Student-attorneys in the Pediatric Advocacy Clinic prepare for a court hearing with Julianna Lee (far right), a clinical assistant professor of law.
By Bob Needham
Michigan Law
Student-attorneys in the Pediatric Advocacy Clinic won a significant court victory on behalf of a family who had been denied Medicaid coverage for a prescription device.
Michigan Medicine had prescribed a Cubby bed—which combines features for safety, sensory regulation, and better sleep—for a 12-year-old boy who has severe autism, attention deficit hyperactivity disorder, and post-traumatic stress disorder. He was prone to eloping, leaving the house in the middle of the night.
Instead of providing relief, however, the prescription touched off a two-year struggle—eventually leading multiple court hearings—to actually get the bed.
“My son doesn’t have that safety awareness that a neurotypical kid might have,” the boy’s mother said. “Unfortunately, when he gets the urge to run and he just leaves, he’s not thinking about his safety.
“It does not matter what time of day it is. He will leave at night when people are sleeping. We’ve tried multiple things like locks or alarms on the door, but he always figures out a way to disable them. I’ve been sleeping on the floor in front of the door, but then he started going out the window. With the Cubby bed, I was hoping at nighttime we could all try to get some sleep.”
However, Medicaid denied a prior authorization for the bed, which costs around $15,000.
“Medicaid can be very tricky,” the mother said. “If you’re going in blind and you just know you need the bed, it can be very hard to navigate. Medicaid said they shouldn’t have to pay for it, but then the information on the denial letter was wrong. The phone number on the denial was some sweepstakes number; it had nothing to do with who I should actually be calling. Navigating this as a parent is super difficult, because you really just get the runaround.”
A nurse put the mother in touch with Michigan Law’s Pediatric Advocacy Clinic, which represents low-income families on legal issues related to child health and well-being. Various students worked on the case over several semesters, starting with an appeal of Medicaid’s prior-authorization denial.
That appeal was also denied, so in the fall of 2024, the clinic took the case to a state fair hearing before an administrative law judge. But the judge affirmed Medicaid’s denial.
“We were undeterred,” said Professor Debra Chopp, director of the clinic and also associate dean for experiential education. “So we filed the next level appeal, to the Circuit Court.”
“I can’t even tell you how many hours our students put into preparing for this case, to identify exactly where the Michigan Department of Health and Human Services (MDHSS) misinterpreted and misapplied the Medicaid provider manual—and violated controlling federal law that gives very expansive Medicaid coverage for children,” Chopp said.
Lauren Lewis and 3Ls Alexis Freeman and Lynnaya Hamby worked on earlier aspects of the case. This fall, 3Ls Jennifer DaPolito and Julie Liu took up the mantle, culminating with an oral argument in Circuit Court.
Getting up to speed on the case was initially challenging, as was navigating this complex area of the law.
“Luckily, we had a lot of time to really sink deeply into this and think about all the arguments and how they worked together,” Liu said. “We talked about the law with different students in our clinic, with Debra–our supervisor–and thought about it in so many different ways. Hearing those different perspectives helped things fall into place.”
DaPolito led the oral argument in court, and the clinic team was thrilled when the judge ruled from the bench in their favor, requiring Medicaid to cover the bed within 30 days.
Chopp said, “When the students did their oral argument, I was so proud of them for how much work they put into this case and how much they cared. I knew that we should win this case legally, but I don’t walk into hearings expecting the right outcome.
“We all teared up when we got this ruling. We were cautious because of the previous rulings, but it was totally the right decision.”
DaPolito said one of the most rewarding aspects of the experience is not only winning the case for this family, but also the potential precedent it sets.
“These beds are not covered very often. And in Michigan, we couldn’t find any instances in which a circuit judge had overturned a Medicaid denial for a Cubby Bed specifically,” DaPolito said. “Now there is case law to say, here’s an instance in which a Cubby Bed for someone with autism, when it’s medically necessary, should be covered. So I think it’s encouraging because Medicaid may be less inclined to automatically deny coverage for these beds in the future.”
The mother said working with the clinic, and the student-attorneys in particular, was a positive experience.
“The students are very easy to communicate with and very easy to get ahold of. If I have a question, they might not know everything, but they work really hard to get the answer. It feels like teamwork,” she said.
“I’m so grateful that the Law School has this clinic and is able to help families like mine, because it can definitely be very scary and intimidating trying to navigate these systems.”
Michigan Law
Student-attorneys in the Pediatric Advocacy Clinic won a significant court victory on behalf of a family who had been denied Medicaid coverage for a prescription device.
Michigan Medicine had prescribed a Cubby bed—which combines features for safety, sensory regulation, and better sleep—for a 12-year-old boy who has severe autism, attention deficit hyperactivity disorder, and post-traumatic stress disorder. He was prone to eloping, leaving the house in the middle of the night.
Instead of providing relief, however, the prescription touched off a two-year struggle—eventually leading multiple court hearings—to actually get the bed.
“My son doesn’t have that safety awareness that a neurotypical kid might have,” the boy’s mother said. “Unfortunately, when he gets the urge to run and he just leaves, he’s not thinking about his safety.
“It does not matter what time of day it is. He will leave at night when people are sleeping. We’ve tried multiple things like locks or alarms on the door, but he always figures out a way to disable them. I’ve been sleeping on the floor in front of the door, but then he started going out the window. With the Cubby bed, I was hoping at nighttime we could all try to get some sleep.”
However, Medicaid denied a prior authorization for the bed, which costs around $15,000.
“Medicaid can be very tricky,” the mother said. “If you’re going in blind and you just know you need the bed, it can be very hard to navigate. Medicaid said they shouldn’t have to pay for it, but then the information on the denial letter was wrong. The phone number on the denial was some sweepstakes number; it had nothing to do with who I should actually be calling. Navigating this as a parent is super difficult, because you really just get the runaround.”
A nurse put the mother in touch with Michigan Law’s Pediatric Advocacy Clinic, which represents low-income families on legal issues related to child health and well-being. Various students worked on the case over several semesters, starting with an appeal of Medicaid’s prior-authorization denial.
That appeal was also denied, so in the fall of 2024, the clinic took the case to a state fair hearing before an administrative law judge. But the judge affirmed Medicaid’s denial.
“We were undeterred,” said Professor Debra Chopp, director of the clinic and also associate dean for experiential education. “So we filed the next level appeal, to the Circuit Court.”
“I can’t even tell you how many hours our students put into preparing for this case, to identify exactly where the Michigan Department of Health and Human Services (MDHSS) misinterpreted and misapplied the Medicaid provider manual—and violated controlling federal law that gives very expansive Medicaid coverage for children,” Chopp said.
Lauren Lewis and 3Ls Alexis Freeman and Lynnaya Hamby worked on earlier aspects of the case. This fall, 3Ls Jennifer DaPolito and Julie Liu took up the mantle, culminating with an oral argument in Circuit Court.
Getting up to speed on the case was initially challenging, as was navigating this complex area of the law.
“Luckily, we had a lot of time to really sink deeply into this and think about all the arguments and how they worked together,” Liu said. “We talked about the law with different students in our clinic, with Debra–our supervisor–and thought about it in so many different ways. Hearing those different perspectives helped things fall into place.”
DaPolito led the oral argument in court, and the clinic team was thrilled when the judge ruled from the bench in their favor, requiring Medicaid to cover the bed within 30 days.
Chopp said, “When the students did their oral argument, I was so proud of them for how much work they put into this case and how much they cared. I knew that we should win this case legally, but I don’t walk into hearings expecting the right outcome.
“We all teared up when we got this ruling. We were cautious because of the previous rulings, but it was totally the right decision.”
DaPolito said one of the most rewarding aspects of the experience is not only winning the case for this family, but also the potential precedent it sets.
“These beds are not covered very often. And in Michigan, we couldn’t find any instances in which a circuit judge had overturned a Medicaid denial for a Cubby Bed specifically,” DaPolito said. “Now there is case law to say, here’s an instance in which a Cubby Bed for someone with autism, when it’s medically necessary, should be covered. So I think it’s encouraging because Medicaid may be less inclined to automatically deny coverage for these beds in the future.”
The mother said working with the clinic, and the student-attorneys in particular, was a positive experience.
“The students are very easy to communicate with and very easy to get ahold of. If I have a question, they might not know everything, but they work really hard to get the answer. It feels like teamwork,” she said.
“I’m so grateful that the Law School has this clinic and is able to help families like mine, because it can definitely be very scary and intimidating trying to navigate these systems.”
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