SUN CITY CENTER, Fla. — Imagine not being able to get in and out of bed or take a shower.
A woman said that’s her reality ever since a car accident left her paralyzed from the chest down and Medicaid denied claims for the medical gear she needs.
While Karen Evonosky has gotten used to needing help, she said having quadriplegia shouldn’t leave her living without basic necessities.
“I’m a human, I’m not a drag on the system,” Evonoksy said. “I deserve to be cared for the way that I should and have the things that I need and not have to fight every day.”
NEEDED: ONE LIFT, ONE CHAIR
Evonosky said she relies on a ceiling lift to get out of her wheelchair and in and out of bed, a process she does three times a day.
She said Medicaid paid for her current lift, which she’s had for almost 30 years, but it’s showing its age.
“It’s very dangerous, I could fall,” Evonosky said.
Then there’s the shower situation. Evonosky moved into her current house last year and renovated the bathroom to include a roll-in shower, but to use it, she said she needs a medical shower chair.
“In the past 16 years I haven’t had a shower. I’ve always had a bed bath,” Evonosky said.
“My insurance has denied me the shower chair twice,” she said. “I’m always having to have somebody bathe me in a bed and it never feels like you’re really clean.”
DENIED: “NOT MEDICALLY NECESSARY”
Evonosky’s health insurance is through Sunshine Health, a private company contracted by the state of Florida to cover Medicaid patients. Sunshine Health is a subsidiary of the Centene Corporation, which ranks No. 22 on the 2024 Fortune 500 list of largest U.S. corporations.
Evonoksy said her doctor requested a new lift and a shower chair, but Sunshine Health sent letters denying the claims for being “not medically necessary.”
She said she appealed the denials but months later hasn’t had any success.
“Why is this such a hard thing to approve? It seems silly,” Evonosky said. “There’s days where you just cry because you’re tired.”
Sunshine Health declined an interview and sent the following statement:
Sunshine Health’s top priority is to support the health and well-being of every person we serve. As a Managed Care Organization trusted to serve Florida’s Medicaid recipients, we are committed to ensuring access to high-quality care for our members. We employ board-certified physicians, leveraging their expertise to provide the right level of care, aligning with best practices and state guidelines. Our focus is on delivering efficient, effective, and compassionate healthcare to those who need it most. When questions arise from our members about coverage, care or benefits, we are committed to working with them and their care teams to ensure their individual needs are met.
WHAT RIGHTS DO MEDICAID PATIENTS HAVE?
The Florida Health Justice Project (FHJP) is a nonprofit that advocates for access to healthcare and provides free legal services to fight appeals.
“Folks don’t know that they have legal rights,” said attorney Katy DeBriere who serves as the legal director of FHJP. “You get the initial denial and then you have to appeal that internally with the plan. Then if you get that second layer of denial you can go up to the state and ask for an administrative hearing but that can be very confusing to people.”
DeBriere said there is another part of this picture, private companies contracted by the state of Florida to provide Medicaid get paid a fixed rate for each patient.
“It’s not dependent on how much care is doled out and what that can do is create an incentive within the Medicaid managed care plan to deny care because they keep more money,” she said.
DeBriere said she is concerned that potential federal Medicaid cuts could affect Florida patients.
"We will have a loss of dollars and that loss of dollars will simply incentivize these Medicaid managed care plans to deny more access to medically necessary care," she added.
PATIENTS PAYING THE PRICE
Days after Evonosky spoke with ABC Action News, she said her ceiling stopped working. Evonosky, who lives on social security disability, said she had to buy a manual lift but it doesn’t work the same and she believes it’s dangerous.
“I’ve always been a fighter,” Evonoksy said. “I’m hoping this will have them do something finally that will benefit me for quality of my life.”
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