special needs family member approved for Medicaid coverage, need advice

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Jackson12
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special needs family member approved for Medicaid coverage, need advice

Post by Jackson12 » Fri Oct 19, 2018 11:06 am

We’re new to this. Our special neeeds child was approved for full coverage under Medicaid and it will start early November. We looked at local providers and it does seem like some approved providers are good options ( we hope) However, he’ll need to stop seeing his current physician as he doesn’t take Medicaid patients.

I’d greatly appreciate any advice from anyone experienced with this. I’m nervous about the quality of care he might receive. if anything has a child on Medicaid have you found decent providers? We want to get him in to see a new physician immediately.

Also, when do we terminate his current coverage- which is under our employer insurance? He is technically still covered as we didn’t want to terminate that coverage until he was approved for a Medicaid card. Since Medicaid doesn’t officially start till November, I assume we want to wait to terminate employer coverage till then?

They can’t overlap. Or so we were told, although a few days overlap is fine. We applied for his Medicaid since our current employer provided insurance will no longer be covering special needs children after age 26. Until recently, they covered special needs children past age 26.

So we scrambled to get Medicaid coverage.

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cheese_breath
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Re: special needs family member approved for Medicaid coverage, need advice

Post by cheese_breath » Fri Oct 19, 2018 11:12 am

Can't you tell your employer now the date you want the coverage terminated? I certainly wouldn't want to terminate it before the Medicaid coverage starts.
The surest way to know the future is when it becomes the past.

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dm200
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Re: special needs family member approved for Medicaid coverage, need advice

Post by dm200 » Fri Oct 19, 2018 11:15 am

Is there some kind of social worker assigned or involved?

Jackson12
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Re: special needs family member approved for Medicaid coverage, need advice

Post by Jackson12 » Fri Oct 19, 2018 11:19 am

cheese_breath wrote:
Fri Oct 19, 2018 11:12 am
Can't you tell your employer now the date you want the coverage terminated? I certainly wouldn't want to terminate it before the Medicaid coverage starts.
Yes, I believe we can. I left a message for the Human Resources and benefits rep at work. The timing is almost ideal because the new enrollment t period is about to begin at work. Luckily, we received a heads up that our special needs kid would no longer be covered ( he’s older than 26 but was granted an exemption by the current insurer and was not restricted to the usual age cut-off )

Without the heads up his coverage ending would have been a surprise and we would have had to figure something out till Medicaid was approved.
Last edited by Jackson12 on Sat Oct 20, 2018 12:58 pm, edited 2 times in total.

Jackson12
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Re: special needs family member approved for Medicaid coverage, need advice

Post by Jackson12 » Fri Oct 19, 2018 11:21 am

dm200 wrote:
Fri Oct 19, 2018 11:15 am
Is there some kind of social worker assigned or involved?
There is a local state agency and I’ll call them for input. Replies aren’t quick but they do get back to me, eventually. No complaints.

Rupert
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Re: special needs family member approved for Medicaid coverage, need advice

Post by Rupert » Fri Oct 19, 2018 11:51 am

It can be difficult to find good doctors who accept Medicaid patients in some areas, especially rural areas. Your best bet is going to be a university-affiliated medical system -- a hospital tied to a medical school and various physicians' groups.

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3CheersforLkyJack
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Re: special needs family member approved for Medicaid coverage, need advice

Post by 3CheersforLkyJack » Fri Oct 19, 2018 3:02 pm

Your question is very timely as our son was very recently approved for Medicaid. Our coverage date was retroactive back a few months so we are in the process of having bills we already paid resubmitted so they run through Medicaid. Once those doctors/pharmacists are paid by Medicaid, they refund us via check what we previously paid out of pocket to them after insurance (we are on a high deductible health plan (HDHP)). We have received several reimbursements thus far and I'm quite surprised how easy it has been and how quickly we received reimbursement.

Regarding our son being on our HDHP as well as Medicaid; in our state they expect you to continue to carry primary insurance with Medicaid as the secondary provider. Where did you hear that you needed to terminate employer coverage and that they can't overlap? Is that state specific?

I was doing some online research today and found out that a dependent that is covered under my family HDHP and Medicaid does not disqualify me from contributing to an HSA. There are instances where you can be disqualified from contributing to an HSA if the primary is on Medicaid.

As far a providers, we have found that in our area (not rural), our son's numerous therapy providers, specialists, and pediatricians all take Medicaid. Perhaps we are very lucky in this regard.

Our biggest worry has been determining at what point we need to setup a special needs trust and the best way to fund it.

A lot of emotion and so much to think about with a change like this. Good luck and wishing you the best.


mrsbetsy
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Re: special needs family member approved for Medicaid coverage, need advice

Post by mrsbetsy » Fri Oct 19, 2018 3:29 pm

Our son was first eligible for SSI which makes MediCAL (California)/Medicaid automatic.


In my state, primary insurance is first and MediCAL is second. However, it sounds like primary insurance is not available to your son so Medicaid would indeed be primary. (We experienced the same thing when we left corporate and became small business owners. We only purchase insurance for ourselves even though our son is 21.)

All the major university hospitals where I live accept MediCAL such as UCSF and their satellite offices and his quality of care actually increased. He had Kaiser before and he has some complex medical needs. Specialty doctors under Kaiser are impacted where I live. Whereas at UCSF, he gets seen in a timely way.

We have used the local ER once and they have to take MediCAL/Medicaid in that situation.

Look at ABLE accounts as a way to preserve some assets and increase his standard of living. As a Medicaid client, you can get in serious trouble if you, as his parents, decide to pay outright for a medical service. Through an ABLE account, it is possibility.

We have a special needs trust for him, but it won't be funded until our death.

Jackson12
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Re: special needs family member approved for Medicaid coverage, need advice

Post by Jackson12 » Fri Oct 19, 2018 4:51 pm

Duplicate
Last edited by Jackson12 on Fri Oct 19, 2018 4:53 pm, edited 1 time in total.

Jackson12
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Joined: Tue Oct 06, 2015 9:44 pm

Re: special needs family member approved for Medicaid coverage, need advicekity

Post by Jackson12 » Fri Oct 19, 2018 4:51 pm

3CheersforLkyJack wrote:
Fri Oct 19, 2018 3:02 pm
Your question is very timely as our son was very recently approved for Medicaid. Our coverage date was retroactive back a few months so we are in the process of having bills we already paid resubmitted so they run through Medicaid. Once those doctors/pharmacists are paid by Medicaid, they refund us via check what we previously paid out of pocket to them after insurance (we are on a high deductible health plan (HDHP)). We have received several reimbursements thus far and I'm quite surprised how easy it has been and how quickly we received reimbursement.


Our biggest worry has been determining at what point we need to setup a special needs trust and the best way to fund it.

A lot of emotion and so much to think about with a change like this. Good luck and wishing you the best.
We have already set up a special needs trust for our son as those funds do not count against Medicaid eligibility nor will some earnings or income which are held in his trust. I encourage you to do this. With a decent lawyer, it’s straightforward . He can work but at nowhere near a living wage or above Medicare limits...,due to his disability. We hoped he could support himself and encouraged that but it was a pipe dream . He wants to support himself but it isn’t possible. He’s cheery and basically happy so that’s a huge plus.

Jackson12
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Joined: Tue Oct 06, 2015 9:44 pm

Re: special needs family member approved for Medicaid coverage, need advice

Post by Jackson12 » Fri Oct 19, 2018 5:00 pm

mrsbetsy wrote:
Fri Oct 19, 2018 3:29 pm
Our son was first eligible for SSI which makes MediCAL (California)/Medicaid automatic.


In my state, primary insurance is first and MediCAL is second. However, it sounds like primary insurance is not available to your son so Medicaid would indeed be primary. (We experienced the same thing when we left corporate and became small business owners. We only purchase insurance for ourselves even though our son is 21.)

All the major university hospitals where I live accept MediCAL such as UCSF and their satellite offices and his quality of care actually increased. He had Kaiser before and he has some complex medical needs. Specialty doctors under Kaiser are impacted where I live. Whereas at UCSF, he gets seen in a timely way.

We have used the local ER once and they have to take MediCAL/Medicaid in that situation.

Look at ABLE accounts as a way to preserve some assets and increase his standard of living. As a Medicaid client, you can get in serious trouble if you, as his parents, decide to pay outright for a medical service. Through an ABLE account, it is possibility.

We have a special needs trust for him, but it won't be funded until our death.
We are trying to contribute to an ABLE account. Saving the funds has been an annual challenge since we also have to save enough to fund our retirement...we’ve stayed on track with that so far.

. Assuming Medicaid could do an adequate job, taking him off our employer health insurance plan would save a couple of hundred in monthly premiums. That’s assuming we have to do,that. I need to check our state’s rules.

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