Guest guest Posted March 4, 2007 Report Share Posted March 4, 2007 Here is some federal law that could help: It's found in Paragraph 5 of the federal Medicaid law for children (EPSDT; http://caselaw.findlaw.com/casecode/uscodes/42/chapters/7/subchapters/xi x/sections/section_1396d.html): " (5) Such other necessary health care, diagnostic services, treatment, and other measures to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the State plan. " +++++++++++++++++++++++++++++++++++++++++++++++++++ Here is what Texas rules say about allowable therapies for kids with Medicaid. So with these rules, if you can get a doctor to write you a prescription that says ABA is medically necessary AND you can find an ABA provider who is approved to bill Medicaid (believe me, this will be the harder one to find, the only ones I know are at BTTC in Richmond and at the Bluebird MHMRA in Austin) , you may be able to get ABA paid for. Good luck, S. +++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Acute Care Services Medicaid consumers under age 21 fall under the Early and Periodic Screening, Diagnosis and Treatment program (EPSDT), known as Texas Health Steps in Texas. For this population, Medicaid benefits cover all medically necessary medical treatment (including psychiatric and psychological care), durable medical equipment, physical therapy (PT), occupational therapy (OT) and speech language therapy (SLT) that are identified as stemming from the child's pervasive developmental disorder (PDD) or autism. Certain benefits require prior authorization. Investigational and experimental treatments or services do not qualify for Medicaid federal matching funds and are prohibited by federal law. Medicaid-eligible children who are enrolled in Early Childhood Intervention (ECI) services would recieve the same services covered by EPSDT as well as some additional developmental rehabilitation services. I've cc:d Keisha Rowe at DARS if you have additional questions about ECI services. Unlike children, Medicaid consumers 21 years of age and older are not EPSDT/THSteps-eligible. However, adults are entitled to the full range of Medicaid benefits that are defined in medical benefit policy, e.g., physician service, hospitalization, and certain home health services. Adult Medicaid consumers are entitled to medical and OT, PT and SLT services on a more defined basis, and benefits are subject to certain program limitations. For example, OT, PT and SLT for adults are only covered for acute problems (i.e., not a chronic condition such as PDD), and only for limited periods of time. Long Term Services and Supports Texas Medicaid also has a number of programs that provide long term services and supports, including waiver programs that allow persons who would qualify for institutional care to instead receive care in the community. Each of these programs has income, resource, and disability/functional requirements, and some target those with a diagnosis of mental retardation. For children in the community, they must meet income and resource tests based either 1) on their own plus their parents' income and resources if not in an institution or community care waiver or 2) on their own income and resources if in a community care waiver, nursing home or Intermediate Care Facility for the Mentally Retarded (ICF/MR). Long term care services vary for each waiver and state plan program. .. Re: SSI benefits Does Medicade cover ABA or other speech related or OT services? My son's family should qualify and that will help immensely. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 4, 2007 Report Share Posted March 4, 2007 No they don't. The rule of thumb is MEDICAID usually pays what the insurance pays. Most private insurances do not pay for ABA, and the reason is the providers are not licensed. Re: SSI benefits > > > hrmmm In not sure on that because to my knowledge medicaid wont reimburse > you cash......but i could be wrong. Id call and ask. One thing I have > learned though. Call ask, if the answer is no, call again get a different > person and ask again....repeat. sometimes the answer isnt actually no > its.........well i dont really no and its just easiest to say no . > > i called 6 different medicaid related departs and heard no 6 times trying > to get a carseat for my son. Teh 7th time i got yes its possible to get > medicaid to pay . you have to find a provider that will bill medicaid, > apply, get a preccription for it etc........and we are currently in that > process. > > --------------------------------- > Finding fabulous fares is fun. > Let Yahoo! FareChase search your favorite travel sites to find flight and > hotel bargains. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 4, 2007 Report Share Posted March 4, 2007 I think you are referring to the CLASS program which is a state-waiver program that has nothing to do with how much income you make. http://www.dads.state.tx.us/providers/CLASS/index.cfm Re: SSI benefits > > Well its hard to give an exact amount or cuttoff or whatever. I have a 5 > year old autistic boy who is nonverbal. We are extremely blessed and were > approved for SSI the first time we applied. they look at the severity, > your family income and how many dependants you have and what you have in > assets. In most states, texas included you automaticly receive medicaid if > you get ssi. Even if you have private insurance this can be a bllessing > because medicaid will covers things your private insurance dosent like > co---pays. > > > > ------------ --------- --------- --- > The fish are biting. > Get more visitors on your site using Yahoo! Search Marketing. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 4, 2007 Report Share Posted March 4, 2007 Pages 16 & 17 has a link to the sites needed. Might have to cut and paste. Resources Every Parents Should Know About: Helping Our Children with Disabilities to Live a Safe and Enriched Life. http://www.esc13.net/hilit/beattheheat/btharchive/ResourcesEveryParent.p df http://www.hhsc.state.tx.us/Programs/Programs.html Irma Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 4, 2007 Report Share Posted March 4, 2007 No, no, there is another one that will help out with copays and deductibles for people who have private insurance that covers some things. You told me about it, - Do you know what I'm talking about? Re: SSI benefits I think you are referring to the CLASS program which is a state-waiver program that has nothing to do with how much income you make. http://www.dads.state.tx.us/providers/CLASS/index.cfm Re: SSI benefits > > Well its hard to give an exact amount or cuttoff or whatever. I have a 5 > year old autistic boy who is nonverbal. We are extremely blessed and were > approved for SSI the first time we applied. they look at the severity, > your family income and how many dependants you have and what you have in > assets. In most states, texas included you automaticly receive medicaid if > you get ssi. Even if you have private insurance this can be a bllessing > because medicaid will covers things your private insurance dosent like > co---pays. > > > > ------------ --------- --------- --- > The fish are biting. > Get more visitors on your site using Yahoo! Search Marketing. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2007 Report Share Posted March 5, 2007 Here's the link: http://www.socialsecurity.gov/applyfordisability/ > > > > Hello listmates: > > > > I've heard differing information from various parents regarding the > > eligibility of kids with autism for Social Security Disability > > benefits. > > > > I would rather rely on the sage wisdom of my " autism cronies " than to > > dig into the research myself (lazy? Perhaps :-). > > > > So - what's the word? Are our kids (under 18) eligible for SSI > > benefits? And if so, is there any real benefit to be had there? > > > > I'd appreciate any information. > > > > As always, I thank Heaven for the very smart, very seasoned parents on > > the list! > > > > Thank you, > > A. Weber > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2007 Report Share Posted March 5, 2007 HIPP - That's it. I called about it, and you have to already have Medicaid to use it. If I understand the program correctly, it sounds like something that could be helpful to people who carry private insurance, cannot afford deductibles and copays and have a hard time finding providers who accept Medicaid. Re: SSI benefits I think you are referring to the CLASS program which is a state-waiver program that has nothing to do with how much income you make. http://www.dads.state.tx.us/providers/CLASS/index.cfm Re: SSI benefits > > Well its hard to give an exact amount or cuttoff or whatever. I have a 5 > year old autistic boy who is nonverbal. We are extremely blessed and were > approved for SSI the first time we applied. they look at the severity, > your family income and how many dependants you have and what you have in > assets. In most states, texas included you automaticly receive medicaid if > you get ssi. Even if you have private insurance this can be a bllessing > because medicaid will covers things your private insurance dosent like > co---pays. > > > > ------------ --------- --------- --- > The fish are biting. > Get more visitors on your site using Yahoo! Search Marketing. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2007 Report Share Posted March 5, 2007 Hi Ivy~ Even if you use your private insurance as your primary, if your providers accept Medicaid, use it! It'll pay your copays and (usually) anything else your primary doesn't cover. Also, if you have a $500 deductible and your premiums are accepted, Medicaid will reimburse you for your private insurance premiums. In addition to the $600 SSI benefit, Evan's Medicaid is picking up $100/month in therapy copays (and $1000 in therapy after we max out his primary for therapy) plus $500 in insurance premiums. So, that's about $2000/month that we don't have to earn. SSI has definitely been worth the trouble for us! Love, Diane. http://babiesonline.com/babies/e/evankyle ________________________________________________________________________________\ ____ Yahoo! Music Unlimited Access over 1 million songs. http://music.yahoo.com/unlimited Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2007 Report Share Posted March 5, 2007 Which Insurance do you have? Is it private or co-pay? Chris Re: SSI benefits Hi Ivy~ Even if you use your private insurance as your primary, if your providers accept Medicaid, use it! It'll pay your copays and (usually) anything else your primary doesn't cover. Also, if you have a $500 deductible and your premiums are accepted, Medicaid will reimburse you for your private insurance premiums. In addition to the $600 SSI benefit, Evan's Medicaid is picking up $100/month in therapy copays (and $1000 in therapy after we max out his primary for therapy) plus $500 in insurance premiums. So, that's about $2000/month that we don't have to earn. SSI has definitely been worth the trouble for us! Love, Diane. http://babiesonline.com/babies/e/evankyle __________________________________________________________ Yahoo! Music Unlimited Access over 1 million songs. http://music.yahoo.com/unlimited Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2007 Report Share Posted March 5, 2007 The HIPP (health insurance premium program) pays private insurance premiums if you qualify. The number is on the back of the Medicaid card. Love, Diane. http://babiesonline.com/babies/e/evankyle ________________________________________________________________________________\ ____ Be a PS3 game guru. Get your game face on with the latest PS3 news and previews at Yahoo! Games. http://videogames.yahoo.com/platform?platform=120121 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2007 Report Share Posted March 5, 2007 Isn't that funny? When I was in the process of getting the insurance company to pay for ABA for my son, I was told by an insurance rep that private insurance bases what they pay on what MEDICAID pays. You know, I'm just beginning to think that these benefits people will say whatever will get someone off the phone. Oh, and Tricare, the insurance for the DoD--what covers all servicemen DOES pay BCBAs and BCABAs despite them not being licensed. S. Re: SSI benefits No they don't. The rule of thumb is MEDICAID usually pays what the insurance pays. Most private insurances do not pay for ABA, and the reason is the providers are not licensed. Recent Activity a.. 7New Members b.. 1New Files Visit Your Group Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2007 Report Share Posted March 5, 2007 Hi Diane, How do you get medicaid? I have a PPO and my son has tourettes and Aspergers among other things. PPos do not cover a lot of the OT therapy and speech therapy. From my understanding, you have to have a family income under a certain amount. It kind of discouraged me. Any advice?? My situation is kind of interseting. Donna > > Hi Ivy~ > > Even if you use your private insurance as your primary, if your providers accept > Medicaid, use it! It'll pay your copays and (usually) anything else your primary > doesn't cover. Also, if you have a $500 deductible and your premiums are accepted, > Medicaid will reimburse you for your private insurance premiums. > > In addition to the $600 SSI benefit, Evan's Medicaid is picking up $100/month in > therapy copays (and $1000 in therapy after we max out his primary for therapy) plus > $500 in insurance premiums. So, that's about $2000/month that we don't have to earn. > SSI has definitely been worth the trouble for us! > > Love, > > Diane. > http://babiesonline.com/babies/e/evankyle > > > > _____________________________________________________________________ _______________ > Yahoo! Music Unlimited > Access over 1 million songs. > http://music.yahoo.com/unlimited > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2007 Report Share Posted March 5, 2007 > > Hi Diane, > > How do you get medicaid? I have a PPO and my son has tourettes and > Aspergers among other things. PPos do not cover a lot of the OT > therapy and speech therapy. From my understanding, you have to have > a family income under a certain amount. It kind of discouraged me. > Any advice?? My situation is kind of interseting. Hi Donna~ Obiviously, getting SSI is the easiest way to get Medicaid. The income limits on SSI are more generous than Medicaid's, too, although you have to be pretty much broke for both. It sounds like with Asperger's and Tourette's that your son should qualify for SSI. Another thought is to get on the HCS and CLASS waiting lists. Those are based on medical need and not income, but you could wait years for those. I understand why you're discouraged. The NICU applied for Evan's SSI and we were notified when he was six months old that he was denied. My husband was in denial (LOL) and we didn't appeal, but re-applied when he was almost two and were approved. Nothing about having a child with special needs is easy! Love, Diane. http://www.babiesonline.com/babies/e/evankyle Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2007 Report Share Posted March 5, 2007 > > Which Insurance do you have? Is it private or co-pay? Hi Chris~ We have a self-funded plan through my husband's employer administered by United Health Care. Love, Diane. http://www.babiesonline.com/babies/e/evankyle Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2007 Report Share Posted March 5, 2007 Social Security has an online screening tool at https://s044a90.ssa.gov/apps7/best/benefits/index.cfm . This does NOT apply you for benefits. The actual SSI regulations are at http://www.ssa.gov/OP_Home/cfr20/416/416-0000.htm Tonya Re: SSI benefits Does anyone know off the top of their heads what the income limit is? And do they consider liabilities, or is it strictly income? (picture me rolling my eyes, too, that they don’t take into consideration our TWENTY-FOUR THOUSAND DOLLARS WORTH OF ANNUAL HEALTH INSURANCE PREMIUMS). A. Weber Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2007 Report Share Posted March 5, 2007 Social Security has an online screening tool at https://s044a90.ssa.gov/apps7/best/benefits/index.cfm . This does NOT apply you for benefits. The actual SSI regulations are at http://www.ssa.gov/OP_Home/cfr20/416/416-0000.htm Tonya Re: SSI benefits Does anyone know off the top of their heads what the income limit is? And do they consider liabilities, or is it strictly income? (picture me rolling my eyes, too, that they don’t take into consideration our TWENTY-FOUR THOUSAND DOLLARS WORTH OF ANNUAL HEALTH INSURANCE PREMIUMS). A. Weber Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2007 Report Share Posted March 5, 2007 Qualify & Apply for SSI at http://www.ssa.gov/d & s1.htm Tonya Re: SSI benefits Where would one find the 3660 form, perchance? Thanks! 'Don't be humble. You're not that great.' --- Golda Meir Re: [Texas-Autism- Advocacy] SSI benefits > > Well its hard to give an exact amount or cuttoff or whatever. I have a 5 > year old autistic boy who is nonverbal. We are extremely blessed and were > approved for SSI the first time we applied. they look at the severity, > your family income and how many dependants you have and what you have in > assets. In most states, texas included you automaticly receive medicaid if > you get ssi. Even if you have private insurance this can be a bllessing > because medicaid will covers things your private insurance dosent like > co---pays. > > > > ------------ --------- --------- --- > The fish are biting. > Get more visitors on your site using Yahoo! Search Marketing. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 6, 2007 Report Share Posted March 6, 2007 SSI has no generous income limits by me. At one point for several months (2006), I had no income, no child support, nothing and they said because I was supposed to get 600 a monthchild support and because my parents and I share a house that we do not qualify. Mind you, we live in a 1400 sq ft wood frame home (25 year s old) in the middle of the country. My father and mother are both retired. Tehy have some big medical needs too. To date, I have never made even what the beginning salary is for teachers in the State of Texas. So, we do not even have a normal income for a family of 5. I am the only source of income and they would not give my daughter SSI or medicaid or anything. A friend of mine in Copperfield and I were talking about that and we know people who live where she lives and have two professional incomes and they get it. If anyone knows the secret, please tell me what it is. Thanks, Candis Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 6, 2007 Report Share Posted March 6, 2007 Candi, I know this might cost some money, but have hired an attorney that specializes in SSI? The attorney can appeal the denial. Nagla > > SSI has no generous income limits by me. At one point > for several months (2006), I had no income, no child > support, nothing and they said because I was supposed > to get 600 a monthchild support and because my parents > and I share a house that we do not qualify. Mind you, > we live in a 1400 sq ft wood frame home (25 year s > old) in the middle of the country. My father and > mother are both retired. Tehy have some big medical > needs too. > > To date, I have never made even what the beginning > salary is for teachers in the State of Texas. So, we > do not even have a normal income for a family of 5. > > I am the only source of income and they would not give > my daughter SSI or medicaid or anything. > > A friend of mine in Copperfield and I were talking > about that and we know people who live where she lives > and have two professional incomes and they get it. > > If anyone knows the secret, please tell me what it is. > > Thanks, > Candis > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 6, 2007 Report Share Posted March 6, 2007 I heard somewhere (workshop??) that most people get turned down for SSI on the first try and many times it takes 3 or more applications before people get approved. Tonya Re: SSI benefits SSI has no generous income limits by me. At one point for several months (2006), I had no income, no child support, nothing and they said because I was supposed to get 600 a monthchild support and because my parents and I share a house that we do not qualify. Mind you, we live in a 1400 sq ft wood frame home (25 year s old) in the middle of the country. My father and mother are both retired. Tehy have some big medical needs too. To date, I have never made even what the beginning salary is for teachers in the State of Texas. So, we do not even have a normal income for a family of 5. I am the only source of income and they would not give my daughter SSI or medicaid or anything. A friend of mine in Copperfield and I were talking about that and we know people who live where she lives and have two professional incomes and they get it. If anyone knows the secret, please tell me what it is. Thanks, Candis Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 6, 2007 Report Share Posted March 6, 2007 Ditto, appeals are fairly straight forward to make on your own. I used to work for a group, and my boss had heard of several people get approved on appeal. The key is that there has to be a documentable, large delay between what you son can do versus what his same peers can do--that's usually the sticking point to getting SSI for many applying for younger kiddos. S. Re: SSI benefits SSI has no generous income limits by me. At one point for several months (2006), I had no income, no child support, nothing and they said because I was supposed to get 600 a monthchild support and because my parents and I share a house that we do not qualify. Mind you, we live in a 1400 sq ft wood frame home (25 year s old) in the middle of the country. My father and mother are both retired. Tehy have some big medical needs too. Recent Activity a.. 11New Members Visit Your Group Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 16, 2010 Report Share Posted September 16, 2010  I have been trying to navigate the SSA website to figure our which forms I will need to fill out. My son will turn 18 in January and I want to have everything lined up for SSI to get started. However, I can not figure out which forms i need to download. FYI, my son has never gotten SSI, so this is all new to us. He does get the Beckett Medicaid waiver. He has moderate to severe Autism. He is non verbal. We also want to get a rental agreement in place so we may use that when we file. Could someone please help me figure this out? Thanks very much, Theree Sauls ssi benefitsTo: autism-georgia Date: Sunday, September 5, 2010, 3:48 PMmy son's ssi application was approved (he just turned 18) and we received the first check. it is only $449. we expected $674. not sure what is going on. any ideas? can we appeal? how? Quote Link to comment Share on other sites More sharing options...
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