How to Pay for Your NICU Stay – Texas Edition

by Erika Goyer, mom to Carrick (born and died in 1990), Quin (20), and Eli (12)

Money Tree

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Call Your Employer

Let them know what is going on. Ask to speak to someone in Human Resources or Personnel about the following:

    • Your insurance coverage.
    • What time off you have available or accumulated through flex-time, sick time, and vacation time.
    • Whether or not you have temporary disability insurance through your employer.
    • Whether or not your place of business offers time off through the Family Medical Leave Act. Your spouse may also be able to take FMLA leave with a doctor’s note.

If you have recently been laid off or fired you may still be able to access health insurance from your former employer. To find out more about COBRA (Continuation of Health Coverage Act) and whether or not it is a good option for your family call 1-866-444-3272.

Call WIC and the Texas Department of State Health Services

WIC is a nutrition program for women, infants and children and may be able to lend you a breast pump. The CHIP Perinatal program is for uninsured pregnant women and can provide prenatal and pediatric care for your baby and follow-up visits for mom with an OB/GYN.

Find Out if Your Children Qualify for Medicaid

Even if you have private health insurance, it’s good to have Medicaid as your secondary coverage. It will help cover expenses after you have met your annual limits on treatments and therapies.

Click Here

If your child qualifies for Medicaid, they also qualify for Texas Health Steps, which provides free medical screening exams, dental services, and case management. Texas Health Steps will: * Help you find a doctor or dentist for your child * Help you set up an appointment for your child to see a doctor or dentist * Help you get a ride or money for gas to get to a medical or dental appointment * Answer questions you may have about the services your child can receive.

Look at Alternative Routes to Qualifying for Medicaid

Some programs allow you to receive Medicaid for your child without meeting the strict income limits and financial guidelines. Others will help you pay your private insurance premiums, deductibles, and co-pays.

Research Other State Programs

Texas has two programs that are especially relevant if your child has on-going, intensive health care needs after leaving the NICU.

These are just two of the Medicaid Waiver Programs available in Texas. To learn more about these programs read “Which Waiver Does What?” by Kaye Beneke and Imagine Enterprises.

Find Private Health Coverage for Your Child.

If you need help finding private insurance you can visit Texas Health Options at www.texashealthoptions.com This site is run by the Texas Department of Insurance and will educate you about insurance and help you find coverage. The Texas Department of Insurance Consumer Protection Program will also assist you if you have a dispute with your insurance provider.

Get personalized help from a parent who has been where you are now.

If you have questions or need help, call Hand to Hold’s Family Support Navigator for assistance. Reach Erika Goyer at (512) 550-3181 or  Erika [at] handtohold [dot] org.

 

Definitions and Descriptions

Family Medical Leave Act – The FMLA entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave. Eligible employees are entitled to: * Twelve workweeks of leave in a 12-month period for: the birth of a child and to care for the newborn child within one year of birth; the placement with the employee of a child for adoption or foster care and to care for the newly placed child within one year of placement; to care for the employees spouse, child, or parent who has a serious health condition; a serious health condition that makes the employee unable to perform the essential functions of his or her job; any qualifying exigency arising out of the fact that the employee’s spouse, son, daughter, or parent is a covered military member on “covered active duty.”

Women, Infants and Children Program – WIC is a nutrition program that helps pregnant women, new mothers, and young children eat well, learn about nutrition, and stay healthy. Nutrition education and counseling, nutritious foods, and help accessing health care are provided to low-income women, infants, and children through the Special Supplemental Nutrition Program, which is popularly known as WIC. Who is eligible and who can apply? * Pregnant women * Women who are breastfeeding a baby under 1 year of age * Women who have had a baby in the past six months * Parents, step-parents, guardians, and foster parents of infants and children under the age of 5 can apply for their children. If you have a job or if you have private health insurance, you can still apply for WIC. WIC may also be able to assist you in getting a breast pump.

CHIP Perinatal – Texas’ Children’s Health Insurance Program for Perinatal Care – Texas residents who are pregnant, uninsured and not able to get Medicaid may be able to get CHIP perinatal benefits. Coverage starts before the child is born and lasts 12 months from the date the unborn child is enrolled. Benefits include: * Up to 20 prenatal visits. * Prescription drug coverage based on the current CHIP formulary. * Hospital facility charges and professional services charges related to labor with delivery only. Preterm labor that does not result in a birth and false labor are not covered benefits. * Two postpartum visits for the mother. * Regular checkups.

Children’s Medicaid – CHIP – Medicaid health insurance is provided at no cost to qualifying children. Qualification is based on the family’s income and whether or not the child qualifies for SSI. Medicaid covers: * Dentist visits, cleanings, and fillings * Eye exams and glasses * Choice of doctors, regular checkups, and office visits * Prescription drugs and vaccines * Access to medical specialists and mental health care * Hospital care and services * Medical supplies, X-rays, and lab tests * Treatment of special health needs * Treatment of pre-existing conditions Applying for Medicaid for your children can be done online: * The application form is the same as the CHIP application. * You don’t have to go to a DHS office for an interview. * Your children are eligible for six months of coverage even if your income or assets increase. * Parents new to Medicaid must attend an orientation to learn how to use Medicaid properly and all children must receive check-ups and immunizations as described by the Texas Health Steps program Your children may be covered by CHIP if your income or assets increase and they are no longer eligible for Medicaid. You can talk to a Customer Care Representative by calling toll-free 1-877-543-7669 (877-KIDS-NOW) Monday through Friday between 8 am and 8 pm Central Time (except holidays). TTY: 1-800-735-2988

Children’s Health Insurance Program – CHIP – This program is designed for families who earn too much money to qualify for Medicaid, but can’t afford to buy private insurance. Families pay monthly premiums and cost-sharing for doctor visits, prescription drugs, and emergency care. If your child qualifies for CHIP, your enrollment fees and co-pays will be based on your family’s income. Enrollment fees are $50 or less per family, per year. Most co-pays for doctor visits and prescriptions range from $5 to $25. To qualify, a child must: * Be a Texas resident. * Be a U.S. citizen or legal permanent resident. The citizenship or immigration status of the parents does not affect a child’s eligibility and is not reported on the application form. * Be under age 19. * Live in a family that meets CHIP income requirements. * Not be enrolled in other health insurance.

Institutional MedicaidInstitutional Medicaid pays for medical expenses for a child who has a hospitalization longer than 30 days regardless of birth weight or family income. You must apply for Institutional Medicaid prior to discharge. Speak to your NICU social worker or your hospital financial assistance office.

Medicaid Buy-In for ChildrenThis program is for families who have a child with a disability, but earn too much money to get traditional Medicaid. Through this program, families can “buy-in” into Medicaid coverage by making monthly payments. To be in this program the child must: * Be age 18 or younger. * Not be married. * Meet the same rules for a disability that are used to get Supplemental Security Income (SSI). The child doesn’t have to get SSI. * Live in Texas. * Be a U.S. citizen or legal resident. The benefit period for this program is usually one year. Before the end of the benefit period, a renewal application will be sent to the family. This program pays for many health-care services for children. Here are some examples: * Doctor and clinic visits. * Hospital visits. * Emergency care. * Medicine. * Glasses. * Dentist visits. * Mental health care. * Care in the home. * Care in a nursing home or other place of care. * Speech therapy (how to speak again or speak better). * Occupational therapy (how to do everyday activities like getting around your home, getting in a car, and getting dressed). * Physical therapy (how to move around better or become stronger). * Regular checkups and help with Medicaid services (case management). Click here for the application.

Supplemental Security Income – SSI Social Security provides SSI disability benefits to certain infants born with a low birth weight whether or not they are premature. A child weighing less than 1200 grams (about 2 pounds, 10 ounces) at birth can qualify for SSI based on low birth weight. A child weighing between 1200 and 2000 grams (about 4 pounds, 6 ounces) at birth and considered small for his or her gestational age also may qualify. The important thing to know is that babies who qualify for even $1.00 of SSI benefits are automatically eligible for Medicaid. When you call or visit Social Security Administration ask to speak with someone who is knowledgeable about benefits for infants and let them  know that you are stating your “Intent to File” for SSI benefits. This will give you the earliest possible eligibility date.

Texas Health Insurance Premium Payment Program – HIPP -“Get HIPP: Private Health Insurance through Medicaid” If your child receives Medicaid and someone in your family can get insurance at work you may qualify for this program. When Medicaid determines it is cost effective the HIPP program helps families pay their private insurance premiums, deductibles, and co-pays.

Children with Special Health Care Needs – CSHCN – Toll free: 800-252-8023 CSHCN provides health care benefits, family support services, and case management to children in Texas with special health care needs. The program is available to anyone who 1. lives in Texas 2. is under 21 years old (or any age with cystic fibrosis) 3. has a certain level of family income 4. has a medical problem that * is expected to last at least 12 months * will limit one or more major life activities * needs more health care than what children usually need * has physical symptoms. (This means that the Program does not cover clients with only a mental, behavioral or emotional condition, or a delay in development.) Families must meet specific income limits (except for case management, any income), assets, and residency requirements. The CSHCN income limits are slightly higher than Medicaid (SSI) and the same as CHIP. CSHCN can be used as secondary insurance with Medicaid, CHIP, and private insurance.

Medically Dependent Children Waiver Program – MDCP – This Medicaid waiver program provides qualified children with a variety of services that allow the children to live at home. MDCP provides respite, adaptive aids, and supports to enable eligible children to participate in child care. To qualify, only the child’s income is considered. A physician must agree that your child meets medical necessity criteria for admission to a nursing home. MDCP is limited to a certain number of children on a first-come, first-served basis. Once accepted, your child also qualifies for Medicaid benefits. Need to know the criteria for being “Medically Dependent”? Read MDCP – What Does it Mean to be Medically Fragile?
Erika Goyer is the mother of three boys and a family support navigator with Hand to Hold. Her oldest son Carrick Michael was born at 27 weeks gestation and weighed 1 pound, 14 ounces. Carrick died soon after his birth due to complications of prematurity. Erika went on to have two more high-risk pregnancies and two healthy sons.

 

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Site last updated April 16, 2017 @ 9:38 pm; This content last updated June 23, 2014 @ 5:42 pm