Medicaid question.

[lenny]

My husband is retiring, which means our 19 year old son will be losing his current health insurance in January. We can purchase health insurance for him for about $600 a month, but with the deductible, it would cost about 13k a year and would be a strain on our finances.

So, I'm wondering about medicaid. How good is it? Our son has been on Remicade for 14 months and I don't want any interruptions, of course.

Is anyone on medicaid and receiving Remicade infusions?

Thanks!

 

[my little penguin]

You need to check if he even qualified for Medicaid.
Kiddie versions of medical assistance vary by state but are typically not based on income of the parents . Adults versions since he is 19 are a lot harder to qualify for since as you said you could purchase insurance for him.
To qualify I believe he has to be deemed disabled which is not automatic even with crohns and since you state he has been doing well on remicade odds are you or he has to purchase his own insurance .

 

[katertot]

Has your state expanded Medicaid? The Affordable Care Act (Obamacare) has made it a lot easier for adults to get Medicaid with Medicaid expansion - you no longer have to be disabled or pregnant to qualify. Since he is 19 his income, not yours, would be used to determine if he qualifies. However, this is only if your state expanded Medicaid. If he doesn't qualify for Medicaid he would probably still qualify for a subsidy for purchasing a plan on the marketplace. Again, that would be based on his income.

I work at my county's health department and we have people here who are specifically to answer these kind of questions. I would recommend trying that. If your health department doesn't have someone, a lot of hospitals and clinics now have CACs (Certified Application Counselors) and navigators who can help since this can be really confusing. They will sit with you and either get you signed up on Medicaid or help you purchase a plan. They will also advise you on how to contact different insurance companies and ask what medications are covered and what their prior authorization process is.

Good luck!

 

[lenny]

I don't see any reason that my son would not qualify for Medicaid, as I know a couple of healthy, unemployed, twenty-somethings who are on it and living with their middle class parents.

I'm mostly concerned about whether Medicaid is adequate for someone with such a serious illness. I don't want our son's care to be second rate, but I'm also concerned about how spending an extra $13,000 every year, could impact our family's financial security.

That's super helpful info, katertot. I didn't know who to ask or where to start!

 

[lenny]

We live in Colorado. Not sure how it compares to other states.

 

[my little penguin]

Is he able to work to offset the cost of insurance?

 

[Maya142]

I agree -- is he going to school or working? It really helps keep things as normal as possible.

My daughter has been very sick in the last year (uncontrolled AS but her Crohn's has been ok mostly) and she has tried her absolute best to do classes even while at home. She's taken a year off from college, but did try to take classes at a state university near home. She also volunteered at an elementary school.

If he's at school, many colleges offer insurance policies for kids that you can opt out of if you're keeping your child on your insurance. They can be pretty good - we looked into our daughter's school's and it did cover things like Remicade (though we decided to keep her on our policy).

 

[lenny]

He's not in school or working now, but he must be a full time student to qualify for my husband's insurance - even to purchase it. He wants to start college in the fall, but I'll be surprised if he can actually handle a full load. He wasn't able to attend high school regularly and had to drop out. Twice.

He has difficulty leaving the house, tires easily and his concentration isn't what it was, pre-diagnosis. It's hard to know exactly how he feels, as he rarely complains, but I know things aren't completely hunky dory for him.

He's recently gotten into gardening. Tore up half our back yard and planted an awesome vegetable garden lol. And we're happy he's interested in doing anything because for 2 years, he wasn't. But, it's not like a job or school because he can work in it when he wants to, but it is good exercise and it incentivises him to eat better.

 

[my little penguin]

Confused on the dropping out of high school
Most kids who are too sick for school either are homeschooled or have home bound instruction.

Is he doing pt so he will tired less easily ?
Sometimes kids who couldn't do things due to illness get weaker so once the disease is under control need pt to help build up stamina again.
Is he seeing a counseler ?
Not have interest in things can be a flag

 

[lenny]

He quit school because of Crohn's and he wasn't interested in doing anything because he didn't feel well. I don't consider his behavior a flag, just a normal reaction to feeling terrible. As soon as he began to feeling better, he started the garden and started talking about school. He voluntarily saw a therapist for more than a year. I don't have any doubt about him wanting to achieve things in life, if he feels well enough.

I'm hoping someone here is on Medicaid and Remicade, so they can tell me exactly how it is.

 

[Maya142]

He wants to start college in the fall, but I'll be surprised if he can actually handle a full load. He wasn't able to attend high school regularly and had to drop out. Twice.

Has he graduated from high school? I'd encourage him to try college. There is a lot more flexibility in college. My daughter feels worst in the morning because of her AS, so she makes sure her classes start after 10 am. She is also registered with the Office of Disabilities and receives several accommodations.

You'd be surprised at what kids can do. They are very resilient. My older daughter has gotten very good at time management -- she knows that there will be times when she's in too much pain to work, so she works around that. She can get extensions if she needs them and takes her tests separately in the Office of Disabilities (that might help his concentration issue).

She usually takes a full load of classes but there are semesters that she has taken less than a full load because of her health.

If he tires easily but is doing well on Remicade, I'd try PT to build up his stamina. Or exercise. He can start very small -- start with a 10 minute walk or swim and build up. And also make sure his iron/B12 are within range.

 

[lenny]

No, but he's bright and I know he would easily pass the GED. Yeah, we are encouraging him to try college, sorry that wasn't clear. We're just not going to push him to do anything. He gets a lot of exercise working in his garden..my husband went out there to help the other day and was sore the next day lol. I don't know what PT is. They recently told us that his bloodwork all looks good. He's finally taking his vitamins regularly and without being reminded. I know young people are resilient, but they are individuals and he's just not the type to be pushed at all. He knows he can work or start school whenever he likes, though. He's planning to start with a couple classes in the fall and then start a full load in January, if he is still feeling okay. His older sister, who is now getting her third degree also got her ged and not because she was sick, but because high school was mostly a social gathering for her lol.

 

[FrozenGirl]

College wise you have more flexibility than you think. If he can get a doc to certify his disability he can be counted as full time for insurance purposes with a reduced course load.

Otherwise you would be surprised what is counted as a full course load depending on your degree, for my school most programs have 9 credits as a full time course load which is generally 3 courses.

I would talk to his desired school's disability services to see what your options are.