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.
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.