By: Davida Grant
If your child has a serious medical condition, he or she may be entitled to Medicaid benefits, even if your family’s financial resources far exceed the financial eligibility criteria applied to Medicaid recipients.
I feel compelled to talk about this. There are so many middle class families out there with disabled or severe special needs children that simply don’t know about available Medicaid resources. I certainly didn’t. God sent me an “angel” that put the bug in my ear that our family might qualify for Medicaid for Simone’s ailments. And guess what, WE QUALIFIED! Here’s my story.
In an earlier post, I shared that my daughter, Simone, now 3.5-years old, was born with a serious medical condition, requiring hospitalization for the first 6-months of her life. When we finally took her home, we were over the moon. Words can’t express the stress and torment I experienced seeing my infant fight for her life. Despite the euphoria we felt having her home, looming in the background was, how are we going to pay for her care? My husband and I both worked and were not in a financial position to have me stay at home to care for her. And honestly, even if I could have stayed home, Simone needed skilled nursing care. Make no mistake, I took every training class there was to prepare myself in the event Simone experienced a life-threatening issue, but professional care was needed and that costs money, the big bucks!
Yes, we had medical insurance, but if you have a child with significant medical issues, you know that medical insurance only goes so far. The rest is up to you and when those medical creditors come knocking, they are no joke. I can’t even begin to quantify Simone’s total medical expenses, but I can say with absolute certainty that they were in the millions. What middle class family do you know that can afford to pay that, even after insurance covers 80-90%? Simone had already racked up a mountain of expenses before she came home and she still had additional surgeries on the horizon. Not to mention, the day-to day skilled nursing care and equipment usage she required easily generated thousands of dollars in expenses per month. We didn’t know what we were going to do to cover these costs.
So how did we find out? You would think her case managers at the hospital would have advised us of all available financial resources, given that they knew Simone’s recovery would be lengthy. But nope. In our case, one of the nurses that provided home care for our daughter mentioned that there is an exception under the Medicaid program for disabled or special needs children with serious medical conditions – the Katie Beckett exception. Any child that meets the medical eligibility requirements – regardless of their parents’ financial status — can qualify because only the child’s income is considered, which in most cases is nothing or miniscule. She wasn’t sure if Simone qualified based on her medical conditions, but suggested that I research the program. I did and it turned out that Simone qualified. Because we are a middle class family with income well beyond the maximum income thresholds for Medicaid, we never even considered Medicaid as an option. Armed with this information, I applied (oh that process was a BEAR), and ultimately Simone was approved. From that point forward, ALL of her medical expenses that were not covered by our medical insurance were paid by Medicaid. Just to drive this home, we would have had to pay hundreds of thousands of dollars to cover Simone’s expenses, money we absolutely did not have, if we had not qualified for the Katie Beckett Medicaid exception.
All of this came rushing back because a friend who recently had a baby with serious medical issues is in the same boat. After celebrating the fact that her daughter was home, we talked about her family’s plan for care. She had no idea how her family was going to manage the day-to-day care and financial burdens of caring for their daughter. I shared my experience and, not surprisingly, she had never heard of the Medicaid exception. She is in the process of obtaining the necessary approvals.Yay!
I know that we aren’t alone. Resources are out there and unfortunately information is not readily available to many families. If your child has a serious medical issue, I can’t guarantee that they will be covered by Medicaid, but it’s worth pursuing.
I hope this helps.
http://dchealthcheck.net/documents/KB-Fact-Sheet-for-Community-July-2012.pdf
Vida Marie
Just 4 Mommies 