Posted: July 6, 2015
Health-care costs associated with a condition like CP can be extremely high. Finding insurance for children with Cerebral Palsy used to be difficult due the ability of insurance companies to deny coverage based upon a pre-existing condition. However, current insurance rules have opened up the door for children with CP to receive the insurance coverage they need. In order to assist you on exploring your options regarding insurance for children with Cerebral Palsy, we’ve put together a short overview to help!
First, the facts: families with lower income often qualify their child for insurance coverage through the Children’s Health Insurance Program (CHIP), Medicaid or Medicaid Waivers. While finding a program through the government’s healthcare exchange can have its own challenges due to the wide variety of providers in different states, we’ll highlight the three items above to help better explain the options.
CHIP is a program put in place to specifically handle the needs of children where the family’s income fits below affording private providers but above Medicaid’s requirements. CHIP is managed on two levels: the U.S. Department of Health and Human Services at the national/federal level, and by state service departments on the local level. Funding is managed or provided on a state-by-state basis, with some states using CHIP’s funding to match and supplement health insurance services through Medicaid, while others operate completely independently. Premiums and costs associated with visits and/or prescriptions are handled differently depending on the state. Coverage extends to appointments, hospitalization, emergency service, dental, vision, hearing, preventative care, diagnostic services, immunizations and prescriptions.
Medicaid, as you may already know, is a service provided to families, including children, for the sake of ensuring coverage despite financial difficulties within the family. Because it is a government insurance plan, coverage extends to those who qualify in all 50 states. Medicaid is administered on the state level but led or dictated by federal guidelines. Covered payments are provided directly to the hospital or medical provider directly, with additional or extended costs handled by the family, meaning it is crucial for parents of children with Cerebral Palsy to ensure that the physician or service center they go to is covered by Medicaid. Services that fit under Medicaid include all those mentioned above for CHIP, as well as nursing and clinic care, hospice, chiropractor services, mental health, home health care, ambulance services, therapy and medical equipment
Finally, Medicaid Waivers are used as a means to allow individuals with special needs to receive services outside of a nursing home or residential facility they may otherwise stay at. Medicaid Waivers are not available in all states but are federally funded. At its core, Medicaid Waivers are intended to assist those who prefer to stay in a home from being required to live within a facility in order to receive treatments desperately needed. Because they serve as a workaround of existing Medicaid structures, it is crucial that families seeking a Medicaid Waiver are both careful and open to assistance from organizations well-versed in their usage to avoid running afoul of guidelines, which can be extremely costly.
If you have questions about any of the items covered, do not hesitate to contact our offices at your convenience. Available by phone ((800) 692-4453(800) 692-4453 FREE) or through our easy-to-use contact form, our organization is here to help and has a number of resources specifically focused on healthcare and insurance. Obtaining insurance for children with Cerebral Palsy may seem like an overwhelming challenge but there is an assortment of options available, perhaps more than ever before, that families can navigate to get the support they need.
Let us know how we can help, 24/7/365, through the contact avenues above and we look forward to helping you and your child!