A managed care organization will then help Medicaid clients pick up their supplies at a DME, a store for durable medical equipment.

Something broke down between these three, leaving one family with a financial burden since April.

It's been nearly four years since life changed for Maria Soto. A stroke nearly stole her life. What keeps her going is her daughter, Fabiola.

Medicaid provides her with the medical equipment needed to survive. That came to a halt leaving her in need of supplies.

Fabiola lists, "Diapers, bed pads, wipes, right now she's in need of a blood pressure machine, a glucose machine."

She also says she needs a machine that lifts her mother up to help with transporting her to and from her wheelchair. It's affected their budget.

She estimates, "Roughly, I want to say we are purchasing $30, $40, up to $50 each week, extra."

Normally, these products are paid for by Medicaid at a DME. Fabiola was told by the DME that Medicaid stopped paying for the products. She's been looking for a new DME since.

For now, she's resorted to other options.

She says, "These are the diapers that we purchase at the flea markets. The wipes that we purchase. We purchase these, which are like bed pads. We also purchase these, which are the ones that she would receive. We purchase them also at the flea market."

Those in between the DME and Medicaid are called managed care organizations or MCOs.

Fabiola has been speaking to an MCO. She was told approval finally came from Medicaid after months of waiting. All they needed now was authorization for a new DME.

CHANNEL 5 NEWS went to that MCO but were told they could not comment.

So, we reached out to Medicaid. We asked how long it normally takes to receive authorization. This is what they replied:

"Generally, the MCO must issue coverage determinations: within three business days of receipt for most services."

The MCO was not able to speak to us directly. They told us they would be reaching out to the Sotos.

Fabiola Soto told CHANNEL 5NEWS they did. They told her that her mother can expect her supplies by Monday or Tuesday of next week.

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