Re: Medi-Cal

[Guest guest]

Our daughter was approved for medi-cal as well. Since we were not

financially eligible she had to be institutionally deemed. You have

to apply and be denied financially before you can go this route.

From some document I found online:

'The term " institutionally deemed " means that the income and resources

of a parent are not deemed to the consumer, therefore making the

consumer eligible for Medi-Cal if all other Medi-Cal eligibility

criteria are met.'

Also, the advantage to medi-cal, even if you have insurance, is that

it may now cover your co-pays which for us could be in the hundreds of

dollars a month considering all of her therapies, doctors

appointments, etc.

Finally, you may now have an easier time getting nursing care or at

the very least respite nursing. My wife and I have no family in town

and the respite care is the only way she can get a break or have some

alone time with our son while I am at work. Our daughter has a trach

and g-tube and cannot be left with a normal babysitter. With medi-cal

our respite nursing hours were increased, and we were actually

eligible for night time nursing which we declined.

Good luck as it took awhile to work through the bureaucracy. However,

it was definitely worth it.

>

> Now that we have a medical diagnosis of CHARGE for my 2 year old

> daughter Taliah, I have had a number of people recommend that I should

> get her on medi-cal. I work full time and so my need isn't financial -

> but I want to get her approved in case something happens in the future

> and she needs it. In addition, I have heard that there are often

> services that are available through medi-cal that I might not have

> access to otherwise. Has anyone gotten their child approved with medi-

> cal with these same circumstances (i.e. not financial issue). I would

> appreciate any suggestions on how to do this.

>

> Thanks!

>

[Guest guest]

Hi Tammy,

We live in WA state, so it isn't called Medi-Cal, but my son does have a

secondary medical coupon. Because of our income, we have to meet a " spend-down "

every 6 months. This means that our whole family's medical expenses have to

meet a certain level before the coupon is issued for my son. The coupon is

retro-active in the sense that it kicks in from the date we meet the spend-down.

The first spend-down we had was $12,000, but because my son had some surgeries

and was kept as an inpatient, we met the spend-down. We later found out about a

special rule WA state has (it's called an F-99 or " Sneed-Kaiser " ), where if a

child is special-needs and if they have their own resources (ie, a bank

account), then the spend-down can be based on the child's resources (and less on

the parents'). My son's spend-down is now around $3,100--easier for us to meet,

especially since our insurance plan changed and out out of pocket maximum

tripled.

Having a secondary coupon is nice--if you have co-pays or co-insurance the

coupon covers it (basically the provider has to write off whatever your

insurance doesn't pay, unless the primary insurance paid less than medicaid

would have paid if they had been primary--this is RARELY the case). Those

copays or 20% coinsurances add up. Also, in WA, the coupon covers dental

services for children (something our primary insurance does not).

Unfortunately, our coupon doesn't cover outpatient therapy.

I would highly recommend applying.

(mom to Evan, 2 years)

tammywendoll tammywendoll@...> wrote:

Now that we have a medical diagnosis of CHARGE for my 2 year old

daughter Taliah, I have had a number of people recommend that I should

get her on medi-cal. I work full time and so my need isn't financial -

but I want to get her approved in case something happens in the future

and she needs it. In addition, I have heard that there are often

services that are available through medi-cal that I might not have

access to otherwise. Has anyone gotten their child approved with medi-

cal with these same circumstances (i.e. not financial issue). I would

appreciate any suggestions on how to do this.

Thanks!

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