Insurance stops for family of disabled boy, 11; taxpayers now picking up tab

Insurance stops for family of disabled boy, 11; taxpayers now picking up tab »Play Video

HAPPY VALLEY, Ore. -- An insurance company paid for a disabled kid’s nursing care in Happy Valley until it realized Medicaid – essentially taxpayers – covers that type of care and could pick up the tab. Then, the insurance stopped.

That tab to taxpayers now totals $117,000.

Eleven-year-old Javad Mashinchi has had a muscular disorder since birth. He eats through a tube and needs help from a nurse to get ready for school. His family needs that help because both parents work full-time.

The Mashinchis are double insured in health coverage, so they cover Javad’s healthcare under mom Shannon’s plan. She’s a middle school math teacher.

The insurance provider, ODS, now known as Moda Health, decided a year and a half ago that it wasn’t going to cover Javad’s nurse anymore. Moda Health officials said they wanted Medicaid, through the Oregon Health Plan, to start footing the bill.

When KATU investigators first intervened last year, Moda Health relented and said the care could continue. But it only lasted six more months – until the company decided again to cancel it.

Javad still has the help of a nurse to get ready for school, but the coverage is coming from taxpayers instead.

“As a taxpayer, I want my taxpaying money to go to families that truly need medical coverage,” Shannon Mashinchi said. “I teach in a school that has a lot of kids that don’t have healthcare benefits and their family doesn’t have healthcare benefits … And my son who has parents that work … is taking some of that money away.”

The family’s pro bono attorney, Jose Klein, said the situation goes beyond a matter of principle. It violates federal law.

“Federal law is very clear when benefits determinations are being made … it’s impermissible to factor in whether or not someone receives government assistance through Medicaid,” Klein said.

We made several attempts to reach Moda Health’s vice president of marketing. But VP Jonathan Nicholas could not be reached for this story.

Another marketing official with Moda, Katie Paullin, emailed a statement explaining that Moda can only cover certain types of care outlined in the Mashinchi family’s insurance plan. The rest of the care is covered by the Oregon Health Plan.

Paullin also said Moda does not believe it is violating federal law with its decision.

Coincidentally, Moda Health’s name will soon be displayed on one of the most prominent buildings in town, the Rose Garden.

“What burned me is when they renamed the Rose Garden,” Shannon Mashinchi said. “You can’t cover my nursing benefits for the year, but you can spend $40 million to have your name on the outside of the Rose Garden?”

Thursday afternoon, Moda Health officials released this statement:

Moda Health is working with the Maschinchi family and the state of Oregon to ensure that Javad gets the care he needs.
 
It’s important to understand that Moda Health, the state of Oregon and OEBB work collaboratively on cases like this to ensure children receive the health services they need. Javad is covered by both OEBB benefits and the Oregon Health Plan. In this instance, Moda Health covers care available under OEBB benefits. Oregon Health Plan covers the portion of his care that is not an OEBB covered benefit.
 
We all have an equal responsibility in providing access to programs and care for individuals such as Javad. OEBB benefits are part of a benefits package provided to public school employees.