Applying for Medicaid

I have seen a lot of posts places lately about how many people abuse the government and how medicaid needs to be cut back because the people that are on it are freeloaders. So since I am in the midst of the process I will detail for you what it is like because I understand how easy it is to get behind that idea and get riled about it when it is a "those people" thing but sometimes we need to stop and look at things before grabbing pitchforks.

1. I called the woman from the local agency that does the medicaid enrolling and talked to her about Lydia's needs and why I thought she qualified. This was not a 30sec phone conversation, I had to answer multiple questions before she would agree to send me the paperwork.

2. The paperwork. Have you ever had to sit down and write all of the things your child struggles with, can't do or is delayed in? It is emotionally exhausting. I like to think of all the wonderful things about my children, but this paperwork is not for writing the amazing things about my kids, its writing all the struggles. There is form after form after form to fill out and you have to be as detailed as you possibly can be. This makes those new patient forms at doctors offices look tiny.

3. Collecting of records. I need to have therapy progress notes, information about where each of the different doctors and therapists Lydia sees, and any records that I think would help them in understanding Lydia's needs. For many of these things it is a process to track stuff down.

4. Home visit. Next week a woman from the state will come to our house. I will need to rehash all of the things Lydia can't do. It is like a job interview but for healthcare for my child with just as much stress as a job interview, just this takes place in our house so the house needs to be clean as well.

5. We turn all of the paperwork in and then it goes to the state where they request all of Lydia's medical records. The review of her records and all of the paperwork takes about 3 months while you sit there waiting.

6. You get a letter in the mail telling you if you child has been deemed disabled under the state's standards. When you get that letter either way it goes is like a punch in the gut, either they say your child is not and therefor you do not qualify, or your child is and it is like a punch to the heart getting a letter saying the state has deemed your child disabled. I know it doesn't change anything about my child but it is like the first time I heard the doctors label each of my children as "failure to thrive" it is hard.

7. Then you wait for a letter to find out if you are being enrolled in medicaid or not, when we went through it with Jilli they told us that there always is a small chance that your child will be deemed disabled but the state says no to medicaid.

8. Once you get the letter saying you have been enrolled in medicaid, it is not a one and done thing, this process happens EVERY YEAR to make sure your child still qualifies. And just because your child qualifies doesn't mean they pay for everything no questions asked. For therapies we have to get a prior approval every 6mo where they like to ask lots of questions, and currently for Jilli they will only approve 6 visits in a 6mo time-frame, which is less then 1/4 of the therapy visits she gets during a 6mo time frame. There are also many things not covered by either insurance, the belts and pads the girls wear to help to prevent the tubes from being pulled out, Jillian's oxygen stickers, vitamins and probiotics  (Jilli's one vitamin is over $60 a month, her probiotic is another $30, plus the 3 other vitamins she is on), Jillian's special bed, and tons of other things we pay out of pocket for.

For us medicaid is a secondary insurance.  We pay 2,090.40 a year in premiums, then $4,200 in deductible and $10,000 in out of pocket max for insurance through Brent's work. Remember we are a one income household with student loans, mortgage and car loan plus all of the other bills. Without medicaid we will go bankrupt. It is not even the end of January and we have already blown through our $4,200 deductible. 

We also do what we can to save our insurance companies' money. We combine procedures when we can, we only do tests that we have to, we get our tubes changed out every 3 months so they don't have to pay for an emergency admission if it breaks outside of IR hours, we pay for things that help to keep the tube secure.

There are always going to be people who scam things, always and I agree there needs to be accountability, but are you will to cut funding to the program and risk people dying? I hope this post helps you to see how many checks and balances are already in place in our state (I can't speak for other states). 

The paperwork packet. When I posted this picture on facebook every person who has had interactions with these forms expressed how much they suck or gave me a pep talk about how I could tackle this challenge, because the people who have done them understand how hard the process is