Finding Financial Aid
Raising a child is expensive. Raising a child with disabilities is even more expensive. The unique supplies, equipment, treatments and procedures such a child needs can strain even families with significant personal assets. Fortunately, financial relief may be available. State and federal government programs, community resources, Social Security benefits, private foundations, medical insurance and special education resources provide aid. Consult city, county, state and federal agencies for help in answering financial aid questions.
Generally, government benefits are paid to a disabled dependent child, based on family income. But once a child turns 18, these benefits are awarded based on the child's own assets and income (even if the child is still living at home with the parents).
The most important public benefit programs are Medicaid and Supplemental Security Income (SSI).
Medicaid is a state-administered, federally reimbursed program that pays for needed medical care for eligible persons. An applicant's medical diagnosis, finances and age are used in determining eligibility. To apply for benefits, contact your local Medicaid office or the state health department.
SSI is a federal program that provides income from the federal government to certain individuals with disabilities. Cash benefits are paid each month, up to the "Federal Benefit Rate." To apply for SSI, contact your local Social Security Administration office.
Eligibility for both of these programs is based on need, as well as disability. A person is not qualified to receive SSI if he or she has "countable resources" in excess of $2,000 or "countable income" in excess of the Federal Benefit Rate. Keep in mind that gifts or inheritance are "countable resources" and may reduce payments received or cause the child to lose SSI benefits for up to three years. Also, assets in a special needs trust may be claimed by Medicaid upon the death of the beneficiary if Medicaid paid benefits while the trust was in effect. Medicaid laws and the laws pertaining to special needs trusts vary from state to state. Contact your local Social Security Administration office for additional information.
Planning for Medical Needs
Specialized medical treatment may be needed for individual with special needs, sometimes beginning in a neo-natal intensive care unit. Other times the need for such treatments arise much later as you or your pediatrician begin to notice developments that give rise to questions.
You need to take precautions to ensure that you make the most of your medical insurance coverage. Otherwise, you could be left holding the bill-or a large part of it.
Obtaining medical insurance authorization for specialized services and products, such as therapy or medical equipment, can be complicated. The following are tips to better manage your medical insurance and get much needed benefits paid:
" Read your policy! If you have any questions about coverage, call your insurer and ask them to clarify exactly what is covered, under what conditions and at what rate. For example, traditional therapy services often do not take into account the specific needs of infants and children requiring therapeutic intervention. There also may be limits on therapy services.
" Create a one-page summary of your policy provisions as well as one for limitations and exclusions. This summary can be given to the treating physician or therapist who will either be writing a report or speaking to an insurance company representative on your child's behalf.
" Check the list of participating providers if you are part of a Preferred Provider Plan or Health Maintenance Organization (HMO). You may be limited to using only providers within the network. Make sure there are professionals qualified to serve children and or adults with special needs. You may have the option of using out-of-network providers, but be required to pay more out of pocket. The out-of-network option may be useful if your child requires non-participating medical specialists such as pediatric therapists or neurosurgeons.
" Speak with the same case manager or claims supervisor, if possible. When you call your insurance company, ask for the name and phone number of the representative and try to speak with that person every time. He or she may become familiar with the needs of your child and you will not have to repeat your child's story.
" Request a case manager be assigned to you if your child has ongoing medical or therapy services. Working with the same people can provide continuity of services.
" Include a photograph of your child when you submit a claim or begin your relationship with a case manager. Photos can personalize a case file, which might earn "special treatment" when trying to resolve problems that might arise.
" Obtain prior authorization for therapy, prescriptions or equipment from your insurer. Call your case manager and ask if there is any procedure regarding prior authorization. Your insurer may require a letter of medical necessity, or the written prescription from your primary care physician.
" Stay on top of your child's case. Document everything, from phone calls to faxes, and include dates. Send all correspondence by certified mail so you have a return receipt for documents you send. Call the insurer if you don't get a timely acknowledgment of your correspondence. Keep copies of everything.
" Obtain a claim denial in writing. It should include the specific reason for denial. Insurance companies are legally obligated to provide this. Question denials, and if you believe the claim is valid, appeal the denial and resubmit the claim.
Making the most of your medical insurance can be time consuming and sometimes exasperating. However, being the parent of a child with special needs also means being his or her advocate. By being organized and proactive, you can give your child the best possible quality of life.