Financial

We know from experience that having a child with special health care needs can cause financial stress on a family. There are costs for visits to specialists, therapy, medical equipment, assistive technology, modifying your home and medications. Contact your CSHCN Care Coordination social worker to learn more about the programs and benefits for children with disabilities.

Tips for Any Health Care Benefits

• Know your family’s benefits and insurance.  This is your road map to paying for services. 
• Health insurance is tricky, but your CSHCN care coordination team can help.
• Don’t be afraid to appeal a decision if your insurance won’t approve a service your child needs.  It is your right and many denials are overturned when a parent appeals.

ABCs of Child Disability Insurance

Navigating health care is a big and complicated job. You see terms you’ve never seen before or can’t always remember what the abbreviations stand for. Here is a list of common terms you are likely to see.

Managed Care Plan: A type of insurance that works with certain providers (doctors, specialists, and therapists) to make health care cheaper for their clients. HMOs, PPOs, POS plans, and EPOs are all types of managed care plans.

Health Maintenance Organizations (HMOs): Your child can only see certain doctors covered by your insurance, and you might need your child’s primary doctor to give you referrals to specialists.

Preferred Provider Organizations (PPOs): Your child can see in-network as well as out-of-network providers, but there are cost benefits to staying within the network. Be sure to ask your provider. Your child does not need a referral to see specialists.

Point of Service (POS): These combine some of the features of HMOs and PPOs. Your child needs to have a primary doctor, and you can see out-of-network providers too.

Exclusive Provider Organizations (EPOs): Your child can only see providers within your insurance company’s network, but doesn’t need a primary care doctor or a referral to see specialists.

Referral: When your doctor gives your child approval to see a specialist, this is called a “referral.” A referral is often something in writing that you or the doctor must give to your insurance before they will pay for your visit to a specialist.

Copayment: Also known as a “copay,” this is a payment you make any time you or your child uses your insurance. You usually pay a set amount for things like doctor’s visits or prescriptions.

Deductible: For some medical services, you will usually have to pay a certain amount on your own before your insurance benefits start paying. This is called “meeting your deductible.”

Premium: The fee that you, your employer, or both pay for your insurance each year.

Government Health Benefits and Insurance Programs

Government health benefits and insurance programs might help your family get health coverage or insurance at little or no cost for care your other health insurance might not cover. Read about the different types of programs offered in West Virginia below.

• Medicaid
  Medicaid is a government program that provides medical services for people who meet certain income or disability requirements. See Your Guide to Medicaid for more information.
• Children’s Health Insurance Program (CHIP)
  A program that offers coverage to children age 18 and younger at low cost. The fees depend on family income levels.
• Children with Special Health Care Needs (CSHCN)
  A state program that offers extra health care benefits for children under the age of 21 who have disabilities.
• Health Insurance Premium Payment (HIPP)
  A program that helps families pay for health insurance if someone in their family gets Medicaid and if someone in their family can get private health insurance through their job.
• Supplemental Security Income (SSI)
  A government program that is based on financial need and helps pay for living and health care expenses for children with disabilities and special health care needs. If you are approved to get Medicaid, you also can be approved to get SSI.
• Social Security Disability Insurance (SSDI)
  A benefit for your adult child where they get a monthly payment based on their own or their parents’ earnings if they (or you) have paid enough Social Security taxes.
• Waivers
  Waivers let states use Medicaid funds to offer long-term home and community-based services to people with disabilities and special health care needs – and people who are elderly – in order to help them live in the community. Waivers are not a kind of insurance. Unlike other programs, many waivers are based on your child’s, not your family’s, income. You might have to wait a very long time to get waivers, so it’s best to sign up as soon as you can.