Why do we need Government Services?

The first and foremost reason is for your child’s protection. Given that he/she has serious medical needs puts him/her in the risk category by the insurance companies. Many HMOs have caps on their spending, so, for some unfortunate reason when your child’s bill exceeds the cap you have a secondary source to tap into. Usually Medi-Cal agrees to pay most of the bills which the HMOs have rejected except if they were deemed to be unwanted procedures.

The second reason is the uncertainty of job situations. If the caretaker/parent is laid off or decide to quit a job, this should not in any case affect the medical care of the children. If you child is approved for Medi-Cal, all you need to do is to inform his/her Case Worker in the Medi-Cal department that Medi-cal is going to be your child’s primary insurance and make sure the necessary changes are made in the system.

The third reason is that medical may approve certain services that your primary insurance may deny to pay.For example: Nursing or Respite services, medical equipments etc.

Last but not the least, once a child has been approved for Medi-Cal, he or she is always under the supervision of the government. In case a parent/caregiver is unable to take care of the child, the state takes custody of the child and does what is needed to care of him/her.

 

How To Get Government Services?

 

MEDI-CAL Waiver Clause

The government has a waiver clause under which a person with a rare disorder or disability and who is a citizen of the United States may be eligible for Medi-Cal or Medi-Caid benefits depending on the state he/she lives in. In all states except in California, this waiver clause is called Medicaid waiver. In California however it is called a Medi-Cal Waiver. (Medicaid and Medi-Cal are different from Medicare. Medicare is health benefits for senior citizens.).Since the well known criteria to be eligible for Medi-Cal/Medi-Caid is low income, getting a child with disabilities approved for Medi-Cal / Medicaid is not an easy process. Enquiring about Medi-Cal benefits for a child on the basis of his or her health condition, may initially result in frowns and rejects. However filling in the application with your local Social Security will result in a caseworker being assigned. A personal hearing with the caseworker will also be arranged. During the interview there is more opportunity to talk to the caseworker about getting Medi-Cal based on the child’s disorder rather than the parents income . The caseworkers in many cases do not even acknowledge the existence of such a clause, in fact sometimes they do not know if such a clause exists in the first place. We suggest providing all proof of the child’s medical history and may be even copies of hospital bills and doctors certificate, and some literature about the disorder, his/her prognosis and its effects on the child’s development. If the caseworker still denies any knowledge of any such a clause, requesting for her/his supervisor may clear the problem and help proceed in the right direction.

Medi-Cal Health Insurance Premium Payment Plan (HIPP):

Medi-Cal, California’s Medicaid plan, operates a program called HIPP, which pays private insurance premiums for Medi-Cal beneficiaries. This program is a cost saving plan since paying the insurance premiums for someone who is seriously ill costs much less than paying the medical bills which Medi-Cal would have to do in the absence of the insurance.

Eligibility Requirements:

To be eligible for this plan the following requirements must be met:

  • There must be a private health insurance plan in force which covers the high cost medical condition. It may be an individual policy or a group health plan on self-pay through COBRA or a conversion policy. HIPP does not purchase new policies for persons. NOTE: HIPP will not pay the premiums for the California Major Risk Medical Insurance Plan (MRMIP).  

 

  • There must be current Medi-Cal eligibility either with full Medi-Cal or with a Share of Cost less than $200. Share of Cost equals total income less health insurance premiums, child support, alimony and the Medi-Cal maintenance need of $600 ($620.00 for persons who are disabled). For example, someone who is disabled with an income of $950 and insurance premiums of $250 would be eligible for HIPP as their Share of Cost would be less than $200 ($950 – $250 – $620 = $80.00 Share of Cost).

 

  • The applicant must have a disability resulting in high medical costs, such as Cerebal Palsy. Proof may be requested that medical bills exceed twice the monthly premiums, but this is usually waived with a diagnosis of Cerebal Palsy.

 

  • The applicant must not be enrolled in a Medi-Cal related pre-paid health plan, the San Mateo County Health Plan, the Santa Barbara County Health Initiative or a Medicare HMO.

 

  • HIPP will NOT pay premiums for plans written by the California Major Risk Medical Insurance Plan (MRMIP).

For more information please visit http://www.dhs.cahwnet.gov/mcs/psd/tplb/html/hipp.htm

Regional Center:

There is another organization that is dedicated to the well being of children with serious health conditions. It is called as the Regional Center. Call the regional center in your county and ask to talk to a caseworker or fix up an appointment. They are aware of the proceedings of Medi-Cal and hence will be able to put you through the right contact in the Medi-Cal Department. Once your child is approved as a Regional Center’s client, he will be eligible for the various services offered by them.

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