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Pediatrics

What are the potential sources of financial support for Brian's care?

1. Children With Special Health Care Needs (CSHCN) Program
    

2. Commercial Insurance
    

3. Children's Health Insurance Program (CHIP)
    

4. Medicaid
    

5. Medicare
    

6. (Correct)  All of the above

All of the choices might apply in different cases.  The hospital social worker will have likely already assisted the family in obtaining services from one or more of the agencies.  A brief outline of each  service follows:

CSHCN (Children With Special Health Care Needs Program) provides reimbursement for very specific diagnoses, For example, if Brian had a club foot or cleft palate, the program might cover the cost of surgical assessment and correction.  Income is a qualifying factor here.

Commercial insurance is not always available, and sometimes the cost is prohibitive. Children born to families with insurance are automatically covered by their mother's policy for 30 days.  During this 30 day period the child should be enrolled in the families insurance to prevent any interruptions.  Commercial insurance coverage can vary, and some might require deductibles or co-pays of several thousand of dollars per year.  It is important that premium payments be kept current to avoid interruption, and if the parents must continue to work in order to keep insurance coverage then their capability as caregivers for the child becomes even more complex.

Children's Health Insurance Program (CHIP) is a low-cost insurance program for children who do not qualify for Medicaid. CHIP's monthly premiums are low, and co-payments are low to none. This program requires annual reassessment.

Medicaid is a Federally and State funded program to provide medical services to low-income patients.  Qualifications very depend on the child's age, and based on the family's financial resources.  Children born to mothers on Medicaid are automatically covered for 30 days, and then the child is eligible for another full year if the mother follows through on application procedures.  After 1 year, certification of eligibility must be done more frequently.  This can be very cumbersome.  Specific requirements change periodically, but may require documentation of the family income and assets (cars, home, etc.).  It also considers the value of family car and any savings. 

Medicare does not usually provide coverage to children unless they are blind or have renal failure.  In those cases coverage will be provided for services related to the visual impairment or to the dialysis.  A child might also be eligible for Medicare if they are receiving benefits from their parent's social security benefits.
 

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