Medicaid question

Discussion in 'General Parenting' started by klmno, May 4, 2008.

  1. klmno

    klmno Active Member

    I was flipping through a book about difficult child help today and they had a section on medical insurance. If I understood it correctly, a difficult child wouldn't qualify for medicaid if neither the difficult child or the parent was on disability/SS and if the parent worked (at all). It said this put many families in the position of turning their child over to the state to be placed in foster care so then they would qualify for medicaid.

    This makes no sense to me- why would they pay medicaid for a child in foster care (with people who probably wouldn't do as much for a teen difficult child than the parent would do) but not pay the medicaid if the difficult child lives with parent? Why require a bad situation to get worse by separating the family if the family has shown themselves to be appropriate parents and why put the difficult child in this position? Furthermore, what if the whole reason that the parent can't provide private insurance at that point in time is due to already expending all resources on difficult child issues? They would be putting difficult child into a different home that couldn't/wouldn't provide it either. I don't get it.

    Is this true? Does anyone have any first hand experience with this?
  2. flutterbee

    flutterbee Guest

    It is going to vary by state, but that is not an entirely accurate statement. In Ohio, for example, a family of 3 can earn somewhere around $35,000 per year and still qualify for medicaid on the children. There are also buy-down type programs where if you are over the income threshold by a certain amount you can buy it down. I'm not exactly sure how that works, but I do remember seeing it on the Virginia website when I looked at it for you. There are also waivers for a child that is disabled, but they can be hard to get.

    It is true that some people who's income is too high have had to turn their children over to the state in order to get the help their child needs. There was a front page article on it here about a year ago addressing the very issues you raised. It doesn't make sense to me and, in my opinion, is a crime. It seems to go against the 'keeping families together' motto that social services is so big on, doesn't it? Besides a million other things...I could go on for hours.

    Even those who have private insurance find themselves inadequately covered when it comes to mental health. Their insurance won't provide coverage for the help the child needs and they make too much to qualify for medicaid. That is another thing that article in our paper was local rep has been trying for years to change the law in Ohio for mental health parity. There was a small change last year, but it's still not enough.
  3. klmno

    klmno Active Member

    Thank you! I have those links bookmarked and am exploring them. I had to "detour" from it a little due to difficult child being in psychiatric hospital this past week and having one meeting after another to go to.
  4. DammitJanet

    DammitJanet Well-Known Member

    Heather has it just about right. Im not sure how the wording is about medicaid and parents on SS but it really all comes down to income. For example, I get both medicaid and medicare because Im on SS disability and my monthly income is under the medicaid guidelines even though I make a tad too much for SSI.

    I could explain the spend down but it would be lengthy and boring unless you really want to understand it.
  5. KTMom91

    KTMom91 Well-Known Member

    Miss KT is on Medi-Cal; all her medical expenses are covered by the state of California. Because her useless father and I are divorced, the state counts only my income, not Hubby's, and I work part-time and have no health insurance available. California has several programs for health insurance for the kids; some are no cost, some have the parent pay on a sliding scale.

    I don't know about having to put your child into foster care to get treatment, but I did read about a couple here who divorced because the husband needed residential treatment and they would have had to liquidate everything and leave the wife with nothing. Once they were divorced, he had no assets, so the state picked up the cost.
  6. mom_in_training

    mom_in_training New Member

    "I was flipping through a book about difficult child help today and they had a section on medical insurance. If I understood it correctly, a difficult child wouldn't qualify for medicaid if neither the difficult child or the parent was on disability/SS and if the parent worked (at all). It said this put many families in the position of turning their child over to the state to be placed in foster care so then they would qualify for medicaid."

    Yep all of its true. The state qualifications for Medicare or Medicaid if you make more then the income limits. In my case the other parent abandoned his children and I am sure he has worked but just working would not qualify a certain family member. At least one parent has to be receiving SS benefits if none are your out. I have no clue as to where the father is let alone if hes still breathing. I just scimmed through a site on American Disabilities and Rights and sadly many elder and young adults are forced out of their own communities and having to go to a care home environment just so they can get everything that they need medically or nutritionally due to not qualifing for Medicare or Medicaid. They find themselves not being able to get the appropriate medical attention while in their own homes because they can't pay the astronomical share of cost (Spend Down). There are many that are forced to purchase their own formula because their Ins, Medicare, Medicaid will not pay until they have met their share of cost. Just spoke to someone today that is in that position. Your talking like $600.00 for a 30 day supply of just formula alone. I'm talking about people that have Gastrostomy feeding tubes that depend on the formula to survive. Its their only way of nutrition period.
  7. klmno

    klmno Active Member

    GEEZ- as if the mental health treatment in our society wasn't a big enough issue without throwing in the insurance problem on top of it. I just can't see why and how so many legal authorities and agencies want to still act like parents should be blamed for all the kids' issues, when it seems more than a little obvious that it is not us parents that have our heads stuck in the sand.
  8. dreamer

    dreamer New Member

    IL has a program for children Kidcare, and nope neither parent nor child MUST be on soc sec to qualify at all--it is income based------but, the income cut off is higher than you might think in IL right now------I worked and my kids got Kidcare for a short while. There were different "levels" and higher income people did have to pay a premium and a deductible - but- it was MUCH MUCH cheaper than haveing nothing, I want to say um.......hmm, cannot remember now. and yes, lower income people can get Medicaide, Kidcare is not for coverage for adults.....the income cut off is much higher to get Kidcare than it is for Medicaide, in IL.

    Now yes, I worked in our county nurseing home for almost 15 years and yes, it was not uncommon for spouses to divorce so as to not financially devastate married couples and families.....often, once divorced, the state picked up the tab for care for the ill person, so the remaining spouse did not lose home, car etc, whatever.
    BUT as far as people going residential becuz they cannot otherwise afford things? Not so much of that going on, at least not here.....getting placed residential is not easy at all. SOmeone who has a g-tube feeding but few other health problems, likely will not get approved to go into a facility.....sadly many people even with serious difficult health issues have a hard time getting into a facility. My best friend had MS and lost an eye to cancer, and then the cancer spread more- and eventually was in her entire body- and blocking her bowels, and she was quite psychotic from it being in her brain, and between the ms and cancer being in her spine, she had no bowel or bladder control, she also had it in her lungs, plus she had asthma.....and even THEN the insurance nor Medicaide would permit her to be in a facility. Her 2 young kids did her end of life care with help from me and my kids.

    when my mom was end stage lung cancer mets to brain- she could not walk, had no memory, was not safe alone, grand mal seizures were a concern----and she lived alone------her ins and Medicare still would not pay for residential, inmpatient nurseing home.

    It can get quite complicated.

    But yes- as I stated in a thread on another forum, I know people who have broken laws to go to jail so as to get medical care......I know people who divorce to get medical care for themself, a spouse or the is all a sad mess. ANd yes, I also know several people who have been told if they give up their kids, their kids medical needs will be met (me included, I was told that 15 years ago)

    I also know several people who have moved to states who are more generous in help they provide to families for Medical. Some states are much more genrous than others.
  9. CrazyinVA

    CrazyinVA Well-Known Member Staff Member

    I had to threaten our local social services with giving up my parental rights to them, in order to get them to pay for Youngest's residential treatment a few years ago. This was after exhausting every possibility I could find to get her in somewhere, somehow (after 3 overdoses in a 4 month period). I went so far as to actually file the paperwork with the court, copying the Director of Social Services, and they relented. Supposedly it had to do with them not wanting to appear in front of the judge and admitting they hadn't done all they could to help my child. I ended up revoking my petition once they approved funding.

    Sad, sad state of affairs. Mental health parity is desparately needed.
  10. klmno

    klmno Active Member

    Thanks to everyone for the insight! I have decided to try to hang on a little longer with the insurance that I have. I will pay out of pocket for another month- I am trying to line up programs for difficult child to attend so maybe I can work very close to full time hours during the summer- assuming he isn't put in detention. If he's in detention, I can work however many hours I need, but of course, that isn't the ideal situation.

    The big problem is that if I work 38 hours a week, I still have to pay the insurance. If I can work 40 hours every week, they pay mine and difficult child's. You would think 30 hours or more would get half paid or something, but no. If I work 40 hours, I can't take him to appts and be here supervising him after school. If he stays on probation, then there is more of a problem.

    After reading all this, I guess my big concern is that if I could get him on medicaid or other state assistance, there would be problems getting adequate professionals- and I am really picky about his mental health professionals- well, I don't think I am picky- I think it is hard to find competent ones who take the insurance, who are males (recommended by everyone for difficult child due to his specific underlying issues), who don't go back to the behavior management cr*p, who really do have some experience with kids who have mood cycling, and who keep up with files, return calls, and don't take 2+ hours in their office with me sitting in the waiting room. Then of course, difficult child and I need to feel comfortable with them.

    Is that picky? LOL!