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Special Needs
breezy0629
member
PA folks? CHIP?
breezy0629
member
Where do I call to find out the info on whether my son will qualify for Medicaid based on his diagnosis? I just got off the phone with CHIP (I still don't understand this system, as NC doesn't have this kind of children's insurance) and she said that b/c of his diagnosis he will automatically qualify for Medicaid instead of CHIP no matter the income requirements. I'm confused b/c I don't want to be misinformed when we get there. Is there not any qualification of %delay or anything for PA disability medicaid? I was also told my daughter will qualify for CHIP no matter what. Is there not any reason a child can't get CHIP in PA (other than being over the income req)?
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Re: PA folks? CHIP?
Here is the website for CHIP.
https://www.chipcoverspakids.com/about-chip/what-is-chip/
CHIP is for ALL uninsured kids (up to age 19) who are not eligiable for medical assistance. According to their website, there is no income limit anymore. What you pay depends on your income.
What diagnosis does your son have again ? I am sorry I don't remember.
I want to say autism ?? If I am wrong, please correect me.
Here is a website that helped me.
https://www.dpw.state.pa.us/ServicesPrograms/Autism/AutismRsrc/003676289.htm
This is true (if you are talking about applying for MA for your son.) Income has NOTHING to do with it. ( They will still ask for your pay stubs though! )
They need to see a psych evaluation saying that your son has "x" diagnosis and he will be able to get it.
It is a VERY SLOW process (just to warn you)
In PA most children with diagnoses will qualify for medicaid regardless of income. My son (dx severe apraxia) qualified for medicaid based upon the evaluation completed by EI. I filled out the application online (state's website) which provided a list of things I needed to mail or fax in. The list included verification of our income (which definetly would not qualify us for any type of public assistance), verification of diagnoses (or limitations in certain areas which was our situation initially) and verification of identification (birth certificate for ds and license for us). They then asked for further documentation at which point I sent in a copy of his IEP. We then received medicaid. This covers his private speech therapy (my private insurance covers the first 20 visits so this covers every other appointments) as well as the co pay from my private insurance.
In PA, CHIP is for children whose parents work but do not have insurance or cannot afford insurance. This is different then medicaid because this is based upon income and provides different coverages. Your son should qualify for medicaid b/c of diagnosis. Assuming you meet the income requirements, your daughter would then qualify for CHIP.
I hope this helps. If I can provide any more information please do not hesitate to ask. As I mentioned my son has medicaid and I work in the mental health field with many children who have CHIP or medicaid.
Heather
Natural m/c 3/28/10 5w6d** Natural m/c 9/4/10 5w4d**
BFP: 2/27/12. u/s showed blighted ovum at 9wks Natural m/c started 4/11, cytotec 4/13/12 (at 12 wks). **
First appt with RE 5/7. Testing complete. Dx: luteal phase defect
BFP 10/25/12. u/s on 11/16 confirms heartbeat
Thanks for the site. By very slow.... do you mean 45 days? 90 days? etc...
The formal diagnosis is Autism.
Also... When you said children who do not qualify for insurance.... does that generally just mean children who aren't covered by an employers insurance? I specifically asked and she avoided the question.
Ideally, a TSS is supposed to help your child meet the goals set forth in the treatment plan designed by the BSC or MT (behavior specialist or mobile therapist). They are often recent graduates with a bachelor's degree in human services or at least 12 college credits of human services if the degree is in another field (minimum state requirements).
If you are moving to a certain area I could possibly provide assistance with referrals (again I work in the mental health field in PA so am very familiar with services and providers). Auntie is correct (as usual) many providers do not accept medical assistance for private therapy but at minimum with medicaid you will qualify for BHRS (behavioral health rehabilitation services).
Regarding medicaid, the previous poster mentioned it takes awhile and she is correct. It took me about 2-3 months to obtain coverage but once I did it was retroactive. It paid for the speech therapy ds was receiving even after we hit my limit on my private insurance.
If you want to PM me to talk further please feel free to (just let me know you did b/c I don't check it otherwise).
Heather
Natural m/c 3/28/10 5w6d** Natural m/c 9/4/10 5w4d**
BFP: 2/27/12. u/s showed blighted ovum at 9wks Natural m/c started 4/11, cytotec 4/13/12 (at 12 wks). **
First appt with RE 5/7. Testing complete. Dx: luteal phase defect
BFP 10/25/12. u/s on 11/16 confirms heartbeat
Yes, CHIP is for kids whose parents either don't have insurance or when the parent's employer doesn't cover their dependents. Obviously they will require proof of this.
Heather
Natural m/c 3/28/10 5w6d** Natural m/c 9/4/10 5w4d**
BFP: 2/27/12. u/s showed blighted ovum at 9wks Natural m/c started 4/11, cytotec 4/13/12 (at 12 wks). **
First appt with RE 5/7. Testing complete. Dx: luteal phase defect
BFP 10/25/12. u/s on 11/16 confirms heartbeat
Whatever insurance we choose will be private... not through the employer as we will be self employed. It's a sticky situation all the way around as far as documentation of income, etc.. b/c this will be our first year as such for the whole year. To me, it's mind numbingly complicated
because my brain doesn't work that way.
All that said, I'm guessing we could technically qualify...
When I said it awhile - it took 7 months!! I had to go to downtown Pittsburgh once (which was no fun at all) because they kept giving me the run around.
I am not sure what part of PA you are moving to, but there are a lot of places that take MA for your childs therapy in or around Pittsburgh. The only thing is that there is always a waiting list. Which sucks big time. I had my son on 15 different waiting lists at one time!
Thanks for all the thoughts and information! It is greatly appreciated. We are moving to Pittsburgh. We have been told by multiple sources this is the epicenter of great care for kids on the spectrum (in PA) and we should have a multitude of options at our disposal. Whether that is true and if we can financially access them remains to be seen. Our move has nothing to do with that at all... but I'll call it a hopeful perk. At least if the school system maybe deals better/understands better it will be an improvement.
I am going into this move knowing that he may have a delay in services when we arrive. I'm compiling a relocation spreadsheet at the moment and trying to get some ducks lined up if anyone has anything specific to share (names, specialties, etc...). I know the world will not end if we end up having a lapse in care & he will survive. I think it will be hard enough just moving to a new home (with a new house number and street name) and I am prepared to just offer him some special home & mommy time if that's all we can do. Our current team (namely SLP,OT,Psych) are a phone call or email away and would gladly give me some tips in the event something big starts going on.
Not sure why all that detail was important, maybe I just needed to get it out and feel like everything will be ok.
I live in Pittsburgh, so if you have any questions, let me know
*Kristen* If you have any insight into schooling areas...especially if you did Preschool.... email me.. I've heard some stuff... but if you've already dealt with IEP implementation, that would be a piece I haven't had any first hand. [scott and briana at hotmail dot com]
*Auntie*, I was a bit sarcastic saying 'epicenter of PA', I am skeptical and hopeful at the same time that DS will have resources we can afford. I can't tell you how many times I've been told - 'Get CHIP, Get Medicaid, Everything will be paid for. Your son will qualify for whatever he needs through EI until he is 7.' etc... I know that is not realistic, so thanks for some real information.
I am on my way out the door to work a 13 hour shift - fun fun
I will email you tonight when I get home, ok ?