While I wish I had solid statistics to go with this post, I only have observations because I have yet to find anywhere that has studied this.
I see this question asked at least once a week in different medical parenting groups... "how are services in _______ state?" And that question is typically asking three things 1. How good are the hospitals 2. How are the schools 3. How is the insurance situation.
There seems to be a list of states people always promote and ones they always say to stay away from. One of the biggest things that people say when recommending a state is about insurance because you can always homeschool or online school or open enroll and you can always travel for hospitals but where you live determines a lot about insurance.
States handle Medicaid differently. There are a few websites where you can find information on what waver programs are offered in which state however one thing that I can tell you effects many families with kids with special needs is a program that is often referred to as the Katie Beckett program. This program means that a child under the age of 18 must qualify for nursing home or hospital level care however they must be care for in a community setting. Additionally these programs are exempt from the income guidelines of Medicaid. Those two things together are important. You have to prove a level of care is needed and to do so there is a lot of paper work involved and turning over your child's medical records and a home visit and requires you to prove yearly that your child still meets the medical requirements. They dig deep to make sure your child medically qualifies. But the second part is important too because the families that qualify make over the poverty line. Many of these are middle class families.
Having a child with medical needs is expensive. I have written about it HERE about how much things cost additionally to the purely medical costs. There is also just that, the medical costs. Our primary insurance has paid over $5,000 in medications for one of our kids this year but Medicaid has also picked up over $2,000 for that same child and it is only July. That is because for these programs medicaid always pays second so they only pick up what our primary insurance does not. Honestly if we had to pay outright for all of the girls after primary insurance medical expenses we would be getting close to how much my husband makes in a year.
Most of those families who are asking about insurance in a state are asking about the waver programs because most of them are families who make over the poverty line however these programs help to keep these hard working families from going bankrupt with their child's medical bills. But not all states offer programs like this making many of those states without someplace that families with kids with medical needs choose not to live. Having a child with special needs does not exclude the parents from working as hard as they can for their families. While there is sometimes interruptions and sometimes there are different needs of an employee with a child with special needs (my husband works from home on Wednesdays so he can be here when oxygen is delivered) it doesn't mean that the employees are not hard working and valuable employees that work hard for the company. Many hard working professionals that do great things for companies and our economy have kids with special needs. These hard working employees though when choosing where to live are often looking at how good the state is for their family.
Because even though my husband works hard, has a 4 year degree and an employer based health insurance plan, without Katie Beckett we would be bankrupt and likely would have lost our house. That is just the facts. Sucky, crappy facts but what is.
Earlier this year a company came seeking my husband out to work for him (he had not applied for the job, they heard of him by word of mouth) and then a second company made note of interest, however this was April and our out of pocket max is hit in February each year and without Katie Beckett we would not have been even able to talk to either of those companies let alone take a job with one without Katie Beckett because there is no way we could state a deductible over without that helping.
There are many people who chose not to move to states due to their lack of quality medicaid wavers... I see people talk about this all of the time and we have turned down jobs that would mean moving to states with less then desirable Medicaid wavers.
And this pays for a state too. My husband is a professional and we pay taxes. We are evolved in our community. We own a home. While we are not the millionaires states love, we a valuable part of the community.
Without Katie Beckett a cycle of poverty would be stated that I don't know that we could get out of because there is no way we even with a middle class paying job could pay all of the medical bills and extra expenses in a year and that cycle would cost tax payers more. It also incentivizes parents of kids with medical needs to find higher paying jobs because they know they have this net behind them to help them out so that they don't need to stay under the poverty level for straight medicaid.
So I firmly believe Medicaid waver programs help the states that offer them. I know some of you will disagree. Some on the point of complete free market that if you can't pay for something you shouldn't have it however in terms of healthcare for kids given the fact that we are one of the riches countries I think that making kids go without healthcare and making them suffer so you can hold more of your money is cruel. Some will reject this point on the fact that if we didn't have taxes then people would give more to churches and they could help people more but I go to a white church in a well off community and they don't bring in enough money to pay for everything Katie Beckett pay for our family let alone the others in the church and people really like their money. I think waver programs are a good investment for states to make because it helps to keep down other more expensive costs (institutionalized care) and it helps to encourage their citizens with children with special needs to make carrier advancements that help us all as a state.
***I have been writing this post in my head for weeks. Trying to figure out how to put this on paper to get my ideas across. Medicaid is a tricky topic and something so many people view as no matter what it is bad, however I see that it can be used to help not just the people who it is helping but also help the state as a whole and I hope this helped to show why I think that. Before being a parent with two kids with special needs I didn't think I would be on Medicaid and I really didn't have an opinion one way or another other then I have always had a social justice heart so I was in favor of helping others but didn't know much about it but now that it impacts my daily life I see the true value in it. I also don't want anyone to think I am against more traditional medicaid because after interning with Early Heard Start in college I see how much it meets a need to so many hard working families and children and I don't want any of my comments in this post to come off that I am bashing those families, I just want to make a point of how this programs helps a specific group of people and how it helps, I believe how we help and view the poor says a lot about us a society***
