UPDATE: 8/31/23, 9:39 a.m.

North Dakota Health and Human Services has released a statement on the matter:

ND Medicaid reviews and authorizes out-of-state services that are medically necessary and not available in North Dakota.

North Dakota’s review process is completed by a team of health care professionals who review medical documentation provided by the member’s primary care or in-state specialty provider.

To protect costs and prioritize spending, ND Medicaid members are required to exhaust in-state options prior to receiving care out-of-state.

ORIGINAL: 8/30/23, 5:48 p.m.

BISMARCK, N.D. (KXNET) — Visiting the doctor of your choice is ideal for any patient, and for any parent whose child needs help. But when insurance, specialty practitioners, and other factors come into play, this is not always possible.

This is a struggle that four-year-old Keegan Blair is facing, as Medicaid and a concerned parent fight over how best to care for his needs.

Keegan was born with a club foot, which points down and turns in instead of remaining straight.

Keegan’s mother, Maran, states that a surgical procedure would help fix the issue and allow him to stand up, but according to her, Medicaid’s treatment plan differed greatly from her own.

“Medicaid denied him the ability to see an out-of-state doctor at Gillette Children’s in St. Paul, Minnesota,” explained Blair, “because there’s an orthopedic surgeon here.”

As their decision would imply, Medicaid wants him to see a doctor here in North Dakota.

However, Blair says that she doesn’t want Keegan to go to the in-state surgeon. According to Keegan’s mother, the North Dakota doctor they were sent to did not do the initial X-rays requested by her and Keegan’s physical therapist.

She states that eventually, his pediatrician, not the surgeon, was able to take a set of necessary X-rays and if they had not done so, Keegan’s condition could have gone south extremely quickly.

“Both his hip and spine were concerning,” Blair recalled, “because his hip is dislocated, and will need surgery. He also has a mild case of scoliosis.”

She states that at Gillette Children’s in St. Paul, Minnesota, they work with more kids like Keegan, and have even built a previous relationship with him, meaning that heading to the hospital in the Twin Cities would make her and her family more comfortable.

But Keegan is not the only one suffering. Blair says that she will continue to advocate on her son’s behalf, but also that the clock is ticking to fix the problem.

“Unfortunately, it happens a lot,” she stated. “I know people who have wanted to go out of state for care and get denied. I think everyone has a right to a second opinion, no matter where the doctor’s at.”

Blair says Keegan’s pediatrician wrote a letter to appeal the denial. She has also reached out to the previous orthopedic surgeon in order to obtain a referral. 

KX News has attempted to contact Medicaid’s Medical Services Division with the North Dakota Health and Human Services Department. HHS is expected to send a statement Wednesday night, that will be posted as soon as it becomes available.