Having a child with special needs can be an emotionally, physically, mentally, and financially draining on a family. When diagnosed with a significant impairment like a genetic syndrome (e.g., Down Syndrome, Trisomy 13, XXX Syndrome, Marfan Syndrome), a congenital anomaly (e.g., Autism Spectrum Disorder, Cleft Lip/Palate, Encephalopathy, Spina Bifida, Encephalopathy), or an acquired syndrome (e.g., Traumatic Brain Injury, Cerebral Palsy, Aphasia) parents are inundated with doctor appointments and recommendations for therapies, medications, follow-ups, etc. In a perfect world, insurance would pay for everything recommended by a medical professional and we wouldn’t worry about the rising costs of said care. But, unfortunately that isn’t our reality.
When you are able to acquire Medicaid as a primary, secondary, or tertiary insurance for your child with special needs, Texas Medicaid covers the “patient responsibility” amount that your primary insurance approves. So, if your child has a $10,000 deductible Medicaid will pick up that charge. These programs are life savers, ways to keep your head above water financially and ensure that your kiddo still is able to get all of the therapy sessions they need.
It seems every year I see benefits cut/reduced, increasing co-pays/deductibles, and flat out denials. I have compiled a list of resources for my families with special needs to apply for in order to provide additional assistance for their families and hopefully reduce the financial strain felt. This list is current as of the date of the post and is exclusive to Texas.
It seems every year I see benefits cut/reduced, increasing co-pays/deductibles, and flat out denials. I have compiled a list of resources for my families with special needs to apply for in order to provide additional assistance for their families and hopefully reduce the financial strain felt. This list is current as of the date of the post and is exclusive to Texas.
 Supplemental Security Income (SSI): Social Security has a strict definition of disability for children. (1) The child must have a physical or mental condition(s) that very seriously limits his or her activities; and (2) The condition(s) must have lasted, or be expected to last, at least 1 year or result in death. If approved for SSI you will receive a subsidy check and Medicaid insurance for your child. If your child is already insured with a private policy Medicaid will pay all co-pays, deductibles, and co-insurance required by the primary insurance carrier. |  Children with Special Health Care Needs (CSHCN) Services Program: CSHCN is a program that provides children with disabilities medical/dental/mental health care (Medicaid), prescription drugs, special therapies, case management, family support services, travel to health care visits, assistance with insurance premiums, and transportation of deceased clients. If your child is already insured with a private policy Medicaid will pay all co-pays, deductibles, and co-insurance required by the primary insurance carrier. Because the CSHCN Services Program is the payer of last resort, all applicants must also apply for the Children’s Health Insurance Program (CHIP) and Medicaid. |
 |  |
| Children’s Health Insurance Program (CHIP) and Medicaid: CHIP and Children’s Medicaid both cover services need to keep kids healthy, including: dentist visits, eye exams and glasses, medical care, prescription drugs and vaccines, access to medical specialists and mental health care, hospital care and services, medical supplies/X-rays/lab tests, and treatment of pre-existing conditions. | Medicaid Buy-in: Most Medicaid programs require that families have a very low income to be approved. However, Medicaid Buy-In programs use higher income requirements to help children and adults with disabilities or special health-care needs get Medicaid health-care coverage and benefits. This program is for families who have a child with a disability, but earn too much money to get regular Medicaid. Families can “buy-in” to Medicaid coverage by making monthly payments. |
Intellectual Developmental Disability (IDD) waiver program: Planning for the future is important. While we hope all kiddos are able to live fully independent lives, we can’t predict the future which is why preparing for the worst case scenario while striving for the best case scenario is important. This program will determine level of functioning, review all medical documentation, and provide IQ testing. Results will allow the child to be placed on different waiver lists, offering state funded programs to the child, if they qualify. Some of these waiver programs have waitlists of 10-15 years and therefore it is vital to be placed on these lists when the child is young in order to have the availability of these waiver programs later, even if not needed when she is older. Waiver programs that might be beneficial to have available to patient in the future include: Medically Dependent Children Program (MDCP), Community Living Assistance and Support Services (CLASS), Home and Community Based Services (HCS), and Long Term Service and Supports (LTSS).
RSS Feed
