Guest guest Posted July 13, 2010 Report Share Posted July 13, 2010 Serena if OT, PT, and speech are what you want, you'll get them through your school district. You might find out what your ped would have to do to accept medicaid. It might be as simple as he/she wanting to do so once they realize the need/importance. All the best getting what you want. > > Hey there. I'm really hoping that someone out there can help us out. My husband works for Garland ISD (and I used to as well). Our health insurance specifically excludes all therapy for children with developmental delays. We are fortunate at this point to be receiving our speech, p/t and o/t through PIP/ECI, but come November, our two year old will age out of ECI, and we will no longer have access to any speech, p/t or o/t services. At the moment, we qualify for SSI, but as our monthly payment (which just started this week) is $25, I'm guessing we're nearly at the max where income is concerned. Anyway, I'm guessing that any sort of teacher raise this fall is going to bump us out of SSI, and will lose the Medicaid services right before we really need them. > > So what are our options? We're a family of five, and our take home pay is $2700 - not enough to pay our regular bills, let alone pay for therapy. We qualify for CHIP, but I'm so scared about the prospect of dropping off our our insurance in order to get CHIP for him. It would mean losing our pediatrician (who we adore), our neurologist, our allergist, you name it....all for the slight chance that we'd find a local (we're in Rowlett) speech pathologist, o/t and p/t that would even take CHIP. > > Is there anything out there that will help us if/when we lose the SSI? I'm not looking for income, I'm only looking for basic therapy for him (he needs and currently receives speech, p/t and o/t with ECI). > > Serena > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 13, 2010 Report Share Posted July 13, 2010 Oh , I have no faith whatsoever that the same school district that is denying my son services now (by way of specifically excluding all speech, p/t and o/t for any child with a developmental delay) is going to appropriately service him once he turns three. I was a kindergarten teacher with the district for 10 years, and the 15 minutes per week of speech that my last autistic student got is probably not going to do much for my non-verbal son. The fact that I was such a champion for this morally reprehensible school district for a decade makes my stomach churn now. My ped will take traditional Medicaid, but not CHIP. I loooooove her, and the new neurologist was pretty cool as well. Plus, I'd lose the allergist/DAN doctor. If, in return, I'd be guaranteed good speech, p/t and o/t services within a 30 mile radius, I might be half way tempted. But as it stands, there's just no telling. Oh, and the kicker? CHIP couldn't even guarantee me that wouldn't have a lapse in health coverage while they did the paperwork to get him started. I just can't believe that we're going to fall through the cracks. There's got to be some sort of way to get basic services for special needs kids when their parents cannot pay for them. Serena > > > > Hey there. I'm really hoping that someone out there can help us out. My husband works for Garland ISD (and I used to as well). Our health insurance specifically excludes all therapy for children with developmental delays. We are fortunate at this point to be receiving our speech, p/t and o/t through PIP/ECI, but come November, our two year old will age out of ECI, and we will no longer have access to any speech, p/t or o/t services. At the moment, we qualify for SSI, but as our monthly payment (which just started this week) is $25, I'm guessing we're nearly at the max where income is concerned. Anyway, I'm guessing that any sort of teacher raise this fall is going to bump us out of SSI, and will lose the Medicaid services right before we really need them. > > > > So what are our options? We're a family of five, and our take home pay is $2700 - not enough to pay our regular bills, let alone pay for therapy. We qualify for CHIP, but I'm so scared about the prospect of dropping off our our insurance in order to get CHIP for him. It would mean losing our pediatrician (who we adore), our neurologist, our allergist, you name it....all for the slight chance that we'd find a local (we're in Rowlett) speech pathologist, o/t and p/t that would even take CHIP. > > > > Is there anything out there that will help us if/when we lose the SSI? I'm not looking for income, I'm only looking for basic therapy for him (he needs and currently receives speech, p/t and o/t with ECI). > > > > Serena > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 13, 2010 Report Share Posted July 13, 2010 Haven, we are on the Class list, but just got added this year, so it'll be years and years before we see anything at all from that. His only other diagnosed condition is PICA. He's got a pretty serious sensory processing disorder, but I think that most of us here are dealing with that to some extent. Otherwise, thankfully, we're not dealing with any other significant medical issues. We're seeing a neurologist due to concerns about seizures that may have caused my child to go from typical to affected by autism overnight. It's something I don't even know how to feel about, because if he is in fact having seizures and there's no good treatment for them, well.....we're just permanently worse off than we already are. If you're asking if he's medically fragile...no, he's not. That's something to be thankful for, I suppose. Serena > > Serena, > > Did you sign your child up on the CLASS and DADS lists? Does he perhaps > have additional health problems that might qualify him for MDCP? I was just > hoping you might be able to get a Medicaid waiver and get services that way. > > I know where you are coming from. Our school district has NEVER given > adequate OT or speech, and we have always had to pay for services out of > pocket due to insurance not covering. Then we ran out of money and had to > rely on school services and our son did not make much progress in speech > just relying on the school services. > > Then he got on MDCP and got a waiver and now Medicaid is paying and he is > FINALLY even getting some PT. > > Haven > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2010 Report Share Posted July 14, 2010 The first then I would suggest you do is sign up for CLASS through DADS - I know there is along waiting list but you are one day closer the day you sign up. CLASS does pay for therapies, attendant care, respite care as well as other stuff. Next, contact the Texas Medicaid Health Insurance Premium Payment (HIPP) program. You said that you son is currently on medicaid. This program will reimburse you for your entire "family" health insurance premium. It does not have a waiting list. The process for getting on the program is not bad - just faxing paperwork bad and forth. We were approved in less than 30 days which is excellent for a government program. Also, contact your local MHMR office and ask about the In Home and Family Support program. They work off of a sliding scale and help pay for therapies and respite. This program is suppose to be a temporary step as they help you find other programs that you qualify for. Even though it is "temporary", we were on it for over 9 years because they can't drop you unless you go on another program which was CLASS for us. But you need to show proof that you have signed up on the CLASS list. Finally, if your husband's potential raise will knock you off of SSI and Medicaid, and it is more beneficial for you to stay on SSI and Medicaid, which it most likely is, he can request to not receive the raise. I do know someone who did this and it is possible. This will allow you to stay on Medicaid and qualify for HIPP. With HIPP, you stay on your private insurance and Medicaid at the same time. Private insurance is your primary and Medicaid is your secondary. Hope this helps. Subject: SSI Medicaid optionsTo: Texas-Autism-Advocacy Date: Tuesday, July 13, 2010, 8:19 PM Hey there. I'm really hoping that someone out there can help us out. My husband works for Garland ISD (and I used to as well). Our health insurance specifically excludes all therapy for children with developmental delays. We are fortunate at this point to be receiving our speech, p/t and o/t through PIP/ECI, but come November, our two year old will age out of ECI, and we will no longer have access to any speech, p/t or o/t services. At the moment, we qualify for SSI, but as our monthly payment (which just started this week) is $25, I'm guessing we're nearly at the max where income is concerned. Anyway, I'm guessing that any sort of teacher raise this fall is going to bump us out of SSI, and will lose the Medicaid services right before we really need them. So what are our options? We're a family of five, and our take home pay is $2700 - not enough to pay our regular bills, let alone pay for therapy. We qualify for CHIP, but I'm so scared about the prospect of dropping off our our insurance in order to get CHIP for him. It would mean losing our pediatrician (who we adore), our neurologist, our allergist, you name it....all for the slight chance that we'd find a local (we're in Rowlett) speech pathologist, o/t and p/t that would even take CHIP.Is there anything out there that will help us if/when we lose the SSI? I'm not looking for income, I'm only looking for basic therapy for him (he needs and currently receives speech, p/t and o/t with ECI).Serena Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2010 Report Share Posted July 14, 2010 Great advice, Lori!I hope your son DOES NOT test positive for seizures, Serena. If this winds up to be the case, then you would get him on MDCP and then requests a Rider 28, so that you receive a waiver and continue his therapies. then you would be able to continue his therapies, receive respite hours, and help pay for prescription meds. I hate that this is the way it is. It is just one more reason TEXAS is forty-ninth in the nation regarding children with special needs. It took us over seven years to finally get our son on MDCP --He was on DADS and CLASS, but no one had told me about MDCP, and one day we were broke, in debt due to all the meds and medical bills, and I called up DADS and just cried, and then I was told about MDCP, so we got on that list, and then I ran into a mom who told me about the Rider, but she told us our son would have to stay in a nursing home for THIRTY days. Then another mom told me that we needed to get a letter from his doctor to get that many days waived (ton 2 instead of thirty) due to Ethan's dietary needs, so our doctor did that. Then we finally got him on it in Jan. of '09. But come to find out, we had received the waiver in July '09, but we didn't understand and I never used it until the following Jan. However, the new paperwork still comes in July. Last summer, I was so busy with taking care of Ethan and Mom, I didn't get the paperwork in on time, and we lost services for a while, but I got him back on. Be sure you know that if you get on a waiver program, then qualifying is based on your child's assets. Your child cannot have any bank accounts nor inherit anything directly. You will have to gt a special needs trust set up that provides only for " over and above " what the state provides. This way, you can leave your house in trust for your child to live in so that the state doesn't take any inherited assets to pay back Medicaid and wind up in an institution. Or if you have someone you trust and will be his guardian, you can leave it to them for his care. I think the best idea is a special needs trust with at least three trustees. You have to plan for all contingencies. Your child may reach independence, but if not, then you want to be sure at least he has a place to live. Property taxes for special needs persons are usually frozen and cannot go up, though I know there are certain conditions which must be met. I know talking about setting up a trust sounds silly, considering I'm sure most of us are broke due to autism and other things, but at least you can put the house in it so he is guaranteed a place to live. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2010 Report Share Posted July 14, 2010 Serena I was a teacher too. You've figured out quickly the reality of the situation. I never allowed my child to get services from the district and didn't want to waste my time fighting. However if it's the only option...you can get it. Yeah I realized after I sent it..you said CHIP..not Medicaid. The only thing I can add is that you won't fall through the cracks...you'll have to fight like all of us...but you will find a way...it's in your blood. I remember signing up for MDCP years ago.....such a long waiting list. But girlfriend when our name did come up we had a good system in place and it was a blessing to now have this to add to our recovery effort. I'm sorry you won't get it sooner...but deep breaths, at some point it will be there and you'll be grateful. I often think that I wasn't organized enough or knowledgable enough to have known how to use it in the beginning years anyway. Once I really knew what I was doing..it was very easy for me to know just how to use for our needs. > > > > > > Hey there. I'm really hoping that someone out there can help us out. My husband works for Garland ISD (and I used to as well). Our health insurance specifically excludes all therapy for children with developmental delays. We are fortunate at this point to be receiving our speech, p/t and o/t through PIP/ECI, but come November, our two year old will age out of ECI, and we will no longer have access to any speech, p/t or o/t services. At the moment, we qualify for SSI, but as our monthly payment (which just started this week) is $25, I'm guessing we're nearly at the max where income is concerned. Anyway, I'm guessing that any sort of teacher raise this fall is going to bump us out of SSI, and will lose the Medicaid services right before we really need them. > > > > > > So what are our options? We're a family of five, and our take home pay is $2700 - not enough to pay our regular bills, let alone pay for therapy. We qualify for CHIP, but I'm so scared about the prospect of dropping off our our insurance in order to get CHIP for him. It would mean losing our pediatrician (who we adore), our neurologist, our allergist, you name it....all for the slight chance that we'd find a local (we're in Rowlett) speech pathologist, o/t and p/t that would even take CHIP. > > > > > > Is there anything out there that will help us if/when we lose the SSI? I'm not looking for income, I'm only looking for basic therapy for him (he needs and currently receives speech, p/t and o/t with ECI). > > > > > > Serena > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2010 Report Share Posted July 14, 2010 Garland ISD's self insured plan specifically excludes all speech, p/t and o/t for children with developmental delays. It's in the health plan documents. There's no appealing. It's deplorable that they're doing that, and shameful that they're ALLOWED to do that, but it is what it is. They do not have to comply with the state house bills. They have chosen to strip these needy children of basic services, and until someone comes along and tells them that they can no longer do so, I don't expect our situation with the insurance company to change. Using a label with my insurance company actually makes our situation worse, because they use the label to deny him services. That's why I finally went to government help. I just can't imagine that there aren't safeguards in place to keep my special needs son from losing all of the services that I've fought to hard to secure for him. As a teacher, I know first hand that he won't get sufficient speech, p/t and o/t through PPCD, and I can't believe that there will be nothing we can do (besides scream into deaf ears, which I assure you I'll be doing) to secure those services privately. Honestly, there's just no money for us to pay for the therapies. I'm at home with because that's what's best for him (and because I need to get him from one therapy to another), and because of that, we lost half of our income. We pay nearly $700/mo for healthcare. It's not like I'm looking for a handout. We PAY for coverage. My personal preference would be that someone make that coverage actually COVER my son. Ok, so I'm just ranting now. So there aren't any buy in programs in Texas or any other ways that I can keep Medicaid? I just can't believe that there's not some way to keep it. Serena > > > > > > From: omalleyfamily1 <serenaomalley@> > > Subject: SSI Medicaid options > > To: Texas-Autism-Advocacy > > Date: Tuesday, July 13, 2010, 8:19 PM > > > > > >  > > > > > > > > Hey there. I'm really hoping that someone out there can help us out. My husband works for Garland ISD (and I used to as well). Our health insurance specifically excludes all therapy for children with developmental delays. We are fortunate at this point to be receiving our speech, p/t and o/t through PIP/ECI, but come November, our two year old will age out of ECI, and we will no longer have access to any speech, p/t or o/t services. At the moment, we qualify for SSI, but as our monthly payment (which just started this week) is $25, I'm guessing we're nearly at the max where income is concerned. Anyway, I'm guessing that any sort of teacher raise this fall is going to bump us out of SSI, and will lose the Medicaid services right before we really need them. > > > > So what are our options? We're a family of five, and our take home pay is $2700 - not enough to pay our regular bills, let alone pay for therapy. We qualify for CHIP, but I'm so scared about the prospect of dropping off our our insurance in order to get CHIP for him. It would mean losing our pediatrician (who we adore), our neurologist, our allergist, you name it....all for the slight chance that we'd find a local (we're in Rowlett) speech pathologist, o/t and p/t that would even take CHIP. > > > > Is there anything out there that will help us if/when we lose the SSI? I'm not looking for income, I'm only looking for basic therapy for him (he needs and currently receives speech, p/t and o/t with ECI). > > > > Serena > > > Quote Link to comment Share on other sites More sharing options...
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