Re: Medicaid for high functioning/Asperger? Finding therapy?

[Guest guest]

Hi Sheri -

Thanks for this reminder. I have not persued Medicaid

yet for my oldest (the only one " on the spectrum " ),

because -well besides not being up for it - he is so

high functioning that people always initially argue

that he's not " autistic " (well of course he's not-he's

) although any length of observation shows that he

clearly meets the diagnostic criteria for Asperger.

So my question is... has anyone accomplished (or know

of someone who has) obtaining Medicaid coverage for

Asperger Syndrome for a young child? (My son is now

7.) He actually scored in the middle of moderate to

severe autism on the CARS rating scale from school,

but a lot of that rating evaluates history prior to

the protocol and no longer apply, and another

test scored him as " likely Asperger " - it was not a

diagnostic test. I wonder sometimes if the testing

done by the school is sufficient to apply for

services. He actually gets very little service from

the school - a short period of behavior and speech,

and he isn't going to be in speech much longer, and

the 'behavior' is basically targeting discipline.

Really, he needs social teaching, physical therapy

(like teaching him to be more active and improve motor

skill coordination and help develop muscle tone), and

sensory, but he may not be " poor " enough in that area

to qualify for that to be a paid service (at least not

that I know of).

Wow. I had almost forgotten how good he is doing! We

had had a bad regression for a while and I discovered

only recently that it was probably diet related.

Either that or salami is a miraculous healing food!

lol. (Started giving him salami and OMG he brightened

up in 3 days! There IS a connection - seriously.) Oh

but I digress and move off topic.

Anyway, I'm ashamed to say that I have seriously

neglected to utilize any therapies that could be

helpful for him for the last 3 years as I was consumed

w/trying to get help for PANDAS and CFS and not

functioning, so if anyone could direct me to a good

site that would help me identify what would be helpful

and locate those services, I would be so grateful!

I also can't begin to figure out where to look for

someone very good at evaluating deficiencies that

could be improved. In my previous experience, even

prior to the protocol when my son had all sorts of

problems, he would only barely meet standards for

therapy and would quickly 'graduate' out of the

planned program (of course he had just started the

protocol by the time this began so he was having all

sorts of 'miraculous' improvements). What kind of

therapist or other professional would you guys

recommend to seek out?

Thanks for any help. Both kids are now in school and

I'm not currently working (yet?), so for the first

time I may actually be able to focus on this and

accomplish something to help my sons instead of just

trying to get thru the days. But Medicaid would sure

be helpful! If only for medication copays!

Thanks bunches-

--- Sheri <eszbi5@...> wrote:

> , Have you tried to find Social Services

> agencies to help off set the costs for your son's

> treatment? I know it is possible because I found

> help today through a charity. I also found out that

> my daughter will qualify for Medicaid based on her

> disability not on our income. If it was based on

> our income then we would not qualify. I know that

> it seems hopeless at times when you are trying to

> come up with the money but sometimes it pays to ask

> for help if you truly can not afford it. Good

> luck!!! Sheri

__________________________________________________

[Guest guest]

Check into the Becket waiver in your state. In Texas, it's done

through the CLASS (Community Living Assisted Services) but I don't know if they

call

it CLASS in other states. There's usually a long wait that varies by state.

That particular program is designed for higher functioning individuals that

still need assistance. Qualifying for CLASS ( Becket Waiver)

automatically qualifies the person for Medicaid. The biggest problem with

Medicaid though

is finding people who'll take it.

Gaylen

[Guest guest]

, I will tell you how this process goes for . The social worker

asked me a bunch of questions about her behaviors. 's behaviors have

improved but she wants reports from doctor's that are not more than 12 months

old. No problem since has only been diagnosed since April. In the

report from the Developmental Ped they state that has institutional

autism and that it is quite severe. I know that does not have

Institutional autism although that could be a part of the problem she has

as she has all the symptoms but hey call it what you will just give me the

assistance. We will probably only use the Medicaid card for the co-pays for

scripts but every little bit helps. Sheri

<thecolemans4@...> wrote:

Hi Sheri -

Thanks for this reminder. I have not persued Medicaid

yet for my oldest (the only one " on the spectrum " ),

because -well besides not being up for it - he is so

high functioning that people always initially argue

that he's not " autistic " (well of course he's not-he's

) although any length of observation shows that he

clearly meets the diagnostic criteria for Asperger.

So my question is... has anyone accomplished (or know

of someone who has) obtaining Medicaid coverage for

Asperger Syndrome for a young child? (My son is now

7.) He actually scored in the middle of moderate to

severe autism on the CARS rating scale from school,

but a lot of that rating evaluates history prior to

the protocol and no longer apply, and another

test scored him as " likely Asperger " - it was not a

diagnostic test. I wonder sometimes if the testing

done by the school is sufficient to apply for

services. He actually gets very little service from

the school - a short period of behavior and speech,

and he isn't going to be in speech much longer, and

the 'behavior' is basically targeting discipline.

Really, he needs social teaching, physical therapy

(like teaching him to be more active and improve motor

skill coordination and help develop muscle tone), and

sensory, but he may not be " poor " enough in that area

to qualify for that to be a paid service (at least not

that I know of).

Wow. I had almost forgotten how good he is doing! We

had had a bad regression for a while and I discovered

only recently that it was probably diet related.

Either that or salami is a miraculous healing food!

lol. (Started giving him salami and OMG he brightened

up in 3 days! There IS a connection - seriously.) Oh

but I digress and move off topic.

Anyway, I'm ashamed to say that I have seriously

neglected to utilize any therapies that could be

helpful for him for the last 3 years as I was consumed

w/trying to get help for PANDAS and CFS and not

functioning, so if anyone could direct me to a good

site that would help me identify what would be helpful

and locate those services, I would be so grateful!

I also can't begin to figure out where to look for

someone very good at evaluating deficiencies that

could be improved. In my previous experience, even

prior to the protocol when my son had all sorts of

problems, he would only barely meet standards for

therapy and would quickly 'graduate' out of the

planned program (of course he had just started the

protocol by the time this began so he was having all

sorts of 'miraculous' improvements). What kind of

therapist or other professional would you guys

recommend to seek out?

Thanks for any help. Both kids are now in school and

I'm not currently working (yet?), so for the first

time I may actually be able to focus on this and

accomplish something to help my sons instead of just

trying to get thru the days. But Medicaid would sure

be helpful! If only for medication copays!

Thanks bunches-

--- Sheri <eszbi5@...> wrote:

> , Have you tried to find Social Services

> agencies to help off set the costs for your son's

> treatment? I know it is possible because I found

> help today through a charity. I also found out that

> my daughter will qualify for Medicaid based on her

> disability not on our income. If it was based on

> our income then we would not qualify. I know that

> it seems hopeless at times when you are trying to

> come up with the money but sometimes it pays to ask

> for help if you truly can not afford it. Good

> luck!!! Sheri

__________________________________________________

[Guest guest]

Can you have Medicaid in addition to other insurance? We are self-employed

so our insurance is not that great, but I don't want to see Medicaid ped's

when my little guy is sick or for well-checks. Medicaid would be helpful with

the meds - they are very expensive!

[Guest guest]

In a message dated 8/18/2006 7:21:10 AM Central Standard Time,

Seattlejg@... writes:

<<Can you have Medicaid in addition to other insurance?>>

I was told, yes. I'm still a bit confused and haven't read all the paperwork

since it just came along with my son's admittance into the CLASS program but

when I talked to the rep who called about it, I was told that it can be used

to cover co-pays for various things and that we still had the option to see the

doctors on our other insurance. Since the other insurance's forms ask about

additional insurance though I'm not sure if this will cause some fighting over

who pays for things. Anyone else use private insurance mostly and just have

Medicaid pay for some things like co-pays?

Gaylen

[Guest guest]

Hi All,

We have been with Dr. G for almost 10 years and have really done well

with the medicaid and insurance issues. Dr. G just faxes in the scripts to my

local grocery store pharmacy and they run it through the medicaid system.

All scripts (except 1 I think) has been paid 100%. Obviously, this has been a

huge help in allowing us to continue with Dr. G for so many years. It sounds

like a long time but we started when he was 2.3 and he is now 12. He is in

6th grade and getting A's and B's. He does have an aide part time and we are

working to make him into a " thinking 6th grader " so he can be self-motivated

and completely self-sufficient. We are looking forward to a great year!

Hope this helps.

Lori D in PA

[Guest guest]

Hi -

Yes, Medicaid would always be secondary to a primary

insurance, and would be filed afterwards. One reason

so few peds accept Medicaid is they only pay around

$24 to $36 per office visit and they have to write off

the rest. So if insurance pays and leaves a copay,

there would not be any additional payment from

Medicaid but rather they have to write off the rest.

However, the regular scheduled pediatric checkups and

vaccines are paid pretty well but w/a lot of paperwork

and documentation requirements. Now, doctors can also

choose to accept Medicaid for some patients without

accepting them all (but the office may not realize

that as it used to not be that way), so you could

still approach current doctors re accepting it - but

don't be surprised if they cannot.

But when you have Medicaid, the copays for meds, labs,

or any outpatient or hospital testing ARE covered,

since they mostly all accept Medicaid, and this is

where it really pays off. (With 2 kids on several meds

w/$40 copays and my needing the same meds, even with

great insurance like I have it gets very costly.) I do

not know, however, if Rx's covered by an MD out of

state like Dr G are covered... I'm under the

impression that you have to have an in-state provider

willing to write the Rx for it to be approved by

Medicaid. I don't think they have to actually accept

Medicaid but that they would need a Medicaid ID#

(which most would have whether they choose to accept

it or not). Perhaps someone can confirm that?

HTH-

--- Seattlejg@... wrote:

> Can you have Medicaid in addition to other

> insurance? We are self-employed

> so our insurance is not that great, but I don't want

> to see Medicaid ped's

> when my little guy is sick or for well-checks.

> Medicaid would be helpful with

> the meds - they are very expensive!

>

>

> [Non-text portions of this message have been

> removed]

>

>

__________________________________________________

[Guest guest]

yes you can have Medicaid in addition to your regular

insurance. Your primary insurance goes first and then

Medicaid would pick up the rest. You can also get

Medicaid based on your child's disability if you do

not meet the financial requirement. You can see

whatever doctor you want.

--- Seattlejg@... wrote:

> Can you have Medicaid in addition to other

> insurance? We are self-employed

> so our insurance is not that great, but I don't want

> to see Medicaid ped's

> when my little guy is sick or for well-checks.

> Medicaid would be helpful with

> the meds - they are very expensive!

>

>

> [Non-text portions of this message have been

> removed]

>

>

__________________________________________________

[Guest guest]

We have had Medicaid pay for Valtrex and the

prescription is written by our doctor in Calif.

--- <thecolemans4@...> wrote:

> Hi -

>

> Yes, Medicaid would always be secondary to a primary

> insurance, and would be filed afterwards. One

> reason

> so few peds accept Medicaid is they only pay around

> $24 to $36 per office visit and they have to write

> off

> the rest. So if insurance pays and leaves a copay,

> there would not be any additional payment from

> Medicaid but rather they have to write off the rest.

>

> However, the regular scheduled pediatric checkups

> and

> vaccines are paid pretty well but w/a lot of

> paperwork

> and documentation requirements. Now, doctors can

> also

> choose to accept Medicaid for some patients without

> accepting them all (but the office may not realize

> that as it used to not be that way), so you could

> still approach current doctors re accepting it - but

> don't be surprised if they cannot.

>

> But when you have Medicaid, the copays for meds,

> labs,

> or any outpatient or hospital testing ARE covered,

> since they mostly all accept Medicaid, and this is

> where it really pays off. (With 2 kids on several

> meds

> w/$40 copays and my needing the same meds, even with

> great insurance like I have it gets very costly.) I

> do

> not know, however, if Rx's covered by an MD out of

> state like Dr G are covered... I'm under the

> impression that you have to have an in-state

> provider

> willing to write the Rx for it to be approved by

> Medicaid. I don't think they have to actually

> accept

> Medicaid but that they would need a Medicaid ID#

> (which most would have whether they choose to accept

> it or not). Perhaps someone can confirm that?

>

> HTH-

>

>

>

> --- Seattlejg@... wrote:

>

> > Can you have Medicaid in addition to other

> > insurance? We are self-employed

> > so our insurance is not that great, but I don't

> want

> > to see Medicaid ped's

> > when my little guy is sick or for well-checks.

> > Medicaid would be helpful with

> > the meds - they are very expensive!

> >

> >

> > [Non-text portions of this message have been

> > removed]

> >

> >

>

>

> __________________________________________________

>

[Guest guest]

Well I confirmed thru the ASA that Alabama does not

have the Beckett Waiver, so I suppose we are out

of luck. But everyone should check to see if their

state does have it.

__________________________________________________

[Guest guest]

Yes you can have Medicaid as a secondary insurance. Sheri

Seattlejg@... wrote: Can you have Medicaid in addition to other

insurance? We are self-employed

so our insurance is not that great, but I don't want to see Medicaid ped's

when my little guy is sick or for well-checks. Medicaid would be helpful with

the meds - they are very expensive!