Finding Help for the Uninsured or Underinsured

Many families have health insurance coverage but are still scrambling to cover healthcare bills. Monthly premiums for most families are high to begin with. Add in rising deductibles, copayments for covered services and the rising list of limits, or caps, on services most companies will actually cover and the cost is astronomical. What good is having health care coverage if the policy won't cover serious illnesses?

What can I do if my family, or a member of my family, doesn't have healthcare coverage?

Apply For Medicaid and Supplemental Security Income (SSI)

There are two programs every parent needs to apply for FIRST, no matter if they believe they are eligible for benefits or not. These programs provide coverage for families, or individuals, even if you work. These programs do have income and asset limits but as I wrote in SNRP's May 2008 Newsletter, these programs provide eligible applicants, when enrolled, needed funds and services. A denial of eligibility from these same programs may also help families receive services from other programs available within the local community. Often privately funded programs will require applicants to apply for Supplemental Security Income (SSI) and a Medicaid program then show proof of ineligibility (a letter of denial) from both programs before proceeding with their own application process.

Parents should apply for Medicaid and SSI even if they are not sure they qualify. Income rules are often complicated so it is best to apply and let a qualified caseworker in your state review your situation. Don't second guess the program. Even if your child is not eligible for traditional Medicaid he or she may be eligible for a Medicaid Waiver program. These programs vary by state, change frequently and are not always well advertised. It is also important for families to reapply for these programs whenever family financial, or medical, circumstances change. You won't know if you're eligible until you apply.

State Programs for Medical Assistance

If you have catastrophic medical bills that you are unable to meet there are state programs in every state that may be able to assist you. However, they are not going to come after you, you are going to have to go find them.

These programs provide health insurance coverage to some people who cannot afford to buy it on their own. These programs generally have income and asset limits and will vary by state and by agency providing the coverage. Many states have specific insurance programs for Children with Special Health Care Needs. Some have open enrolment year-round. Others offer open enrolment only at certain times of the year. Some programs have enrollment limits and others will enroll children even if their parents don't qualify as income limits are generally higher for children.

The first place to ask is your State Health Department. We have included links for Health Department Offices in most states. Click on your state in the "Resource Links" section. In most cases, you must contact the office in person to initiate a request for an application. If you are using the web, look for specific links to agencies that deal with children with severe disabilities and chronic health issues. You MUST contact your local office to learn what the coverage polices are for you state.

State High-Risk Pool

What is a High-Risk Pool? High-Risk pools are state-run programs that sell health insurance to a small group of people who have been turned away by insurance companies for several reasons. Generally these are companies that offer very limited or highly expensive policies or preclude pre-existing health conditions.

Currently 30 states have established High-Risk Pool policies available to "uninsurable" residents in that state. High-risk pools policies generally offer coverage benefits similar to those available through private companies. Even so, in some states, high-risk pool benefits are limited and often will impose a waiting period of 6-12 months on coverage of pre-existing conditions. Some high-risk pools will waive the pre-existing condition exclusion period if you have prior coverage although this will vary by state and by policy purchased.

Be aware that some states may impose enrollment caps or have waiting lists due to availability of state funding.

Private/Nonprofit Programs

Don't be afraid to ask for help. Many medical facilities and agencies will work with parents. Many nonprofit hospitals are required to provide financial assistance because of their mission and to maintain tax exempt status. Many Children's Hospitals, especially, have charitable programs but you'll need to ask if financial assistance programs are available. Some programs may be available long term and others may be "one time only". This is decided on a case-by-case basis. Be sure to contact the billing office and ask to speak to a financial counselor or a patient advocate, if they have one. Be sure to request an application for financial assistance and apply.

It is best to contact the hospital billing office about possible assistance programs BEFORE making a visit or an appointment, if at all possible. If you cannot make prior arrangements be sure to contact the billing office before you leave! It is important you make an effort to pay any bills you may acquire.

(Attention families in Idaho, Utah and Wyoming- If you have received treatment through an Intermountain Health Care (IHC) hospital or clinic you may contact the local billing office and request information and assistance forms. At Primary Children's Medical Center the program is called "Primary Assistance" (known locally as "Pennies by the Inch"). Primary assistance programs are available at all IHC Hospitals and clinics in the Intermountain West. Some programs may be available long term and others may be one time only. This is decided on a case-by-case basis. Be sure to ask for an application and apply.)

Shriner's Hospitals for Children are also excellent resources for those children needing orthopedic care and equipment relating to those conditions. To find the Shriner's Hospital in your Region click http://www.shrinershq.org

Low Cost Community Health Clinics

Another option for parents with children with chronic or special health care needs. These clinics offer health services generally on a sliding-scale fee basis but also accept some insurance programs as well. You'll need to check with your local Health Department for clinics available in your area.