In this day and age, and crappy economy.. layoffs and unemployment, it is a comfort for us to know our children will ALWAYS (hopefully), have healthcare coverage for their Autism diagnosis. No, we cannot afford healthcare as a family.... when the "self-employed," are on and off unemployed, heathcare coverage tends to go. (Well, its either that or the truck payment.. take your pick). Because of their diagnosis the boys QUALIFY for Medical Assistance. They cannot be denied coverage for this diagnosis, based on a wonderful loophole called simply, "PH 95," which states the following;
If your child has a disability but your household income is too high to receive family coverage, your child may still be eligible for Medical Assistance. The program is called PH-95 or “loophole” and uses only your child’s income to determine eligibility. If your child is under 18, and has an income of less than $851.00 per month, and has a diagnosis of ASD, he or she may be eligible for Medical Assistance. If your child is eligible, they remain eligible until the end of the month of his/her 18th birthday. You must complete an annual reapplication, and keep the County Assistance Office notified of any address change. When your child turns 18, a new application must be filled out and begin the application process. You will have to provide a parental contribution letter at this point, stating that you do not provide financial support to your child. This does not mean that you do not provide your child with food and shelter; it only means that you do not give your child money to use at his discretion. When your child turns 21, again, a new application will need to be filled out. At this point, an applicant’s resources, as well as his income, will be counted toward eligibility. Also, the applicant will need to have his doctor fill out an Employability Assessment Form. This assessment acknowledges that your child has a disability that prevents him from working.
(Courtesy of Autism Handbook Transition, Devereux)
Now, having written this, every State may or may not have the loophole coverage. That is something you would have to visit at your State DPW website. I was unable to find if there was a loophole for ALL 50 states. Anyway, Medical Assistance is imperative if you are looking for behavior therapy, or wraparound services for your diagnosed child. They are covered 100%. The sad truth is that many state Governors, especially the ones who could give a rats ass if you have a child on the spectrum, are looking to CUT the loophole, in order, you guessed it, to SAVE money. Hey, I don't blame them. This country is in a really bad state, with enough blame to go around. I personally am willing for my taxes to go up, in order to keep this loophole in place, for ALL kids with disabilities, not just autism. Currently, although you must show your income, it DOES NOT COUNT TOWARD YOUR ELIGIBILITY, if the child is UNDER 21. The Pennsylvania Law Project, whom I have contacted many times for FREE assistance with my children getting coverage, explains the loophole and how to apply. Click HERE to access their website. Although I am showing you the loophole for PA, your state may have the exact same situation and criteria. If you need these services now, better not wait to apply. I fear all covered health care support for children with disabilities will be cut, or it will be more difficult to qualify. Although I would not wish another to have to walk in my shoes, I think if more politicians had children with disabilities, or had a close family member with a disability, say autism, we would not be so apt to see the sharp ax dangling so closely to our childrens heads.
Hello, my name is SPD Mom. I'm a 37 year old self-employed US.