Medicaid

[Osmosis Mom]

Curious about a few things and hope somebody might be able to enlighten me.

 

Dd was recommended orthodontic procedures that would apparently be covered by Medicaid. I was wondering, what happens when we start earning again and se doesn't qualify anymore? As we all know, then if we could by then afford dental insurance, it'll be minimum one year before any orthodontic services are covered. Would Medicaid cover the procedure begun?

 

Essentially I want to know in general with Medicaid, if you qualify for something and then your eligibility changes, what do you do then? Fx. in the case of pregnancy, if you are on Medicaid, everything is covered, then you are no longer eligible, but can't then get insurance because of "a pre-exisiting condition"? What then? Are you doomed to sail it on your own? Or would you assume that Medicaid would look at your income and say, hmmm, if you are above the monthly limit then still within the amount of time left in the pregnancy your income would still be below guidelines???

 

Hope my questioning is clearer than mud.

[chiguirre]

I understood your question, but have no idea of the answer. Could you check on your state's Medicaid website or call their helpline?

[forty-two]

With pg, in FL at least, if you are eligible and covered by Medicaid for at least one month, they will cover the entire pg, even if your income rises afterwards. Not sure about other services - you could try browsing your state's medicaid site or giving them a call (though ime you'd better set aside the better part of a morning to getting through.)

[Kim in Appalachia]

Every state has their system set up a little differently. You might have a hard time getting an answer to your "what if". They will tell you if you qualify for coverage now, but are not always good on what will happen in the future, but you can ask. Maybe you will find someone who knows.

 

I think in KY the pregnancy will still get covered, and maybe in TN too, but the policy has changed recently. Kids in KY are covered up to a fairly high income level. I'm unsure about income changes, when it affects it, or the time gap with it. Maybe at tax time? TN used to be the same. Every state is different.

[Mommyof4ks]

Pregnancy is not considered a pre-existing condition, so it is covered as soon as the new ins. begins.

 

I don't know about the orthodontic work. Is it going to be paid up front or over the course of the time they have the appliance? In other words it is a lump sum payment or a payment plan? The orthos around here prefer a lump sum, but they offer payment plans since most people cannot afford the lump sum. Call and ask the ortho how they are billing. If nothing else you could work out a payment plan once you begin working again.

[z2_mom]

depends on the state and the insurance....when i was pg with my last child...dh switched jobs therefore we had to get new insurance. The new insurance would not cover my pg because I was already pg! We had to pay for the cobra to cover us until I delivered. We could not drop dh etc from the cobra to make it cheaper because he was the worker! It was expensive but less than paying out of pocket. We did not qualify for any type of medicare etc at the time.

 

Lynda

[Kari C in SC]

I don't know for sure, but I do know that in SC your kids are approved for a year. If something changes during that time - you are not required to inform them. In other words, they get their year no matter what. At the end of their year, you have to inform them on any changes. So, if the care would happen within the year - it would still be covered.

[Osmosis Mom]

I don't know for sure, but I do know that in SC your kids are approved for a year. If something changes during that time - you are not required to inform them. In other words, they get their year no matter what. At the end of their year, you have to inform them on any changes. So, if the care would happen within the year - it would still be covered.

 

Actually, I did try bo browse their website and this is the info I found as well. Re. the pg. then I was also under the impression that if once eligible, then you'd be covered. Otherwise you'd think they'd be having a huge paper mess, no?

 

Thanks for trying to figure this out with me.

[Amy in NH]

Hi Nadia :seeya:

 

I think I may have an answer for you! My oldest son has Medicaid which pays for his orthodontia, so I called his orthodontist and asked them your question.

 

Background: Here in NH, Medicaid is called Healthy Kids Gold. If you make too much money to be eligible for Gold, you can buy into a state health insurance program for your children on a sliding fee scale depending on your income. So, if you can't get Gold, then Healthy Kids Silver is $25/month/kid, and Bronze is $50/month/kid, etc (those used to be the fees, but I'm not sure if they've changed).

 

My understanding is that there is no guarantee that a particular child will get orthodontic services even with Gold. The orthodontist has to do consultation to assess the problem (x-rays and impressions) and write up a treatment plan, which all gets submitted to the guy at the state office. He then yays or nays each case depending on level of the child's problem, the amount funding available at that time, and the number of requests they have then. So, even if you get rejected at one time, you can resubmit the request at another time and get approved. The other challenge is finding an orthodontist willing to take Medicaid, since it is basically charity to them because they get paid so little for taking Medicaid cases. BTW - Dr. Reynolds in Salem is excellent (898-9773). We used him for a long time (traveling 2 hours each way to see him), and really loved him.

 

So, now for your question. What our orthodontist's office told me is that they had a Gold patient who moved onto Silver, and they are still being paid for that patient's visits.

 

I had thought that if you start off in orthodontics on Silver it doesn't pay 100% (I think it's a regular 20/80 split through NE Delta, or it used to be), but it may have changed, or I could have been wrong.

 

I hope that helps!

[Mommyof4ks]

depends on the state and the insurance....when i was pg with my last child...dh switched jobs therefore we had to get new insurance. The new insurance would not cover my pg because I was already pg! We had to pay for the cobra to cover us until I delivered. We could not drop dh etc from the cobra to make it cheaper because he was the worker! It was expensive but less than paying out of pocket. We did not qualify for any type of medicare etc at the time.

 

Lynda

 

Wow, that's crazy. I thought it was a federal thing that pg was covered no matter what. At least my state adopted this policy or we would have been broke when our dd was born.

[Osmosis Mom]

Hi Nadia :seeya:

 

I think I may have an answer for you! My oldest son has Medicaid which pays for his orthodontia, so I called his orthodontist and asked them your question.

 

Background: Here in NH, Medicaid is called Healthy Kids Gold. If you make too much money to be eligible for Gold, you can buy into a state health insurance program for your children on a sliding fee scale depending on your income. So, if you can't get Gold, then Healthy Kids Silver is $25/month/kid, and Bronze is $50/month/kid, etc (those used to be the fees, but I'm not sure if they've changed).

 

My understanding is that there is no guarantee that a particular child will get orthodontic services even with Gold. The orthodontist has to do consultation to assess the problem (x-rays and impressions) and write up a treatment plan, which all gets submitted to the guy at the state office. He then yays or nays each case depending on level of the child's problem, the amount funding available at that time, and the number of requests they have then. So, even if you get rejected at one time, you can resubmit the request at another time and get approved. The other challenge is finding an orthodontist willing to take Medicaid, since it is basically charity to them because they get paid so little for taking Medicaid cases. BTW - Dr. Reynolds in Salem is excellent (898-9773). We used him for a long time (traveling 2 hours each way to see him), and really loved him.

 

So, now for your question. What our orthodontist's office told me is that they had a Gold patient who moved onto Silver, and they are still being paid for that patient's visits.

 

I had thought that if you start off in orthodontics on Silver it doesn't pay 100% (I think it's a regular 20/80 split through NE Delta, or it used to be), but it may have changed, or I could have been wrong.

 

I hope that helps!

 

Amy -Thanks for all this info. The four kids got Gold and one got recommended orthodintic treatment. However, the dental office is new to us and I am a bit leary. The girl is 8! I'll ask for the x-rays and reasons further at the next visit and probably go for a consult, but now I'll probably go to your recommended orthodontist. We were using an excellent guy here locally in Hampstead for older ds, but I don't know if I want the neighbourhood to know we are on Medicaid!!! Small town and all.