Tag Archives: Katie Beckett Medicaid

Helpful contact information for healthcare premium assistance programs.

Due to Connor’s diagnosis of tuberous sclerosis complex, he qualified for Katie Beckett Medicaid (known as TEFRA in some states). He is eligible for that program based solely on his medical condition. Parent finances are not a consideration. It acts as a secondary insurance, picking up a lot of what isn’t covered by our primary insurance. It is the reason we are able to get him so much therapy. As a result of qualifying for Medicaid, he also qualifies for the Health Insurance Premium Payment Program (HIPP). It assists with the monthly cost of the premium of our private insurance we get through my husband’s employer by reimbursing us on a monthly basis. Basically, it’s cheaper for the state to make sure we are able to keep our private insurance, rather than lose it and resort to full Medicaid.

We had recently been Googling to try and figure out whether a couple other states had similar programs to HIPP and were struggling to find the information. My husband was surprised to find a list of all states with such programs in his recent benefits enrollment package. I thought I’d post the contact information in case others were not aware of the possibility of applying for this program. We were lucky that Connor’s early intervention coordinator is really good about letting us know about various programs, but I meet a lot of people that have no idea. Hope this is helpful to other special needs families.

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I agree to jump through your hoops. Can’t you just agree to just hold them steady?

I had the most ridiculous morning Friday thanks to the Georgia Department of Human Services. I am unconvinced they know the definition of either “human” or “service.”

It started Thursday evening. I received an automated phone call from them informing me that they had tried to mail me something on behalf of Connor, but it had been returned to them due to an incorrect address. Since it must relate to one of the programs Connor has qualified for, either Katie Beckett or HIPP, this concerns me. We’ve changed our address with them, but whatever, right? I was given two numbers to call the next day — as it was after seven (thanks for making me worry when it’s too late to do anything) — a local and a toll free.

Friday morning around 8:30 I attempt to call the local number. Call fails, so I call the toll free number. I spend seven minutes, according to my phone log, trying to navigate the automated system to get a person. I end up trapped in a dead end when I make a selection for which I don’t have the information to input that they want. So I hang up and call again. I try hitting anything to get a person. After I slam my phone down still connected, Chris takes it and successfully gets a person on the line who informs him that she can see us in the system, but she doesn’t know what was mailed. She gives us another number to call.

I call it. Then I spend almost 45 MINUTES on hold. In the time I wait, I give Connor breakfast, get dressed and carry my phone and Connor’s KB Medicaid card around the house with me in case they need his Medicaid number. When she finally picks up, I realize I’ve left the card somewhere and I have no idea where. She’s asking for his social or some other number. I am already about to lose it, so I’m shrieking, “Shit! I had it the whole 45 minutes I was on hold and now it’s gone!”

She keeps telling me to give her some other identification number I don’t have, so I run up to Chris to get Connor’s social security number that I so desperately need to memorize, but agencies like this have left no room in my brain to keep it, and I give it to her. She keeps asking me for some other number and I tell her I don’t know what she’s talking about. At this point Chris takes the phone and goes off. He basically has to tell her to shut up and listen and use the social security number. A total of 49 minutes was spent only to be told, again, that she can’t see what was mailed to us either. Call your local agency.

By now, I’m late taking Connor to music therapy and about to have an angry, ugly cry meltdown because my morning has been ruined, my happy baby trying to get my attention to no avail, all so I can return a phone call to an inept agency when I don’t even know if it actually matters or is important.

Well, we’ve been getting our monthly HIPP checks with no issue. And I sent in all the paperwork for Connor’s Katie Beckett renewal last week. KB is the only thing up in the air, so in order to save my sanity, Chris makes the call to our local agency and to Connor’s caseworker leaving a voicemail to find out if she has received the paperwork and if she knows what was returned to them to trigger this auto call. Well over an hour spent returning a phone call and I still don’t know what the problem is.

This is after the recent ordeal of renewing Connor’s Katie Beckett Medicaid. KB is a fantastic program. It provides a secondary insurance to kids who have private primary insurance and major medical issues, but it is not based on income. It helps cover costs that are not covered by our primary insurance. We first applied last year with the help of Connor’s early intervention caseworker. The application is a lot of work and a lot of information to gather, but worth the end result. Then the letter came that it was time to renew. We were directed to fill out an online application. We were naive and new to the game so we did it. Several weeks later, we received a denial stating we hadn’t submitted all the requested information. I quickly garnered in FB support groups that 1. it’s better to have them send you the full paperwork packet all together — the online form consistently spells trouble as it’s not really intended for KB recipients, and 2. even if I do fill out the online form, I should then receive a packet asking for additional information, doctor forms, and — naturally — a lot of the same information already asked online. We never received the packet. Just a rejection. I started trying to call for help. You know what you get? A lot of voicemail boxes. Boxes that are full. The denial letter offered me the opportunity for a hearing — you know, in a court. With judges and lawyers. I don’t pay anything out of pocket, except as a taxpayer. Like you. All to get a benefit for which my son no doubt qualifies. I learned in the support groups that this is very common and that you pretty much always get it on appeal at that pesky additional cost to the taxpayers. Then I speak with someone else who advises getting in touch with Connor’s caseworker and seeing if she’ll just give me an extension. Once I finally get the VM when it’s not full, I finally can leave a message which results in the needed extension. We currently await the results of our completed renewal application.

This renewal will happen every year even though Connor has an incurable condition. That’s how it is for everyone.

I’ve been hesitant to be critical of programs that I am so grateful for. We’ve been very lucky in Georgia. I read terrible stories in my support groups of people in other states trying to get their children into the early intervention programs and being wait-listed (which defeats the entire purpose of EARLY intervention), some states  have Katie Beckett wait lists so long the kids age out before receiving benefits and HIPP — which is a huge financial support for Connor — isn’t available everywhere. He receives KB and HIPP because our family has too much income for him to qualify for social security disability.

I agree to jump through your hoops. Can’t you just agree to hold them steady?

I have filled out your paperwork and gathered your very specific requirements of what kind of specialists must provide evaluations of my son (ironically, this leads to you considering an evaluation from someone who saw him once to a much higher value than anything submitted by his regular doctors and therapists that see him all the time). I have made the drives back and forth to the office when my carefully organized packet still turned out to be lacking something.

If we screw up, the penalty for our kids is huge. That’s why we parents jump these hoops. That’s why we give each other tips in support groups. That’s why countless parents lose sleep every year when KB and HIPP renewal rolls around.

Yet the hoops keep moving and changing. Full voice mails, directions to call numbers where no one can help, paperwork not being sent, paperwork being sent minus essential forms, required forms not being available online, people having to go to hearings when if the process was clear and streamlined, it wouldn’t be necessary. You have made it impossible to return a simple phone call.

How much taxpayer money is wasted on these inadequacies? I’ve heard more people are losing benefits as the belts tighten. Maybe if this system worked, more money could be spent helping people. I’m more than happy to submit the proof you need, but perhaps we can agree that an annual renewal for kids who have incurable conditions is excessive? How much time and paper and manpower could be saved on that alone?

Truly, Georgia, I appreciate these programs. I don’t feel entitled. I feel grateful. But special needs parents have to reserve our energy and sanity for more important things.

I need my energy to stay positive on the days when Connor has a setback with his seizure control and wakes up with a violent tonic clonic.

I need my energy for being patient while waiting for my 2-year-old to say his first word.

I need my energy for carrying my 2-year-old who WILL walk…but isn’t YET.

I need my energy for mixing meds twice a day.

I need my energy to fight a government that thinks my child’s access to medical cannabis should be based on his zip code.

I need my energy to keep track of 4- 7 therapy appointments a week.

I need my energy to coordinate an MRI and doctor’s appointment in a very narrow window of when we will be in Boston for a TSC study and when his doctor is actually available.

I need my energy to make multiple follow up calls to hospitals and doctors to remind them they should have billed secondary or that they never sent a form I asked for three times already.

I need my energy to trouble shoot my son’s medical diet for seizures and figure out why it isn’t working as well now as it was in the beginning, and also to force him to eat when he doesn’t want to, because not eating = more seizures.

 

You see, I simply don’t have anything left for you. I will fill out your forms and collect your documents. I will meet your deadlines. I will provide you whatever evidence you need to believe that my son has an incurable genetic condition that causes seizures and developmental delay. But that’s all I have to give. The energy supply is gone. I can’t sit slumped in the waiting room of music therapy, drained from trying to return a phone call.

Please, please stop moving the hoop.

 

“You’ll feel more rested if you get up at the same time every day.” LIES!

I’m having a terrible time keeping up with the blog now that I’m doing some other writing for meager pay to support my eBay habit. I’m trying, I swear! If I could just become a morning person, I could get so much more done. But almost 17 months of consistently getting up at 8 a.m. and I still can’t function properly until 10. Grover taunts me every morning with his chipper, go-getter attitude.

The big news is that Connor just started crawling the other day while we were in Blowing Rock, NC with my parents. He’s not doing it consistently, still doing a lot of commando crawling, but at least we know he can do it now. We are very excited. The cats are not. He’s also now demanding far too much attention after having Chris’ parents stay with us for the half a week leading up to the trip, and then another half week with my parents.

I think Connor would really enjoy having pet ducks in our backyard. Chris disagrees.
I think Connor would really enjoy having pet ducks from Blowing Rock in our backyard. Chris disagrees.
Swinging with Grandpa in Blowing Rock.
Swinging with Grandpa in Blowing Rock.
Meeting the giant doggie at Mast General Store in Boone, NC.
Meeting the giant doggie at Mast General Store in Boone, NC.
The dog makes a great rug.
The dog makes a great rug.

He also just added aquatic therapy to his regimen.

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We are so loving how attentive he is to what is going on around him these days. He had a delightful meeting with the Chick-fil-A cow recently, and also cheered up some not-so-enthusiastic waitstaff at Texas Roadhouse during their obligatory hourly line dance. His clapping and enthusiasm had the embarrassed, Man-I-really-need-the-money staff smiling.

I like ladies. I like music. This is some sweet line dancing.
I like ladies. I like music. This is some sweet line dancing.

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We had an appointment with his neurologist this morning and I requested we try name brand seizure meds (Trileptal and Keppra), in place of the generics since we continue to have breakthrough seizures. Many people swear by them as generics can vary in potency so much, so I’m hoping it makes the difference. I’m sure insurance will be delighted. But after they just sent me the private info of three people by accident…well, let’s just approve it, seeee (in gangster voice).

In other awesome news, as Connor was approved for the Katie Beckett Medicaid Deeming Waiver, we were then also able to apply for HIPP. which is a Medicaid program that helps pay your private insurance premiums in cases of serious health issues, as it is in their better interest to make sure you keep you private insurance, than lose it and resort to full Medicaid. We were approved, and this allows us a lot more income to put towards any other needs we want to meet for him. And my wine. I’m so thankful that Connor’s Early Intervention program people have been so good at making us aware of these programs. So if you have a kid in EI, make sure you have applied for Katie Beckett, and if you have done that, make sure you apply for HIPP (I don’t know what the variation is from state-to-state. I know we are lucky that such services are easily attainable here in Ga compared to what I hear about some other states, particularly in the midwest).

As for the house, I kid you not, we told our realtor toward the end of the month that we were taking it off the market July 31. We finally got an offer on July 27. So this house is under contract and we are under contract on our new house, as well. We will finally have a room we can dedicate to Connor’s mess–I mean, toys.

Don't feel bad! You've been a good house.
Don’t feel bad! You’ve been a good house.

I swear this has been the most humid Georgia summer of all time, but others have told me I’m insane and it’s always this bad. At any rate, I’m ready for fall and to wear my new scarf that my sister-in-law Donna made for me from Chris’ old shirts.

The King of Izod has some extra space in his closet now.
The King of Izod has some extra space in his closet now.

Also, two events I want to make sure TSC families are aware of in the area:

298465_187704037963818_1579148_nOn Saturday September 8, we are having a family bowling event. Cost is $10 per person, which includes shoes and unlimited bowling. Food will be provided. Details here.

On Thursday October 10, we are having an educational meeting on financial planning for your children with special needs. Details here.

 

The Axis of Medical Evil, the Board of Education and Gordon Ramsay would totally love my shoe collection.

The weirdest thing happened when I called Boston Children’s Hospital to schedule Connor’s MRI for August when we will be up there for the TSC study again. An actual person answered the phone, and he immediately scheduled the test.

It was surreal. I dialed. Someone answered. Things were accomplished.

Meanwhile, I’m still waiting for Children’s Healthcare of Atlanta at Scottish Rite to return a message I left with the medical records department 2.5 weeks ago. So my list of CHOA departments that don’t return phone calls is now:

1. Scottish Rite EEG (note: call was returned after I recruited neuro office to get involved)

2. Emory-CHOA billing (note: call was returned over a month later once I wrote a letter of complaint and sent a copy to every single board member including the CEO)

3. Scottish Rite Medical Records (note: pending)

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The reason I was calling them is that I recently submitted my application for Katie Beckett Medicaid, which, if approved, will help pick up costs of Connor’s medical care not covered by insurance. I’ve submitted 8 metric tons of paperwork, only (I hope) minus his surgery discharge papers. Those must have been accidentally thrown away. I don’t know if the board is going to want proof from the hospital (even though the neurology notes make plenty of reference to it, but it’s government after all) so as a precaution, I sent in a medical records request. None of the check off boxes described what I needed so I tried to explain what I was looking for. They don’t provide the records until they figure out what printing it will cost and then they send you a bill. Apparently the department thinks I need the whole 200 something pages and they want to charge me over $100 for it. So I called to clarify that all I need is a couple pages pertaining to the surgery and I’m not paying $100 for it. The discharge papers were like six pages for God’s sakes. That was 2.5 weeks ago. I hate CHOA and their unprofessional business ethic.

A couple companies that deserve a positive shout out so that I can offer contrast: Level 4 prosthetics. Connor recently got a cranial remolding helmet (a more detailed blog to come on that). At his initial screening, it appeared to be covered and we paid the uncovered 20 percent portion. Fast forward a few weeks and I arrive home today from one of Connor’s helmet follow-up appointments to find a denial from United Healthcare. Say what now? You want us to pay for this $3,000 helmet? So I freak and contact all his doctors and physical therapist to get proof of necessity, and then I call Level 4, who I should have called first. They’re already on the appeal for me. Good stuff. Thank you! And United Healthcare, my child is adorable in his helmet, but I assure you it’s not just a fun accessory.

The other company is AquaTots of Kennesaw. I became nervous that I would soon be doing time for homicide due to parents who think they get to save the limited dressing rooms for their swimmers, so I expressed my dissatisfaction. They were very quick to respond and remedy the situation. And now the mom who thinks it’s okay to let her children leave their cars in front of entrances where other customers can fall and hurt themselves walks the earth safely again (until she once again almost simultaneously paralyzes me and makes me change my kid on the floor, then all bets are off).

So these are my days. Doing Connor stuff, trying to get into some freelance writing and watching Roseanne reruns. I feel like I should miss working more, but I don’t. Probably because by the time I left, my teaching to do list had changed so drastically.

Sample To Do List 2005

1. Lesson plans for next week

2. Copy 2nd grade newsletter

3. pull center materials

4. choose new read aloud novel

5. try not to turn beet red, break out in hives and pass out from anxiety when undergoing mandatory teaching observations

Sample To Do List 2012

1. Some random excel sheet with random meaningless data to be submitted to someone who will never even read it, assigned 5 minutes ago, due now

2. see #1

3. see #2

4. Collect elevendy bajillion weeks worth of data so a student can receive services, but probably not

5. Attend a committee meeting

6. see #5

7. see #6

8. see #7

9. figure out what you’re teaching tomorrow. Somebody wants another excel sheet with data due in 5 minutes

10. try not to turn beet red, break out in hives and pass out from anxiety because it’s a work day

And all for less pay every year. Hey, I get it. There’s no money to be had. Just be ready to see more of this stuff on school property if you don’t want to pay people in the education profession:

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I won’t say where I took this recent photo. I might need them to hire me one day.

What I do miss is how hilarious some of those kids can be. I received texts from a former co-worker the other day. She teaches students now that I taught a couple years ago in first grade. They told her that my “shoes haunted them.” My heels were like two feet tall, and they always watched out for me because they were afraid I would topple over. If I’d known I would have based my compare/contrast lessons on heels vs. wedges.

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I also decided to start pursuing my original plan to make some of Connor’s food myself. I have the little baby blender/steamer combo, but I’ve only used it for pretty basic stuff. I decided to finally make one of the recipes from the little booklet that came with it. Hey, why not? Connor eats EVERYTHING. I mean EVERYTHING. This was the result:

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I used to be disgusted by moms drinking and eating after their kids, but the other day I found myself fighting the urge not to eat half his spaghetti and meat sauce. Then I let him drink out of my water bottle. But I also realized he has 50 percent of my DNA. That means it’s half my saliva. So that’s okay, right? Is that what these moms have known all along that I didn’t understand? Or should I just go out and buy some mom jeans now?

Despite the failure of my foray into baby chefery, I am still happy because winter is finally rolling out and warm days have come. I leave you with photos of my little Gordon Ramsay in a good mood enjoying the weather.

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Only a ball pit until it's warm enough to become a swimming pool!
Only a ball pit until it’s warm enough to become a swimming pool!

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