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Pennsylvania loophole.

Discussion in 'Parents of Children with Type 1' started by Tomdiorio, Feb 16, 2013.

  1. Tomdiorio

    Tomdiorio Approved members

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    I'm just curious, how many PA state residents are aware of the insurance "loophole". How many are using it? And what other states have similar insurance plans.
    It will basically pay for all of your child's D supplies.
     
  2. Darryl

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    It's often called a loophole, but it's not a loophole at all, it's simply a medicare-funded secondary insurance that assists families with children who have certain high-cost medical conditions such as diabetes. We all pay medicare taxes (2.9% of our income split between employer and employee) and are entitled to the benefit having paid this tax and having had the misfortune of a diagnosis that falls within the guidelines of the law.
     
    Last edited: Feb 17, 2013
  3. Tomdiorio

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    You are correct, it is not actually a loophole. That is just what they call it.

    CHIP, however, is something different, children's health insurance program. Anyone can buy that for their children.

    I am talking about medical assistance. I believe they call it "loophole" because you can get coverage due to "disability"(their words not mine) regardless of income.

    If you are above a certain income, you first have to get denied by SSI, then you can file for medical assistance via PA Compass website. Then you select a provider ie. UPMC for you, gateway.

    We were told about this at diagnosis at children's hospital. They nurse eds referred to it as the loophole.
     
  4. Caldercup

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    My son qualifies for Medical Assistance because of his Type 1 D. I don't consider it a loophole either. He qualifies, we use it.

    The Children's Hospital of Philadelphia (where our son was diagnosed) provided us with a social worker to tell us about it, and then an admin who met with me, collected our documentation, and faxed it off to the Medical Assistance office.
     
  5. Joretta

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    I switched my daughter to floridas program as my work insurance cost way more and the premium and company's were way outside what we had as income
     
  6. Darryl

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    You're right, CHIP is something else. I was referring to the medical assistance program.
     
  7. Tomdiorio

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    I believe they call it a loophole because you can get covered regardless of income. I think it is actually called PH-95. Everyone just refers to it as the medical assurance loophole. That makes it sound like you are tricking the system.

    I was curious if other PA hospitals were informing newly diagnosed families.

    I just want to get the word out for people in PA that are unaware and struggling to pay for supplies.
     
  8. momof2here

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    what states offer this and what is it called?

    Back to the OP's original question.... what other states offer this? What is it called in other states or how do you find out what it is called or offered? How does a child qualify? Confused.
     
  9. Joretta

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    In Florida it is healthy kids. You apply online. I found out about by googling health care for kids Florida. When I applied they called me and asked if my child had any chronic conditions. I said I am not sure she has diabetes we were only 2 months in and numb. The lady said she qualifies send in 133 dollars. Cost is a sliding scale based on income. 133 max amount.
     
  10. dshull

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    Here is a link which describes the program and how to apply really well:

    http://www.phlp.org/wp-content/uploads/2012/02/PH-95-guide.pdf

    I do not know how many other states have this program. It is a Medical Assistance program. We live in PA but our son was diagnosed and treated at duPont in Delaware. They told us about the program on the first day in the hospital and actually someone from the hospital did all of the paperwork and legwork for us.

    If you live in PA and have not signed up, definitely do. It pays for everything our insurance does not, including co-pays, etc. I hope that other states have similar programs.
     
  11. hawkeyegirl

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    I can speak for Illinois and say that it definitely does not have such a program.
     
  12. Amy C.

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    No one should be surprised that Texas does not offer such a program either.
     
  13. momtojess

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    Ohio has something called Bureau for Children with Medical Handicaps (BCMH) but I'm not sure of the specific (we were diagnosed in OH and moved a few months later, and that was 10 yrs ago).

    Tennessee does not offer anything like this, as far as I am aware.
     
  14. MrsBadshoe

    MrsBadshoe Super Moderator

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    We were told by the social worker at CHOP 10 years ago. I tried to ignore her and not do it...she was insistent...good thing...7 months later my DH was laid off and we lost insurance. Fortunately my T1D son was covered. Because of this I immediately applied for CHIP for my other kids and 3 months later when my youngest child was DX she was covered too.

    My son turned 18 last year and was switched to something else. Currently he is still covered under the state supplement as we have no insurance and he is in college. I'm not sure if that keeps up once my insurance from a new job kicks in we shall see....because if not life could get medically complicated. My coverage is 100% at my health care facility as I'm a nurse; any where else the deductible is thousands of dollars before any coverage. I am moving away from my family for this job to get experience so my kids will not live any where near the facilities that have the health coverage.
     
  15. Tomdiorio

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    Thank to all. PA is great for this, it is just a shame other states don't have programs like this.
     
  16. William

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    Yes, BCMH is Ohio's program. It is secondary insurance very similar to PA's program.

    A social worker told us about it when our son was diagnosed.
     
  17. mmgirls

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    I might need to look into this, My hubby might be getting a new job with a 90day aiting period for health care.

    Cobra for the whole family will kill us.
     
  18. pianoplayer4

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    We tried to fill this out after dx ( we live in pa) but it never got done... Not really sure what happened with it:-( now Im about to turn 18 and am no longer eligible... Thankfully we have great insurance through my dads work (and its a pretty stable job... He work for our church, his boss is also his best friend:) ) i have no idea what we would do if we lost our insurance!
     
  19. type1moms

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    I am a lifelong PA resident. I assumed that every state offers this support. The program has become an important part of my child's healthcare. I didn't realize how lucky we are.
     
  20. Tomdiorio

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    Yes PA is very good for this type of thing. They also assist with medical assistance for kids with autism.

    If you live in PA and do not have this medical assistance you should call your endo or nurse educator and ask them about. I believe someone posted a link on the steps to obtain medical assistance. It is very helpful.

    Families should not have to suffer in the pocket book due to the fact that our children have diabetes.
     

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