Medicaid Waivers
After posting this the other day, I have received a ton of questions about Medicaid Waivers. So ... I figured this was the best way to try to answer questions.
After Payton was born and we found out that she had Down syndrome, I contacted our local Medicaid office to see if she might qualify for Medicaid. The reason for this is that kids with Down syndrome incur a lot more medical expenses than the typical child does and Medicaid is there to help you with what your insurance won't cover. For some families, the costs that are racked up for things like NICU stays and heart surgery are unbearable.
After I contacted our office and got nowhere, I did find out that the only way she would qualify for Medicaid was to base it on our income ... and for us, that did not qualify us.
Fast forward about two years, I was talking to someone I know that has a child with extensive medical needs. This person is also a special education teacher, so clearly she had a little more insight to the system than I did. She sat me down and told me all about Medicaid Waivers ... they are what you apply for when you would not otherwise qualify for Medicaid.
Now I knew that we could apply for the Medicaid MR Waiver, but I also knew that the waiting list was several years long. Then I learned all about the EDCD Waiver ... that stands for Elderly or Disabled with Consumer Direction. Historically, in my state, this waiver was reserved more for the elderly and not people with disabilities, as the title states. In recent years, it was opened up to include people of all ages with disabilities ... and that is where we come in.
We applied for the waiver for Payton and we were approved based on Payton's needs. So ... not only do we receive the consumer directed care, she also now has Medicaid as a secondary insurance ... which BTW is a God send in light of the costs that our insurance has not covered.
Part of the waiver {actually I'm not sure if it is the waiver or if it is Medicaid in general} is that once the child turns three years old, they are provided with diapers and/or pull ups ... as you saw in my post a few days ago. Now, I want to be clear here that you do not get this assistance until the child is three years old. The reasoning behind this is that most typical children have the ability to be potty trained by age three. However, a child with a disability typically does not ... hence the assistance. Note: I've been told by several others that they do not qualify for diapers and/or pull ups until age four, so I'm assuming that it varies by state?
Each state has different waiver programs available. Click here to see a state by state listing of waivers that are available. My best advice is to be persistent ... because often times the person on the other end of the phone has no idea what a waiver even is. That is a sad reality.
If there is anyone in my state that I can help with this, please let me know. I also have friends in states all across the country, so I can refer you to them for help as well. Actually ... it would be nice to have people post in the comments on this blog entry about specifics for their state. There are tons and tons of parents that are in my shoes that have no idea that such a thing exists ... it boggles my mind.
Now I want to answer some of the questions from the original post ...
Man, are you getting Huggies?
Yes, we get Huggies brand. I wonder if this varies depending on the supplier? Email me and I will give you my supplier ... maybe they will ship to you? I'm not sure if there are boundary limits or not. I just called the company that others in my local group use.
Hey, so does a kid just having Ds qualify? And is there an income limit (not that we make a ton at all I just always thought we wouldn't qualify and so never even applied,) also does this help with co-pays etc and if not is it any help before they are 3?
In my state, I do believe Down syndrome is a qualifier in and of itself. However, I also know that this has not been consistent across the counties. Payton's main qualifiers are DS and sleep apnea. No, with a waiver there is no income limit. I sort of explained how it differs from straight Medicaid above. And yes, Medicaid becomes the secondary insurance for the child (given that the child has primary insurance through a parent) and it covers co-pays, prescriptions and anything else that is not covered by primary insurance. In my state, the catch is that in order to use the Medicaid as a secondary, you have to see doctors who submit to Medicaid. Our ENT, for example, does not ... so we do not use it there. So yes, for all of those reason ... it is still a huge help before the child turns three.
I would love more details about the medicaid waiver. Were you guys on a waiting list, or were you accepted right away?
We were accepted right away in our state ... but I think it is only because there were not telling anyone about the waiver, so nobody knew about it and thus nobody was applying. I know now that more people are aware, they are receiving more calls, but I do not think there is a waiting list. I know some states do have waiting lists, but of course it varies.
I know it varies by state, but we applied one year ago, but in our state there is almost an eight year waiting period (if things are moving quickly.)
Is this for the MR waiver, or a different one? Our state's MR waivier waiting list is similar to yours, or maybe even longer.
Who do I contact to see is my son can receive diapers and wipes like this? My son is on Tennessee Medicaid and receives SSI.
You cannot receive them until your child reaches the age deemed appropriate by your state. I'd call your Medicaid office and inquire about it. If you email me, I can give you my supplier for when your child is old enough, but again ... that might be specific to geographical areas. I'm not sure. Oh, and you mentioned wipes ... but wipes are not part of it. ;)
I said it last time ... and I'm going to say it again, because clearly some don't want to listen. This is my blog and if you don't have anything respectful to say, please feel free to click on that little X in the corner of your browser.
Ahem.
Please ... no attacks about us milking the system, because that is just not the case. I'm only saying this because I've heard this before {in general terms ... not aimed at me, per se} and I pretty much think it is ridiculous. Nuff said. ;)
After Payton was born and we found out that she had Down syndrome, I contacted our local Medicaid office to see if she might qualify for Medicaid. The reason for this is that kids with Down syndrome incur a lot more medical expenses than the typical child does and Medicaid is there to help you with what your insurance won't cover. For some families, the costs that are racked up for things like NICU stays and heart surgery are unbearable.
After I contacted our office and got nowhere, I did find out that the only way she would qualify for Medicaid was to base it on our income ... and for us, that did not qualify us.
Fast forward about two years, I was talking to someone I know that has a child with extensive medical needs. This person is also a special education teacher, so clearly she had a little more insight to the system than I did. She sat me down and told me all about Medicaid Waivers ... they are what you apply for when you would not otherwise qualify for Medicaid.
Now I knew that we could apply for the Medicaid MR Waiver, but I also knew that the waiting list was several years long. Then I learned all about the EDCD Waiver ... that stands for Elderly or Disabled with Consumer Direction. Historically, in my state, this waiver was reserved more for the elderly and not people with disabilities, as the title states. In recent years, it was opened up to include people of all ages with disabilities ... and that is where we come in.
We applied for the waiver for Payton and we were approved based on Payton's needs. So ... not only do we receive the consumer directed care, she also now has Medicaid as a secondary insurance ... which BTW is a God send in light of the costs that our insurance has not covered.
Part of the waiver {actually I'm not sure if it is the waiver or if it is Medicaid in general} is that once the child turns three years old, they are provided with diapers and/or pull ups ... as you saw in my post a few days ago. Now, I want to be clear here that you do not get this assistance until the child is three years old. The reasoning behind this is that most typical children have the ability to be potty trained by age three. However, a child with a disability typically does not ... hence the assistance. Note: I've been told by several others that they do not qualify for diapers and/or pull ups until age four, so I'm assuming that it varies by state?
Each state has different waiver programs available. Click here to see a state by state listing of waivers that are available. My best advice is to be persistent ... because often times the person on the other end of the phone has no idea what a waiver even is. That is a sad reality.
If there is anyone in my state that I can help with this, please let me know. I also have friends in states all across the country, so I can refer you to them for help as well. Actually ... it would be nice to have people post in the comments on this blog entry about specifics for their state. There are tons and tons of parents that are in my shoes that have no idea that such a thing exists ... it boggles my mind.
Now I want to answer some of the questions from the original post ...
Man, are you getting Huggies?
Yes, we get Huggies brand. I wonder if this varies depending on the supplier? Email me and I will give you my supplier ... maybe they will ship to you? I'm not sure if there are boundary limits or not. I just called the company that others in my local group use.
Hey, so does a kid just having Ds qualify? And is there an income limit (not that we make a ton at all I just always thought we wouldn't qualify and so never even applied,) also does this help with co-pays etc and if not is it any help before they are 3?
In my state, I do believe Down syndrome is a qualifier in and of itself. However, I also know that this has not been consistent across the counties. Payton's main qualifiers are DS and sleep apnea. No, with a waiver there is no income limit. I sort of explained how it differs from straight Medicaid above. And yes, Medicaid becomes the secondary insurance for the child (given that the child has primary insurance through a parent) and it covers co-pays, prescriptions and anything else that is not covered by primary insurance. In my state, the catch is that in order to use the Medicaid as a secondary, you have to see doctors who submit to Medicaid. Our ENT, for example, does not ... so we do not use it there. So yes, for all of those reason ... it is still a huge help before the child turns three.
I would love more details about the medicaid waiver. Were you guys on a waiting list, or were you accepted right away?
We were accepted right away in our state ... but I think it is only because there were not telling anyone about the waiver, so nobody knew about it and thus nobody was applying. I know now that more people are aware, they are receiving more calls, but I do not think there is a waiting list. I know some states do have waiting lists, but of course it varies.
I know it varies by state, but we applied one year ago, but in our state there is almost an eight year waiting period (if things are moving quickly.)
Is this for the MR waiver, or a different one? Our state's MR waivier waiting list is similar to yours, or maybe even longer.
Who do I contact to see is my son can receive diapers and wipes like this? My son is on Tennessee Medicaid and receives SSI.
You cannot receive them until your child reaches the age deemed appropriate by your state. I'd call your Medicaid office and inquire about it. If you email me, I can give you my supplier for when your child is old enough, but again ... that might be specific to geographical areas. I'm not sure. Oh, and you mentioned wipes ... but wipes are not part of it. ;)
**************
I said it last time ... and I'm going to say it again, because clearly some don't want to listen. This is my blog and if you don't have anything respectful to say, please feel free to click on that little X in the corner of your browser.
Ahem.
Please ... no attacks about us milking the system, because that is just not the case. I'm only saying this because I've heard this before {in general terms ... not aimed at me, per se} and I pretty much think it is ridiculous. Nuff said. ;)