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Raising Special Needs Kids Raising Special Needs Kids

Need Help/ Advice. Anyone have any experience with an issue like this.

Posted by on Aug. 16, 2014 at 1:36 PM
  • 8 Replies

 Going to try to give needed info but not be too terribley long,  Bare with me.  


 My DD 11 just got out of a 4 1/2 month long term residiental mental hospital on 8-1.  We just recently started getting an ssi check for her.   She has a lot of diagonosis including autism/aspergers and well as mood disorders and behavior disorders just as a genral idea of issues we deal with,   Well I got a letter mid of july saying she wouldnt receive an SSI check for august.  Our income is too high because there are 5 fridays in the month and my husband and I get paid weekly.. We were like 12 bucks over making too much.   What I didnt know was that she would lose her medicaid for the month.. It resumes again in sept.  Here has been my problem.. Shes on about 700 a month worth of meds.  Just her thorazine is 449 dollars,,Shes on a high dose 500 mg a day.    I have been able to find 0, Zip , Nada  help paying for her meds.  Our extra checks for the month dont even equal the 700 for her meds.    Anyone ever go throught this?  I have called every state medicaid #, the value options that superivises mental health medicaid, Social security, tried to find something in the community , Even asked the provider that perscribes those kind of medicines for us, if there is ANY help anywhere.  and there is NOTHING.. We live in Arkansas if thats makes a differnce,.  I did find something that pays for medicine for kids whos parents cant afford it and have no insurance.  BUT it wont pay for MENTAL HEALTH meds, only things like diabetes supplies or something like those kind of illnesses.   


  So has anyone ever dealth with some months having no medicaid/insurance?    Its horrible that I feel i should quit my job. ( i only make 7.75 and hour its not like im raking it in) so she can have her full time med coverage.. but that would be a 900 hit to our monthly income, which we do need in order to keep our bills paid.  She doesnt get a full ssi check normally anyway btw its only 300 instead of the 750 ish it could be.   I even have wondered if I could ask them not give her ssi so she could go back on the state arkids first program and not lapse coverage.  But im afraid of doing that beacuse she will have this check when shes an adult and with her problems may not be able to work and need that money.  Any advice be helpful.

by on Aug. 16, 2014 at 1:36 PM
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Replies (1-8):
TommyAbby
by Bronze Member on Aug. 16, 2014 at 5:46 PM

You need to have the doctor's do a Prior Authorization for Medicaid to have the meds covered. It's easy to do and they only have to put down that "so and so combo of meds have been most effective" sign it and send it in. 

I am surprised neither your primary medical nor her medicaid cover NONE of her meds?? Is she also not covered by your primary insurance? 

saphiraka
by Member on Aug. 16, 2014 at 8:04 PM


Quoting TommyAbby:

You need to have the doctor's do a Prior Authorization for Medicaid to have the meds covered. It's easy to do and they only have to put down that "so and so combo of meds have been most effective" sign it and send it in. 

I am surprised neither your primary medical nor her medicaid cover NONE of her meds?? Is she also not covered by your primary insurance? 

Her medicaid is tied to her SSI check.. if she doesnt qualify for any check in a month.. her medicaid is cut off too... August husband and i each got an extra check.. we made 20 dollars too much by their estimate of how much we would make, so she got 0 for a check.. next month our income is back to normal, so she gets her check and medicaid back.    Did not know it would happen like this until it did... had no warning that if no check then no medicaid.    Medicaid is her primarty and only insurance.  Meidcaid will back pay for services like the testing we had done at childrens hospital ( which btw is where i found out we didnt have any coverage) but it will not back pay for  the medicine because yes  it does require prior authorization, and also at times blood work to get that authorization. 

TommyAbby
by Bronze Member on Aug. 16, 2014 at 8:16 PM

Have you talked to your service coordinator about a medicaid waiver? We filled it out for both kids and they don't count our income for the medicaid portion. We don't even file for SSI. 

Quoting saphiraka:


Quoting TommyAbby:

You need to have the doctor's do a Prior Authorization for Medicaid to have the meds covered. It's easy to do and they only have to put down that "so and so combo of meds have been most effective" sign it and send it in. 

I am surprised neither your primary medical nor her medicaid cover NONE of her meds?? Is she also not covered by your primary insurance? 

Her medicaid is tied to her SSI check.. if she doesnt qualify for any check in a month.. her medicaid is cut off too... August husband and i each got an extra check.. we made 20 dollars too much by their estimate of how much we would make, so she got 0 for a check.. next month our income is back to normal, so she gets her check and medicaid back.    Did not know it would happen like this until it did... had no warning that if no check then no medicaid.    Medicaid is her primarty and only insurance.  Meidcaid will back pay for services like the testing we had done at childrens hospital ( which btw is where i found out we didnt have any coverage) but it will not back pay for  the medicine because yes  it does require prior authorization, and also at times blood work to get that authorization. 


arkansasmama08
by Gold Member on Aug. 16, 2014 at 8:41 PM
Have you applied for Tefra? Or could they maybe put her on arkids B on the months you are over? Do you have any private insurance you can add her to as a secondary insurance to cover when SSI and Medicaid won't?
letstalk747
by Joy on Aug. 16, 2014 at 9:58 PM

  have her DR. try getting this med free for you for this one time- some drug companies do this if a DR requestes it  , call DR. MONDAY

graycalico
by Member on Aug. 17, 2014 at 6:05 AM
Aren't you able to get insurance through either job? Then you'd be covered when Medicaid lapsed. My son is covered through my hubs' job but Medicaid through ssi covers any copays or things not covered by the primary.
darbyakeep45
by Darby on Aug. 17, 2014 at 6:18 AM

Hugs and good luck mama!

Linagma03
by Gold Member on Aug. 18, 2014 at 2:25 AM
I wish I had some advice for you. All I can offer is prayers this can be figured out. Hugs Momma!
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