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This article briefly explains what is medical, who is eligible and the process for filing the medical benefits. This article is compiled by parents who have been approved for services through government funding. It is recommended that the parents and caregivers talk to their respective caseworkers and determine what services they may be eligible for. Topics discussed are as follows:
How To Get Government Services? MEDI-CAL Waiver
Clause: Medi-Cal Health Insurance
Premium Payment Plan (HIPP): Eligibility Requirements:
To be eligible for this plan the following requirements must be met:
For more information please visit http://www.dhs.cahwnet.gov/mcs/psd/tplb/html/hipp.htm
Regional
Center:
Why do we need Government Services? The first and foremost reason is for your child’s protection. Given that he/she has serious medical needs puts him/her in the risk category by the insurance companies. Many HMOs have caps on their spending, so, for some unfortunate reason when your child’s bill exceeds the cap you have a secondary source to tap into. Usually Medi-Cal agrees to pay most of the bills which the HMOs have rejected except if they were deemed to be unwanted procedures. The second reason is the uncertainty of job situations. If the caretaker/parent is laid off or decide to quit a job, this should not in any case affect the medical care of the children. If you child is approved for Medi-Cal, all you need to do is to inform his/her Case Worker in the Medi-Cal department that Medi-cal is going to be your child’s primary insurance and make sure the necessary changes are made in the system. The third reason is that medical may approve certain services that your primary insurance may deny to pay.For example: Nursing or Respite services, medical equipments etc. Last but not the least, once a child has been approved for Medi-Cal, he or she is always under the supervision of the government. In case a parent/caregiver is unable to take care of the child, the state takes custody of the child and does what is needed to care of him/her.
How Do We Get Services Through Our Private Insurance: Even after being approved for
Medi-Cal, the government requires us to get the services approved by our
primary insurance first. Many healthcare organizations may have a hard
time approving specialized services like nursing care or purchase of a
medical equipment. It is however up to the primary Physician or the
specialist to convince the insurance company that it is absolutely
necessary for the patient to be provided with such services. Perseverance
is the only way to get these services approved. It is better to get these
services through the insurance company for two reasons: It is easy to find
a provider who will accept private insurance or HMOs as opposed to
Medi-Cal. Medi-Cal pays its providers minimally and hence it is difficult
to find a provider who would accept Medi-Cal. The second reason is that
the quality of service is much better with non Medi-Cal providers since
they have better qualified personnel especially in case of nursing. The
availability of nurses is also comparatively more. Another way that an
insurance company may approve specialized services is when the human
resources in the company for which you work for puts pressure for
approving these services for the benefit of an employee. This especially
works when you are taking up a new job. Besides all the other conditions
that you agree upon with your employer, make it clear that you would need
these specialized services to be approved for you to consider taking up
the job. Given the hot job market today, this could work to our advantage.
If all the above tactics fail you need to get an explicit denial letter
from your insurance company, and a referral for these services from your
primary physician or specialist and then approach Medi-Cal. You may not
have to approach Medi-Cal directly but rather find a provider for the
service who accepts Medi-Cal and ask them if they would accept to supply
you with the necessary services. If they agree then they will have to go
through a series of paper works and they would need the denial letter from
your primary insurance and the referral from your doctor in addition to
the necessary medical history.
Why Do We Need To Set Up Special Need Trusts? Can you also provide a list of resources available? A Special Plan - Families of
Special Needs Children Need to Take Steps to Safeguard Their Financial
Future She wasn't going to be able to live independently as an adult. It was up to them to create the financial foundation to support Kim long past the days when they would be around. The Webers had taken some steps - putting money in a savings account for Kim, buying savings bonds. But at a workshop sponsored by the Autism Society of Orange County, the Costa Mesa couple learned that what they thought wouldn't be nearly enough financial security for their daughter was actually too much. They found out what many parents of special-needs children don't know: Leaving assets of more than $2,000 triggers a loss of government benefits. That's all it takes to cut off Supplemental Security Income, or SSI, which pays for the food, clothing and shelter of a disabled adult, or an underage child in a low-income family. Even more worrisome, disqualification from SSI means losing the crucial medical coverage provided through Medicaid, or Medi-Cal in California, and perhaps having to pay money back to the state. "I was blown away by that one," Elaine Weber says of the wake-up call she got at that workshop five years ago. "I was like, how horrible, we can't leave her any money." But she also learned of something called a special-needs trust,
established by law in 1993 for the accumulation of funds that are used
strictly for lifestyle needs - education, transportation, leisure – and
don't jeopardize government benefits. "If I hadn't gone to that seminar,"
she says, "I wouldn't know any of this." Financial-planning experts
estimate that less than 15 percent of parents with special-needs children
have done any sufficient planning for the future - financial, legal or
medical. Tips and resources for special-needs planning
Bart Stevens of Bart Stevens Special Planning in Scottsdale, Ariz., has
a book and a kit to help with prep work. Both "The ABC's of Special Needs
Planning Made Easy" ($34.95) and his "Special Needs Planning Kit" ($240)
are available at his Web site or by calling (888) 447-2525. MetDESK
special-needs planning, a service of Metropolitan Life Insurance Co.,
offers free seminars, attorney referrals and other information. Go to the
Web site or call (877) 638-3375. Other useful Web sites include:
"It's partly from lack of knowledge, and partly from hearing so many different things you're not sure what to do," says Nadine Vogel, mother of two special-needs children and founder of the 10-year-old nonprofit organization Special Needs Advocate for Parents, or SNAP. "Part of it, too, is that it's emotionally daunting. A family has to really come to terms with the child's diagnosis and their lifetime issues." Parents typically don't know, for instance, that once their child reaches adulthood at 18, the law does not allow anyone else to make medical decisions for them without a legal document in place naming a medical guardian, Vogel says. Otherwise, if the disabled adult is developmentally incapable, the hospital or the state will make those decisions. There's a growing effort to make parents aware of special-needs planning, including workshops sponsored by support and advocacy groups, school districts, and financial-service companies. Vogel's personal experience and the large number of financial queries made to the SNAP hot line prompted her to persuade her employer, Metropolitan Life Insurance Co., to launch MetDESK (Division of Estate Planning for Special Kids), which she oversees, in 1998. Joe Sahabu, a MetDESK specialist based in Fullerton, says he has given many free seminars in the Los Angeles area over the past three years and is working to make his services better known in Orange County. He is willing to sit down with anyone, no matter the size of the group. Call Sahabu at (714) 255-8158 or (800) 492-3553, Ext. 1286, or e-mail jsahabu@m... . "Even one person, I'll go and talk to them because I think it is so important," Sahabu says. "It's never too early to start, and it's only too late if the parents pass away. As long as one parent is around, it's never too late to make a plan." The Webers, who both work, were in the process of taking out joint survivor life insurance, also known as a second-to-die or last-to-die policy, that would pay into the special-needs trust fund for Kim, now 11, only after both parents are dead. But before the insurance company got back to them, Paul was diagnosed this summer with cancer and is undergoing chemotherapy. Now Elaine Weber is looking at taking out a $500,000 policy on herself that she expects will cost about $400 a month. The cost of a $500,000 joint survivor policy for a couple runs about half that. "I never thought at 46, I'd be sitting here with my husband having cancer," she says. "There's just like this list of things that should be done. It's a lot of work, but when it's done, it's done. Once everything is in place, it really will be peace of mind." The Webers' dilemma underscores what Bart Stevens says he stresses to those who attend the seminars that his Arizona-based company, Bart Stevens Special Needs Planning, puts on around the country: Families with special-needs children - be they underage or adults - can least afford to procrastinate when it comes to long-term planning. "I tell them what if you get in an accident when you leave this seminar? What's going to happen to your child?" says Stevens, who has focused on special-needs planning the past 10 years. "That usually opens their eyes. They've got to do it. They can't put it off." | ||
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