Need Help Navigating Medicaid

Updated on January 15, 2007
J.W. asks from Plano, TX
16 answers

My daughter is 13 months and has Down syndrome. My husband is about to change jobs and therefore, our insurance will change. I'm concerned that we will be turned down for Sophie because she has a pre-existing condition (she has a feeding tube). I don't want to be without coverage (we'll have Cobra but that is so expensive!) so I want to apply for Medicaid (although we'll likely get turned down because of income) and I have no idea where to start. Can anyone advise me?????

Thanks!

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J.T.

answers from Dallas on

J. I think I can help you with advise on how to get medicaid. If you would like to call me feel free.

J. ###-###-####hm ###-###-####
I can't promise anything but I have some ideas that might work

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Y.D.

answers from Dallas on

You can call 211 on your phone and it is a Texas helpline. You can talk to someone (not a recording) about what you need and they can help you out.

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R.C.

answers from Dallas on

I have a good friend of mine that is in the insurance business. He may not be able to help but I am sure he will be able to send you in the right direction. His name is Scott Margolin. I have referred him to a few moms that are members of mamasourse. Anyway his number is ###-###-#### and his email is [email protected]____.com luck. I know Scott will be able to shine some light on you and your family.

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E.T.

answers from Dallas on

Hey, J.,

I think Sherry is right. I changed jobs when I was 8 months pregnant and because of continual coverage, I had no problem getting the new company to cover the rest of the pregnancy and birth. You might check into that. I wouldn't think downs would be different than pregnancy, but who knows...

I CAN'T believe Sophie is already 13 months old!!! Send me some new pics when you get a chance! Kai turns 2 in 12 days! UGH!!!

Take care,

E.

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S.

answers from Dallas on

Sorry, no advice for navigating Medicaid. But as long as you have continuous insurance coverage, the new company can not consider your daughter's condition as pre-existing. I know cobra is very expensive but if at all possible use it until the new insurance is effective. You might also contact the new insurance company and ask them how long you can be without coverage before they consider it a lapse, sometimes it is 30 days which means you wouldn't have to pay for cobra that last month. Hope this helps.........if I have done nothing but confuse you, please feel free to call me. I will try to explain better. S. Wasson

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C.

answers from Dallas on

Apply through CHIP. http://www.chipmedicaid.org/english/index.htm If you apply through CHIP it will also check your eligibility for Medicaid. They are two different programs. CHIP, I believe, has higher income levels which they list on this site.

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R.

answers from Dallas on

Hi, I have a 5 year old with DS and we're on Medicaid and BCBS. If your husband is working for a company that supplies insurance then your daughter's diagnosis should not be counted as a preexisting condition as long as there has been no break in insurance coverage (so as long as you currently have insurance there shouldn't be an issue). The problem with pre-existing conditions arise when you buy private insurance or if you don't have coverage and then start a job that offers coverage, usually there is a one year wait period before they will start coverage.

Getting medicaid requires figuring out the system. If you want to email me privately, we can exchange phone numbers and I can give you some tips.

[email protected]____.com

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T.R.

answers from Dallas on

Hello,

I work in the field of Human Resources in Benefits. By law, if have had credible coverage for a year and no lapse in coverage, it will not be considered pre-existing. The new Company can't turn you down due to her condition. We have had people join our company with many heatlh problems, that have costed us over $1,000,000 a year in claims, but can NOT deny them because of this.

The only problem may arise if your husbands current company has less than 10 employees. Is that the case?

When you fill out the application for insurance at the new company, as long as you show proof of prior coverage, there should be no problems.

Let me know if you have any questions!

T.

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M.W.

answers from Dallas on

J.,
You probably will not have a problem with the pre-existing condition clause if it's a major insurance carrier. I had a special needs child who passed away but when I changed jobs and insurance companies I did not have a problem. As for Medicaid..you are probably not going to qualify for traditional Medicaid b/c you have to be pretty much broke. However, you should check into SSI for her disability. With that I believe you qualify for some form of Medicaid. I hope you are able to get some help. I know how expensive and difficult it can be. Hope everything works out for the best. Good luck and take care.
Amanda

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D.T.

answers from Dallas on

Are you involved with ECI? If so, they will help you with the process. If not, you really should contact them. It is a great program. The one in Plano is called ITIP- Infant and Toddler Intervention Program. It is a state program set up for little ones who have health problems and/or disabilities. Having Downs Syndome and a feeding tube would make her qualified. You are right about being turned down because at this age they look at the household income, but there are other programs out there that may be able to cover her needs.

D.H.

answers from Dallas on

I'm not sure if this will help but I've just recently changed insurance as well and we used a WONDERFUL insurance guy. He was recommended from the Dave Ramsey website and we are so happy with him!
I didn't know this but when you use an insurance guy, he gets paid by the insurance companies so it is free for you.
Here is his information:
Steven J. Neuner, CBC
Vice President
Alkali
Direct: ###-###-####
Fax: ###-###-####
Maybe he will be able to point you in the right direction and help you make an informed decision about your insurance choices.
Good luck!
D. H.

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T.L.

answers from Dallas on

http://www.hhsc.state.tx.us/medicaid/med_info.html there is an application.. I don't know how she could get turned down just because of a feeding tube. I think if you already have insurance your new insurance will cover it. There is also Texas Chip it is almost the same thing as medicaid but you pay like 5 dollars a month for it and there are more doctors it seams that will take it.

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G.F.

answers from Dallas on

You'd be surprised how flexible Medicaid is. Specify that you need Temporary Medicaid only because your husband is in-between jobs and you have a child with down sydrome that cannot be without care. If you have a doctors appointment soon or you think you will need care soon, ask for an emergency medicaid card that is good for about a month. Many people with high incomes are able to do this. You might end up having to pay 10 or 20% of the expenses, but it's very rare. Some questions they will ask, is when was the child diagnosed, name of your doctor, any test performed. Most likely they will call your doctor to request information. But if it's a pre-existing problem there will be plenty of information. Go to the website from your previous advice. Get a number or local office address. It is always faster if you can deal with them in person.

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A.

answers from Dallas on

I wish I could help out with the insurance problem, but I can assist you in possibly helping Sophie have a better quality of life. Glyconutrients is a natural product that has helped many Downs children. It comes in a powder form, so you could actually put it in Sophie's feeding tube. Michelle is a Downs teenager who took the glyconutrients for allergies, and had other great results her parents were not expecting. If you would like to have more information, please email my friend, Lynn Warren at [email protected]____.com and she can tell you more about Michelle and how to find the best glyconutrients.

Blessings,
A.

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S.G.

answers from Dallas on

It's my understanding that if you do not have a lapse in medical coverage (meaning pay the Cobra until the new one kicks in), they must continue coverage for your daughter or anyone that was orginally insured.

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J.

answers from Dallas on

HI,

The website for Texas Medicaid is TMHP.com you will be able to find information & applications there.
Your new insurance cannot turn your daughter down for a pre-existing condidtion as long as she has been covered for the past six months, what they can do though is to not cover the condition for a time period 30, 60 or 90 days depending on the carrier and the condition.
Even thought the cobra is expensive it will keep all of you covered and with the same physician(s)if you can pay for it I would take that route.

I hope this helps
J. D

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