My name is Melinda Q.  I have a 7 year old son, Trey, who has cerebral palsy.  Trey has been eligible for Medicaid through the deeming waiver for about 4 years.  He has been denied once, but was reinstated in the appeals process.

 

Trey is in private therapy 5 hours a week.  We are fortunate that our primary insurance pays for most of Trey’s medical therapies and equipment.  Medicaid is strictly a supplement for us.  In the past is has allowed us greater flexibility in choosing our own doctors and therapists instead of always having to use providers in the network of our primary insurance. The Primary insurance pays their portion, and because this portion is normally higher than the Medicaid rate, and because the providers take Medicaid, this has allowed us to avoid co-pays/cost shares for most of these services.  This is very helpful financially, as there are other expenses associated with having a special needs child that are not medical in nature.  For example, Trey loves to ride a bicycle.  However, I can’t just run out to Wal-mart and purchase a $50 bike for him.  He needs a special adaptive bike which costs about $3,000-not covered by any insurance.  Our Medicaid eligibility has allowed us to save on medical expenses like co-pays and cost shares, even though Medicaid rarely actually issues a check on our behalf. This allows us to provide other opportunities to try to give him as normal a childhood as possible.

 

The main negative impact we have felt from the changes to health care for special needs kids in Georgia is in the effect these changes have had on our providers.  Our providers are spending hours on paper work for pre-approvals for therapies for kids who have already been deemed eligible for Medicaid and the necessary therapies through letters of medical necessity already submitted in the application and renewal processes.  Often these pre-approvals are being denied, resulting in great frustration for these providers.  Consequently, they are electing to no longer be Medicaid providers.  So far this has happened with our speech therapist, and I am sure this is only the beginning.  Now we will have to make up the difference between the rate our primary insurance pays, and her billing rate, potentially costing us hundreds of dollars a month.  Before, when she was a Medicaid provider, we saved on the co-pays because of our eligibility, yet Medicaid paid nothing.  This affects our overall quality of life due to other non-medical expenses like the bicycle mentioned above, which we will no longer be able to afford.

 

Melinda Q.

Alpharetta, GA