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Medicaid, Insurance and the Market Place... OH MY

Discussion in 'Parents of Children with Type 1' started by PrimAdonna, Apr 27, 2015.

  1. PrimAdonna

    PrimAdonna Approved members

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    We have 1 T1D child, age 16. For the last yr we have been getting Novolog through their patient assistance program. We were told that they now require a "medicaid denial letter" before they will process the renewal application. This means my son needs to apply for medicaid. Never been through this before so I call DHS and ask what I need to do. I am told that because of the ACA I need to apply with the ACA Market Place. Since we have a private insurance policy that is grandfathered we are VERY LEARY of doing ANYTHING that may change it. Once we make any changes then we are no longer grandfathered and will then be subject to the new health care rules.

    So here are my questions: Can my son apply without effecting our current policy? If he is accepted does he then have 2 insurance policies?

    Sigh.

    Thank you all for any help!
     
  2. Lakeman

    Lakeman Approved members

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    Well I certainly dont have all the answers:

    Firstly, if your son (or his household) owns more than $2000 in assets he will be denied for Medicaid. When you apply you will have to give them banking information. If you want him to be denied then the solution is to have too much money in the bank. I would not call that fraud since it is a noble goal to have money in the bank and you are not doing it to gain benefits. As long as the money is really his it should never be a problem.

    Will he then qualify for insurance through the ACA? If he does can you just refuse it? How much personal information will you have to divulge in the application process and is it safe?

    I don't know the answer to the last two but your insurance agent can probably tell you if you can have two policies without it jeopardizing either. CAn you keep your grandfathered status if you qualified for another insurance plan? Another good question for your agent.

    Good luck
     
  3. Megnyc

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    The asset test does not apply for a kid applying for medicaid. They only use modified adjusted gross income now (and have for a few years). And you do not need to provide your bank account information.

    To the OP: I think this situation is too complicated for you to get much in the way of assistance here. Especially since TN did not expand medicaid so you have that whole issue. You might consider going in person to a DHS office and having someone assist you in applying. Regardless, you might take a look at the marketplace and see if you can get a subsidy to get insurance which covers insulin. I am assuming you qualify for a subsidy since you qualified for the patient assistance program (income under 200% FPL). Good luck!
     
  4. Sarah Maddie's Mom

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  5. Lakeman

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    Wow. You're right. I just looked that up and hard as it is to believe it is true. I used to be a benefits administrator for adult clients some years ago so I assumed the common sense proposition that people receiving welfare could not be rich would hold. But it does not as the resource tests have been dropped. So now a family that has saved or inherited lots of money can have kids qualify for CHIP as long as their income is not too high. In a few years when parents shuttle their kids off to their retired grandparents house so they can qualify for CHIP some politician will suggest that people with lots of money should not qualify and will be blamed for wanting to deprive little children of medical care.
     
  6. Megnyc

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    Fortunately, I am pretty sure that the wealthy are not all clamoring now to get their kids on medicaid :rolleyes:

    If you are wealthy enough not to work, I would assume that you have enough in unearned income to put you over 133% of the poverty line. Thus, do not worry, we are not about to encounter loads of wealthy children taking advantage of the medicaid system.
     
  7. PrimAdonna

    PrimAdonna Approved members

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    Thank you! This is exactly what I did today.

    Talked to a nice lady at the DHS and I will need to go online, fill out the questions and I should know almost immediately if he qualifies. If he does not qualify there will be a link to a pdf copy of the refusal. I can then print it out and mail it to the PAP with Novolog.

    I also spoke to my insurance co. The Medicaid will not effect our plan. :)
     
  8. Megnyc

    Megnyc Approved members

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    Awesome! And if you need insulin in the mean time, don't hesitate to talk to your endo or children's hospital and explain you are waiting on the PAP. They will most likely be able to help you out with sample vials of insulin.
     
  9. funnygrl

    funnygrl Approved members

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    I'm curious, if you have private insurance, why do you need the patient assistance program? Is Novolog not covered? Is it a high copay? If it's a high copay, would their copay savings card where you pay $25 per fill help enough? You could probably even get your doctor to write the script for a bit extra so you don't need to fill it every month.
     
  10. aprilodell

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    PAP's are designed by nature to be time limited. They are set up to help you while you are applying for assistance. I am wondering the same thing, is there a reason your primary insurance does not cover novolog? I know that some people will be approved for Medicaid as a secondary policy to cover high co-pays. Remember that Medicaid has poor reimbursement rates and does not cover some things, it is also based on what state you live in what they will cover as the feds give each state an amount of dollars but the states determine how it is used.
     
  11. BarbDwyer

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    My insurance has high co-pays and high deductibles. The initial diagnosis, transport to children's hospital, PICU, and hospital stay was thousands of dollars out of pocket and I spent $500 in the pharmacy on the way home - and I have insurance.

    My insurance does cover novolog but it no longer covers humalog. I have no idea why they do that - maybe the insurance companies has some kind of deal with various pharmaceutical companies? Luke uses novolog so I have't questioned it.
     

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