Fall
'98
Katie Beckett Program vs Dr. D
Great News! Vermont has expanded the Dr. Dynasaur program and now provides health coverage to all Vermont children, up to 300% of the federal poverty level. For example, a family of four can earn up to $49,350/year (gross income) and all the children up to age 18 yrs. in that household will qualify for full Medicaid coverage. Even if you have other health insurance your children can still qualify for Dr. Dynasaur coverage. Families will be asked to pay a $10/mo. per house-hold premium, for this health coverage. Enrollment in this newly expanded Dr. Dynasaur Program will be most helpful for families who have children with special health needs and high out of pocket health care and prescription costs.
Expansion of the Dr. Dynasaur Program just began October 19, 1998, so spread the word! For more details or application call: Health Access Member's Services at 1-800-250-8427.©
Many families who have Medicaid/ Dr. Dynasaur coverage for their children have been asked to enroll in Managed Care and to choose a Managed Care Plan. There are two plans to choose from: "Blue First" and "Access Plus." Other families who have Medicaid/Dr. Dynasaur coverage have been exempt and not asked to enroll in Managed Care. Some families are exempt because they have other health insurance, their child is on a Waiver, they live in a section of the state where there is not a choice of two plans, or their child is in the "High Tech Program" (a program for children who are technology dependent.) Two counties have begun mandatory enrollment for children with SSI- Washington and Orange counties. All other children with SSI are exempt for now. In most counties children in SRS custody are exempt but plans are underway to enroll them.
It is difficult for many families to understand the differences between getting health care from managed care plans and "fee for service"- the more traditional way families get Medicaid funded health care. There are many differences but the important thing to remember is: ALL CHILDREN ON MEDICAID ARE ENTITLED TO THE SAME BENEFITS, regardless if they are enrolled in managed care or in the fee for service system. The chart on the following pages might be helpful to parents and providers who want to better understand which services are covered for children with Medicaid and how to obtain those services when enrolled in Managed Care. Some of the most common questions Parent to Parent receives are: "How do I decide which plan to choose?" "The Managed care organization said we have a cap or limit on the amount of mental health or occupational therapy or physical therapy services my child can receive. What do I do?" "I don't understand why a primary care physician has to refer my child to another provider for tests, equipment, or services. I used to be able to just make an appointment and go!" "What do I do if my child is denied a service, test, equipment etc. that my child's doctor or specialist said my child needs?" "I'm confused about how my child gets mental health services now, with managed care." "It's harder to get a second opinion than it used to be."
Parent
to Parent would like to answer the questions YOU may have about Medicaid
coverage and Managed Care. We're here to assist you in understanding how
to access health care for your child in the complex and ever changing world.
We'd also like to hear about any difficulties you may have in getting the
health needs of your children met. Please call Maureen Mitchell at 1-800-559-5256
Mon.-Fri. 9-4pm. or email: mem@together.net©
Everything you wanted to know about Home and Community Based Services (HCBS) WAIVERS, but were afraid to ask!
What is a Waiver? A waiver is a way a state can pay for services they wish to provide to a specific population of people, using Medicaid dollars. States can request the federal government to "waive restrictions" on how Medicaid money is spent, thereby allowing states flexibility in how they spend Medicaid dollars.
There are four different types of HCBS Waivers:
The Developmental Services Waiver (DS Waiver) is for individuals of all ages with developmental delay/cognitive impairments and Autism. Services could include service coordination, support services, day activities, family education, respite, basic life skills, community mobility and self-sufficiency, community integration, recreational activities, job development, etc. Call the State Department of Developmental and Mental Health Services (DDMHS) at 802-241-2604 for more information and the number of your local community Mental Health Center.
The Mental Health Waiver (MH Waiver) is for individuals of all ages with mental illness. Services could include psychotherapy, group therapy, emergency care, service coordination, support services, day activity, family education and training services, respite, intensive day programming, basic life skills, community mobility and self-sufficiency, etc. Call the State Department of Developmental and Mental Health Services (DDMHS) at 802-241-2604 for more information and the number of your local community Mental Health Center.
The Traumatic Brain Injury Waiver (TBI Waiver) is for individuals with recent moderate to severe traumatic brain injury, age 16 yrs. or older, at risk for being in and out of rehabilitation centers. Services could include: rehabilitation services, transitional living, case management services, assistive technology, respite, etc. Contact the TBI Program Coordinator at the Dept. of Aging and Disabilities, 802-241-3186, for more information.
Department of Aging and Disabilities Home and Community Based Medicaid Waiveris for individuals who are elderly or disabled and at risk of out of home placement without waiver services. Contact Bard Hill at the Dept. of Aging and Disabilities, 802-241-2335, for more information.
The Vermont Enhanced Residential Care Waiver is for elderly individuals at risk of placement in a nursing home, also administered by the Department of Aging 802-241-2400. ©
KATIE BECKETT PROGRAM vs DR. DYNASAUR PROGRAM
With the expansion of the Dr. Dynasaur program some families will have children in the Dr. Dynasaur program or The Katie Beckett program. It is therefore important to understand the differences between these two programs.
Katie Beckett Program:
PKU BILL PASSES! Earlier this year Governor Howard Dean signed into Law the PKU Bill! This law requires health insurance companies who operate in the State of Vermont to pay for the medically necessary food and formula needed by children and adults with PKU and other related metabolic disorders. © (Link to previous Vermont Voices to hear about this and more info.)
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