Costs Adding Up

Is it just my imagination or is Medicaid paying for fewer and fewer medicines these days? I know that each state administers Medicaid differently, but I have been surprised over the last 6 months or so at denial of medication payments. And these are meds that previously were paid for.

Because my children with the most significant special needs were adopted, they have automatically received Medicaid coverage. I have also added them to my work insurance policy, but it pays for very little. And, Ashley has reached her lifetime maximum under my work policy. So we rely very, very heavily on Medicaid to cover any medical expenses.

First it was one of Ashley’s medications, then another. Then this month alone, two of Ronnie’s which had previously been covered were denied. So far, the cost of those denied meds hasn’t been excessive if you look at them individually. But, when you start adding them all together, the budget takes quite a hit – a hit which will be repeated every single month.

I’m not sure if there is any sort of appeal process to get the medications covered again, but based on my past experience appealing another Medicaid-denied service, the process is difficult at best. And last night, well past 9pm, when I was at the pharmacy and the pharmacist was on the phone with the Medicaid office, there seems to be very little interest on my state’s part at even addressing this issue.

You know, this past summer, I worked really hard with Ashley to discontinue two of her medications. Perhaps that was a good thing considering this new lack of coverage. But, there are some meds, seizure meds for example, or life-sustaining kidney meds, that we just can’t discontinue.

One would think that between two insurance policies I could get medicines at least partially paid for, but that is not looking to be the case.

Their Lifelines

I try to limit the number of posts I write on political issues. Politics divides people, and I don't want to perpetuate that divisiveness. But, August 2nd is just days away and our politicians can't seem to play nice. As a result, I am scared to death.

There are many things on the chopping block, but the two things of primary interest to me are Social Security and Medicaid. Those two programs are the lifelines for my children. Jessica's SSDI is her only income, and it is already too low to actually live on. Ashley, Jessica and Ronnie rely on Medicaid for their health insurance. They need the medicine that Medicaid pays for to continue to live. They need the surgeries, the interventions, the assistance. None of those things are a nicety or an extra - it is their life. Just one of Ashley's seizure meds costs $450 a week! If she misses one dose, a lifethreatening seizure is a real possibility.

So please, Politicians, get your acts together, but don't do it on the backs of our country's most vulnerable. I'll gladly pay increased taxes if you leave my children's benefits intact.

HIPP for Kids - Money for Parents!

My state Medicaid organization has done their best to keep a secret, a secret about a program that will reimburse parents for some or all of an enrollee’s share of employer sponsored group health insurance premiums. But now the word’s out, and I bet your state has a similar program. And trust me, this program could put an extra couple of hundred dollars in your pocket each month!

The program is call HIPP (Health Insurance Premium Payment). My state also has a HIPP For Kids program that makes a family eligible if their Medicaid-covered child is under the age of 19. Here’s the blurb from my state’s website – “For the HIPP For Kids program, the Medicaid eligible must be under the age of 19, the employer must contribute at least 40% towards the cost of the health insurance premium, must offer qualified employer-sponsored health plan that qualifies as creditable coverage under the section 2701(c)(1) of the Public Health Service Act and must be offered to all individuals in a manner that would be considered nondiscriminatory eligibility. “

So, from a practical standpoint, how does this work. First, you must be covered by your employer’s health insurance program – you must have a child covered by Medicaid (and it can be secondary coverage – i.e. your insurance pays first, and then Medicaid pays).

You fill out an application – it should be on your state’s website page. The application for my state was very simple. It had some basic information about my family, and there was also a section that your employer fills out. In my state, a decision must be rendered within 45 days of the original application, and I’m betting it’s the same in your state.

Once you get the approval letter, you then have to send in copies of your pay stub showing what you paid each month for your employer sponsored health insurance. In my case, my portion of my health insurance premium payment is $220. So each month, if I send in my pay stubs, I get $220.

Easy peasy, and who couldn’t use some extra money. Heck, in my state, I am even provided envelopes for sending in my pay stubs, and I don’t have to stamp them!

Check it out!