Another Small Victory with Medicaid
My Goddaughter's son is a severe asthmatic. She has gotten the run-around trying to get him Medicaid coverage since December. I intervened. While I can't claim all the credit, he now not only has Florida KidCare coverage for $15 a month, but she has the ear of a "friendly" caseworker in her local office who will try to get him qualified retroactively for Medically Needy Share-of-Cost to cover massive hospital bills for January, when he suffered heart failure and respiratory arrest.
A bit of useful news for those of you with disabled children: there is a little-known program to prevent institutionalization of children by providing Medicaid to children based solely on the CHILD'S income. The parent's income is DISREGARDED. The vast majority of Medicaid workers do not know of this program and it is called a different name in each state. I myself argued for hours and went through several caseworkers in four counties before I found one who had any idea of the program I was talking about.
Remember: Medicaid saves lots of $$$ because people give up and go away. If you are not one of those who give up and go away, it is possible to (eventually) get what you need.
All right, I need to know about this "special program".
I'm a Canadian, does it apply to Canada? The Medicare there doesn't cover all of our medications so I need to know if there's a special program for Canadians?
Thanks for bring this information to the group, as it will be helpful for those parents who have a disabled child, and or has a child who does not have health insurance coverage and the parent(s) can't afford to insure them.
I know we have this program in Texas too, but I can't think of the name of what they call it off top of my head. But here, the way it works is that the parent has to apply for this help. To determine if they are eligable, they take the amount of people living in the household, then they only count the income of the parent(s) only. So if someone else in the home is working and bring in money, if they are not the childs parent, their income does not count, where with regular Medicaid, it would. They then deduct out the amount of all bills having to be paid by the parent each month. Then use a average amount of what it would cost to get health insurance for that child or children, and minus that out of their income. Then if they make less then a certain amount, they can get there children on this specail health insurance program for children through the state, and the fee is never more then $20.00 a month, and can be free of charge if income is low enough. But either way, Parent(s) income will count in one way or another. This helps stop the abuse of parents getting their children on this program when in fact the parent makes way to much money and just trying to save money.
I sure hope that in this case, they will back date this for him so to pay that big hospital bill from January, because we all know, hosptial cost is very high. Yet I know here in Texas, it would only pay for inpatient hospital care if the illness or injury was life threatening, otherwise this program does not pay for the childs hospital stays. Only regular doctor visits, and prescriptions.
Something each parent will have to look into on how their state runs this program for children, and I know there are a few states who yet to start this program. Hopefully some day every state will have a program like this.
Kalaya K., I'm sorry, though some programs may be similar, I'm afraid I have zero knowledge of any Canadian governmental or social service programs at all.
Michael B. , I apologize for being unclear. I did actually refer to three different programs in my message, believe it or not. Thanks so much for making me realize so I could clarify.
Florida KidCare is a child health insurance program for low-income families that some states have chosen to adopt, and the cost and structure (and whether a state has even opted to have such a program or not) varies from state to state.
Medically Needy, or Share of Cost, is often referred to as a "Spend-Down" program. Again, this is a program that states have the option of providing or not, as they see fit. The structure is tremendously complicated, but if anyone is interested let me know so I can give you an accurate explanation. This provides Medicaid to people who might not normally qualify because they have "too much income" (like from Soc Sec), but have high medical costs.
The program I especially wanted to be sure everyone knew about (because most Medicaid staff insist it doesn't exist) is a program that completely excludes the parents' income from Medicaid calculations in determining a child's eligibility. My sister and my daughter's best friend would have had a lifetime benefit from such a program decades ago. They would not have had to choose between a lifetime of poverty and giving up a child to institutionalization as the only two options for ensuring that a disabled child had adequate medical care. No one has to make that choice in the US any longer. This program exists now.
You are so right, that generally it doesn't matter what the situation is that a family may have, if they just can not afford to pay for health insurance for their children, their is usually a state funded program now that will help make sure the child or children of that family get medical health insurance. Each state usually has different programs, and they sure don't make it easy for people to know all the programs that are available to them.
I sure hope in the future, these workers will be trained to not have to have the person apply for the benefits, and not have to tell them a program is there that might work for them.
Just like the phone companys LifeLine program, the phone companies will not tell you the program exist and that you might be eligible for it when you sign up for phone service, You have to ask for it or they just don't tell you. This needs to be changed, so that when you apply for something, they will tell you or give you a list of all programs that are avaible.
Dian T., I'm afraid it's not an easy one. You may have to look further. In Colorado it's called "Program 200" or something like that; in Florida it may be an offshoot of "Medicaid Disability" (if this information is correct, which I'm not at all certain of). The program was established when it was recognized that it was far cheaper for the state to provide medical care for disabled children than for parents to give them up, leaving the state responsible for providing for ALL their needs. If you talk to a caseworker who tells you there is no such program, tell them you need to speak to a supervisor. And their supervisor. And the district office. And the district office supervisor. "Supervisors are like ____, everybody's got one." OK, that was a cheap shot. But in the Medicaid system, it seems that this particular program is a big secret most of the caseworkers know nothing about. That's exactly why I posted it. Because the parents who need it really NEED it. It's a shame that it's going to be so hard to track down and I apologize for not being able to make it easier, but I know it's out there if you can only find it.
As far as I know, most all the states do have some type of special programs to help give health care to children under 18, whether they are disabled or not, as long as the family makes under a certain amount of money each year. These programs are called something different in each state. So your best bet if you need health care insurance for your child and think you might be eligable for these programs, call your local Social Service Agency, and ask them about the health care program for children. They can tell you what the name of the program is and what their guidelines are, for the guidelines are different also from state to state. Sometimes you can even get this information from your childs school counselor, and they can tell you where to go to apply.
Your welcome Dian:
Glad to be of help and of support when I can be. You and your family are in my thoughts and prayers and I hope some good will come to you all soon. Migraines can be so rough not only on the person having them, but on the whole family.
I hope you can find help with other programs as well.
Michael, you are always so caring....... thanks.
Re: don't let them steer you to Social Security- it's definitely a Medicaid program.
You know, I don't think that they ever referred us to SS and I really don't remember the programs now. When they threw my kids off Medi-caid, I was like making and taking phone calls for days. After awhile, everything runs into one another and sounds the same and this was a few years ago. I was just grateful to find what I found to help pay medication which runs over $400 a month. Sorry I'm no help, I do remember a spend down and stuff like that but we are a very small town and they couldn't help me a lot. I find this program with the help of a friend... and it's through the state of Ohio.
I know what you mean, and it is so hard when a parent is trying so hard to take as best care for their children, and then get a pay raise or something and the state then tries to take Medicaid away from you and the children.
Yesterday in my regular mail I got my May 2006 Medicaid card. Enclosed with this months Medicaid card was a notice of a change in Texas Medicaid. One of the first changes is that those who try to go back to work that are on Medicaid, they will no longer lose their Medicaid benefits as long as they make less then the allowed amount. Yet, if you have children on Medicaid with you, No matter how much money you make, your income will no longer be taken into consideration, theirby your children can still get Medicaid no matter how much you make. It is about time they did this unstead of telling the parent if they make to much money, they had to apply for a different program for health coverage for their children. At least this is one step in the right direction.
Take care and God bless.
I know what you mean, Dian. I suspect they save a lot of Medicaid $$$ by making the programs so confusing people give up in frustration. I'm really glad you were able to find a program to help, and that you are able to slog through even if you can't get as much help as you should. I know it's really hard to be mommy to a sick child, too, and send strength and blessings your way.
Hooray, Michael, it sounds like Texas got something RIGHT for a change! I can't believe they're willing to allow children to stay on Medicaid when parents return to work regardless of income. Let's just hope some other states are smart enough to follow suit- but I'm not holding my breath.