March 22, 2011

Medi-Cal FAIL

I am so frustrated.

I am once again having issues with A's Medi-Cal. She has had Medi-Cal since she was about 7 months old; we applied for it when she was 4 months old and had just gotten her tracheostomy. We don't qualify for Medi-Cal in the standard way. Most people who are on Medi-Cal are low income with no other insurance. We are blessed that J has a good paying job with great health benefits. However, A qualified for Medi-Cal based on her medical needs; that is, she was institutionally deemed, and qualified for a waiver via in-home support services. Basically, what this means is that our family income can be $1,000,000 or $1000 a doesn't matter. What matters is that her medical issues qualify her.

Medi-Cal has been a blessing to us. Yes, we have great private health insurance through J's work, but we have high co-pays (most visits have a co-pay of $30-$40). Now, for my son, D, that is nothing. He goes to the doctor about twice a year: once for his yearly well-child visit, and sometimes once more if he is sick. We can easily afford those few co-pays. But with A, it's a much different story. At the height of her getting all her medically-based therapies (as recently as January before she was discharged) she had 3 therapies a week. That would have been $120 A WEEK just for therapy! Plus, she has multiple doctor visits a year with a gazillion specialists. And that doesn't even take into account all the equipment we used to have to get for her (monthly supplies for her g-tube and tracheostomy). Of course, she no longer has her feeding or breathing tubes, and her doctors visits and therapy sessions are much less, but we still have them. Medi-Cal pays the co-pays on all of these visits. It has saved us thousands and thousands of dollars, which we really don't have.

Getting her on the Medi-Cal waiver was easy; keeping her on it is the hard part. Why? Because the state of California has failed for the last FOUR YEARS IN A ROW to send me the renewal packet. At first I chalked it up to a glitch in the system; but now, four years later I am convinced it's their way to get rid of families. I have to be pro-active and call months before I *think* we are due for renewal and ask for the packet. And inevitably, when I call, I get someone on the phone who doesn't know what the waiver program is (it IS pretty rare, but still!). It's very frustrating and time-consuming.

This year I didn't call pro-actively. Why? I don't know...I should have. I didn't want to deal with being on hold forever and having to talk to a million people before I found someone who knew what I was talking about. I know, I know, I should have known better. But I decided a few months ago not to call and to see what happens. So....this weekend I got a letter in the mail from CCS (California Children's Services), which is a government program that we have for audiology only (they pay for any hearing aid repairs). The letter stated that there "may be a change in our CCS services because there is a change in our Medi-Cal services". Gah! Yesterday I called Medi-Cal and found out that, sure enough, A's Med-Cal expired at the end of January.

Of course, not only had I not received a renewal packet, but I never got a letter, email, phone call or ANYTHING saying that she had been discontinued! The communication is just terrible. However, when I called Medi-Cal yesterday I hit the jackpot: I got someone on the phone, on the first try, who was a seasoned worker and knew what I was talking about. She said that because it was "county error" (uh-huh) she extended A's Medi-Cal through May, which gives me time to get the renewal packet (which I picked up yesterday), complete it, turn in and have the county process it. Hopefully all will go well, and her Medi-Cal will again be okay. If not, the worst case scenario is that she no longer has it, and while that will be costly to us, we'll make it work (it wouldn't be NEAR as costly as it would have been in years past).

I know it's a minor thing to worry about it the scheme of things, but money really IS tight and this helps so much. Hopefully all will go well and she'll be renewed again past May. And if she is, you can bet I'll be pro-actively calling again this December. Lesson learned.


  1. Being a state employee working with the Waiver programs for years, this part is the most frustrating to me. I do the assessment to determine functional eligibility and we have a financial dept who handles the dreaded redetermination packets. I can't tell you how often I have to track down, resend, and send these packets out and when I want answers from this dept it's even hard for me, an insider, to get answers.
    So, even from the inside of the system, I feel your pain.

    ps. I don't think I ever told you I worked with MR/DD clients for a long time; loved them all! I work primarily w/ the elderly now :)

  2. Hey you shouldn't have to worry about money on top of everythings else going on. I hope all goes well and she gets renewed!

  3. I sure understand why you didn't call when you knew you should have. It is exhausting to keep up with all of the phone calls, paperwork, therapies, doctor appts, and not to mention just being her mom! We shouldn't have to fight for everything our children need and deserve.
    Good luck! I hope it all works out!

  4. How frustrating! I'm glad A has such a fierce warrior for a momma though there's no length you won't go to for that baby girl.


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