insurance

Applying for financial assistance

Most families in America are covered by one primary insurance company through their place of employment.  That was our family until this healthcare crisis occurred.  About the last year we were able to attain triple coverage for my daughter and that truly saved us financially.  If only we had done it sooner.  As the heart problem began to interfere with her ability to hold down a job we realized this was leading to disability.  If your child has been diagnosed and is regularly seeing a heart doctor, chances are they are affiliated with a large hospital.  Most large hospitals have a financial assistance plan.  You can inquire about this through the patient financial services.  Ours was a one page application.  It will probably start at age 18.  The child should have no assets to speak of since the coverage is needs based.  Even if the parents have stable jobs, the child is considered an adult at this point and they only look at the child’s finances.  This is definitely worth pursuing.  They paid for almost everything at that hospital.  We ended up paying only a few dollars for the prescriptions we had filled at the hospital pharmacy.

Disability

We applied for disability and were denied.  My understanding of disability is that it is there more for people who have paid into it through their employment then become disabled.  If anyone was disabled, my daughter was!  I also heard that some people get it after applying two or three times.  The application process is quite lengthy so prepare yourself for that.

Medicaid and EDCD Waiver

The other coverage we applied for and received was Medicaid.  You can do this through your local Department of Social Services.  Request information about what determines your eligibility and the prescreening methods.  My daughter was approved for Medicaid long term care and the Elderly and Disabled Consumer Directed (EDCD) waiver.  This waiver serves elderly and persons of all ages with disabilities.  An individual must meet nursing facility eligibility requirements including both medical and functional needs.  If your child has a disability which requires assistance with dressing, bathing, eating, and toileting (functional needs which would qualify an elderly person for residential nursing home care) then it is possible that they may qualify for this waiver.  The EDCD waiver provides a certain amount of hours per week that you can hire an attendant to help a child or family member (this is why it is called consumer directed – because you hire and train your in-home helpers).  You as a family turn in time sheets to PPL (a company hired be DMAS) who then pays the attendant based on your approved number of hours per week and the local pay scale.  Knowing that it is difficult to get good, quality care for nine dollars an hour, I opted to care for my daughter myself and they paid me for a 40 hour work week.  I worked with her many more hours than that but was thankful for this as every little bit helped.  You need a Consumer Directed Medicaid Waiver Service Facilitator and Case Manager.  The Department of Social Services should provide a list of these.  Ask which ones they recommend.  They arrange everything and if they do their job right it makes things much easier for you.  There may also be grants you can apply for through the Department of Social Services.  When dealing with them be sure to stand your ground and do not let them cut you off.  I found them to be very confusing at times.  If you are not getting the answers you need, ask to speak with their boss.  Jump through the hoops, do the paperwork in a timely manner and you will be glad you did.  Well worth the effort.