I know there’s a few MA families who read this so I thought I would put this out there.
Children who are diagnosed as having autism are eligible for CommonHealth, the disability arm of MassHealth. This can help you with medical co-payments if you go to providers that accept MassHealth, hospital bills, medical visits… It can help with a lot.
There is a secondary program that you may apply to after a child is approved for MassHealth that assists families with paying for their child’s private primary medical insurance. It is called the Premium Assistance program and it can be a godsend. It is via this that J is able to remain with the OT and Speech people he loves so very much.
Here’s how to apply:
For MassHealth visit here, click “apply” on the right hand side of the screen and follow the instructions provided: http://www.mass.gov/eohhs/consumer/insurance/masshealth-coverage-types/masshealth-commonhealth.html
Once approved for MassHealth, which can take a few months, apply for Premium Assistance by calling 1‐800‐862‐4840 and staying on the line. State that you are calling to see if your family qualifies for the CommonHealth Premium Assistance Program and the agent will assist you from there. This process was, to me, so very much more easily handled than the initial MassHealth application. You can read more about the program through a brochure offered by the Federation for Children with Special Needs: http://fcsn.org/mfv/publications/mscpa.pdf
My experience with the application process for MassHealth involved receiving a lot of confusing paperwork initially. If your family is making over 300% of the poverty limit they will send you a rejection for everyone else in your family but the child for whom you are applying for disability coverage. You may even get multiple letters stating this. Don’t panic. Whenever you have questions or concerns, there’s a number on the letters to call and I found the agents to be efficient and helpful for the most part. Out of the many times I have called only once has someone been rude to me. Given that dealing with government agencies doesn’t always go well I consider that a great success rate!
When you are initially approved for MassHealth you may be required to pay a premium. This premium, for me, went away when Premium Assistance kicked in. Does it go that way for everyone? I’m not sure, but the premium I was told to pay would have still been worth it when you compare what I would have otherwise shelled out-of-pocket for hospital bills and medical co-pays that MassHealth picked up. If you wish to use CommonHealth for pharmacy benefits keep in mind they have to get all prescriptions pre-approved before a pharmacy can fill them under those benefits. It’s not something I’ve done yet as J is not medically involved enough to need it but I will come back and edit this post when or if we do experience the process.
I hope this helps someone out there. Early Intervention showed me this whole process and was amazing in leading me through it. Thank you, Virginia and Loretta!