Question About Medical Assistance for My Son Who Is Autistic

Unfortunately, they use a formula based on your income. Based on your income, they use a "scale" to figure out how much you will pay for their state plan. It sucks but that's just how it is.

Do some research, you can go to your local children's hospital & talk with a case worker. Most states have a "waiver" service that waives a family's income. There is usually quite a waiting list but you should look into & get on it if possible. Every state probably runs there's different , so I may not be telling you 100% good info but I'm sure it's somewhat similar.

Not sure if this is the same type of program but I applied for a state program for my sons because their medication is so expensive. Yes insurance covers but I stil lahve to pay deductible and co-pay until I meet out of pocket. My copay is about $1100.00. But they cover anything after that. So my insurance will cover tehir part, and the company will take the amount the insurance does not cover, bill the state program, and then the remainder will be my co-pay. If it is a co-pay, not a premium, then you would be responsible for $400 of his medical and the rest would be covered.

I am not familiar with this program but I can only assume it is needs based. If that is the case then it would seem they feel you can pay the first 400 out of pocket.

I have to pay 100% for all of my son's services outside the school so I don't think 400 is that bad of a deal. Granted beyond his doctors we have never had any outside therapy so it was covered by our insurance.

I am assuming "ma" means Medical Assistance.....

Per year? Per month? How often is the co-pay. It seems that your income may be what is making this co-pay so high.

Since your child is high functioning he may not need a ton of special services. His health should be normal, for extra training or educational services the public school system should take care of any needs diagnosed by a doc.

So paying $400 a month for insurance is extreme. Paying $400 per year sounds very doable IF, IF, IF, if it covers anything above that. Anything.

If there is a long list of things not covered then it's not worth it.

When he gets older and out on his own, whether a group home or supported living, he will qualify for medical assistance based on his own income.

Do you have a deductible you must meet? If so, you will pay out of pocket, until that is met. When you applied, did they talk about paying for everything, or only certain therapies/benefits?

If there is a contact number on the letter, I would see what they say. You might have to pay out of pocket some expenses, or it could be an error on their part. My friend has adopted several children with behavioral and special needs from foster care, and many of their therapies require out of pocket, to meet a small deductible. She has also had to dispute a billing error, that said she owed. Call and see which it is. Good luck!