Parent of Special Needs Child...covering the cost of their care while in school

[azucardulce]

I'm starting PA school this May and am the mother of two boys, one of whom is on the spectrum (PDD-NOS). He is 6 years old and has had ABA therapy for almost three years. We also have him in a private school (he has in the past been kicked out of one school and other schools are not equipped to positively contribute to his development as much as we would like). Long story short, my current insurance covers some treatments, but we spend a good bit of $$$ trying to keep him on track developmentally. Also, when I start school in May, the only way I can keep his autism treatments covered is to elect for COBRA which is around $900/month; the student insurance does not have autism coverage as a benefit for dependents. Has anyone out there been in a similar situation? Are there provisions for getting more aid, special scholarships, or provisions for justifying a greater financial need due to care for a special needs child?

[cinntsp]

Are there state health plans where you are that are an option for your situation?

[azucardulce]

When you say state health plans, are you referring to Medicaid/Medicare? There is a medicaid waiver program that will cover ABA and respite care, but I was told when he was originally diagnosed that there was a 4yr waiting list (or some absurd length of time).

 

I didn't bother to apply for it previously because my insurance covered it, and would permit treatment ASAP, and our household income was way too high to qualify for Medicaid/Medicare (don't know which one). I emailed someone today at the deparment of disabilities and special needs about my current situation in hopes that they might be able to help us. With me not working, we will loose about 40% of our household income. Most of my income goes to his healthcare and private school.

[cinntsp]

Yes, I was referring to something like CHIP. http://www.chipmedicaid.org/en/About It covers mental health access but to what extent I'm not sure. Hopefully you'll find a way.

[azucardulce]

Thanks. My husband makes around 70K by himself, so we wouldn't qualify for a regular program, but I think the requirements for special needs are different and we may be able to get some help that way.

[primadonna22274]

I think the COBRA is your best bet. You may be able to petition the financial aid dept to increase your award accordingly.

Best wishes to you and your family.

[azucardulce]

Thanks primadonna! I am going to contact financial aid to see if there is a way to increase my award, once I get a final notification from them. Your reply suggests that something like this might be possible :) I loathe the fact that I am taking out loans to begin with, and I want to limit the loans as much as possible, who doesn't right??? BUT...I also need a way to keep my son on board developmentally. His development was a major factor in me doing PA vs MD...I digress...Anything will help at this point.

[cinntsp]

COBRA won't last through your entire time in PA school so make sure to look into long term options prior to starting school. You don't want to deal with that and your classes/rotations at the same time.

[azucardulce]

I was unaware that COBRA wouldn't last the entire time, so thanks for that input. CRAP!!! I'm doing my best to get all of my son's tx and coverage figured out prior to starting school. It was something I didn't want to deal with while working and I'm sure it will be something I won't want to have to figure out in the middle of class and rotations.

 

Anyone out there with a special needs kid? Or anyone know anything about the state Dept of Disabilities Special Needs (I'm in SC) and how to expedite getting assistance from them? I've emailed them, but I'm probably going to have to call and/or go to one of their offices.

[JoelleK]

COBRA will last 18 months...then you WILL be offered a conversion plan from your current carrier (which you don't have to take if you can find something cheaper with the same bennies attached). By that time the new laws will be in place (they go into effect January 2014 I believe) so you will likely have more options. This is what I am currently doing. Good luck!

[azucardulce]

When I did some initial research, I remember seeing an increased COBRA rate for coverage after the 18 month period for the insurance I currently have. This must be what is referred to as the conversion plan. My student health insurance doesn't have any autism benefits, but perhaps by Jan 2014 the playing field will change...thanks for your input, it is very much appreciated!

[JoelleK]

Will you be staying in SC? I only ask b/c I have a family member whose son is autistic - they live in southern CA - she has incredible bennies for her son and he is doing fabulous! Wishing you the best of luck on your journey!!!

[azucardulce]

I'm staying in SC most likely, as I grew up here. The benefits we have now for autism are really good, as I am a state employee...and my son is doing well compared to where he started! I'm looking into whether I can have my kids covered through COBRA and I elect the student insurance option, as this saves about $300/month vs. having us all covered under COBRA and this arrangement also allows us to keep the autism benefits.

 

 

I just needed help working through this conundrum to make sure I'm not missing something...thanks for your support!

[gamecaco4]

In Michigan, there is a program called Childrens Special Health Care. It does not currently cover mental health, but is supposed to "soon"...hopefully very soon as my son has Asperger's, depression and anxiety disorder. I tell you this because I'm wondering if there is a similar program in SC that does currently cover ASD. It is a Medicaid program, but the program is income based instead of income dependant. When my son was on it for renal disease, with our income of 47K, we paid $125/year and there was NOTHING that was not covered.