Examples of CYSHCN Program Services (each state’s program will be different)

• Assistive technology
• Case management
• Early intervention and screening for health risks
• Family support services
• Immunization
• Nutrition counseling
• Special education support services
• Translation
• Transportation

To get more information about your state’s CYSHCN program:
Call your state’s Department of Public Health & Human Services, or your county’s Office of Public Assistance or Social Services. Each state or county may assign a unique name to its CYSHCN program.

Also contact the Family-to-Family Health Information Center in your state:

Family Voices, Inc
Call 1-888.835-5669
Visit www.FamilyVoices.org and click “State FV” to find the family center in your state
Write
P.O. Box 37188
Albuquerque, NM 87176

CHIP’s Minimum Level of Medical Services Offered

Each state’s program differs, but all must offer at least these services:

• Routine check-ups
• Immunizations
• Dental and vision care
• Inpatient and outpatient hospital care
• Laboratory and X-ray services

To get more information about your state’s CHIP:
Call your state’s Department of Public Health & Human Services or your county’s Office of Public Assistance or Social Services.
Visit http://finder.healthcare.gov to locate your local office.
Speak with the nurse at your child’s school; in some states, you can apply for CHIP benefits through the public school system.

Who Qualifies for Medicaid

To become eligible for Medicaid, individuals must meet two conditions based on:

• Income, usually tied to the Federal Poverty Level (FPL), which in 2010 was $22,050 per year for a family of four (see Kaiser Commission on Medicaid and the Uninsured. Medicaid: A Primer 2010. The Henry J. Kaiser Family Foundation. June 2010. Page 7).
• Category type, such as pregnant women, children, and individuals with disabilities.

Children under six years of age are eligible for Medicaid if their families’ income, as of 2010, is under $29,326.50 (133 percent of FPL). Children from six through 18 years of age qualify if their families’ income is below the FPL. Again, that level in 2010 is $22,050 per year for a family of four.

The 2010 Health Care Reform Act will broaden Medicaid eligibility to anyone under age 65 whose income is under $29,326.50 (133 percent of FPL) at some time during the first five years of the Act. This broadened eligibility will remove the “category type” condition explained above, thereby basing Medicaid eligibility solely on income.

Each state may apply its own Medicaid eligibility requirements that are less strict than the federal standards. For example, a state may allow families with higher incomes to participate in its Medicaid program by paying a monthly premium or co-payment (see Kaiser Commission on Medicaid and the Uninsured. Medicaid: A Primer 2010. The Henry J. Kaiser Family Foundation. June 2010. Page 17). Speak with your local Medicaid office for information on your state’s Medicaid programs.

Medicaid and Supplemental Security Income (SSI)

Many children enter the Medicaid system through the Supplemental Security Income Program. Each state sets its own eligibility requirements based on income level and types of assets owned. In most states, children receiving SSI automatically qualify for Medicaid, yet enrollment into Medicaid is not always automatic. Check with your county’s Office of Public Assistance or Social Services for Medicaid enrollment information.

What Medicaid Covers

Medicaid covers a diverse range of conditions that many health care plans, such as an employer-paid plan, have typically not covered. In addition to providing traditional medical care, such as doctor’s visits, Medicaid also covers:

• Inpatient and outpatient hospital services
• Dental and vision care; depends on the state—fewer states are offering this type of coverage
• Laboratory and x-ray services
• Early screening
• Transportation and translation services
• Long-term care; includes home- and community-based services (HCBS) and acute (emergency room) care

Each state has the option of providing additional health care services, such as personal care, prescription drugs, and rehabilitation services.

Medicaid Options

Through the provisions of the Deficit Reduction Act (DRA) of 2005, states acquired greater flexibility in qualifying individuals for Medicaid and offering expanded levels of medical services. For example, states may offer optional health care assistance programs that have less restrictive income requirements. The difference in these optional programs is that, unlike Medicaid, individuals may have to go on a waiting list to receive health care service, and the services themselves may be limited.

Buy-In to Medicaid

Through the Family Opportunity Act (FOA) Medicaid Program, families with incomes, as of 2010, up to $66,150 for a family of four (300 percent of Federal Poverty Level) are eligible to purchase Medicaid coverage for their children with disabilities through monthly Medicaid premiums. A child may be covered by private medical insurance and still be covered by the FOA Medicaid Program.

Medicaid Waivers

States can request waivers from federal Medicaid regulations. This means states can expand Medicaid coverage by covering more people and expanding the level of services offered. Presently, waivers allow states to cover “optional” groups that include (see Kaiser Commission on Medicaid and the Uninsured. Medicaid: A Primer 2010. The Henry J. Kaiser Family Foundation. June 2010. Page 9):

• Working individuals with disabilities earning up to, as of 2010, $$55,125 (250 percent of Federal Poverty Level).
• Individuals who receive home- and community-based (HCBS) services.
• Individuals who live in nursing homes with incomes up to 300 percent of SSI requirements (each state sets its own SSI income limits).
• The “medically needy” who don’t meet federal low-income requirements but spend a high proportion of their income on medical expenses.

Home- and Community-Based Services (HCBS)

Since the mid-twentieth century, people with severe disabilities obtained long-term care in nursing home facilities, sometimes located far from the individual’s home and supportive network of professionals, friends, and family. In 1999, the Olmstead decision, a Supreme Court ruling, determined that the practice of only providing health care and other supports to   individuals with disabilities in nursing home facilities (as opposed to in their own home, apartment or other community setting) was in violation of the Americans with Disabilities Act (ADA). Today, states are increasingly providing supports for HCBS services, a trend that helps individuals with disabilities live independently and greatly improve the quality of their lives.

2010 Health Care Reform update: Some states are offering the HCBS Medicaid state plan option called Community First Choice Option. Through this option, states would not have to limit eligibility or the amount of services provided. This option is being offered to people with disabilities who have incomes, as of 2010, up to $33,075 (150 percent of the Federal Poverty Level; see The Henry J. Kaiser Family Foundation. “Focus on Healthcare Reform.” June 2010).

Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) State Plan Option

When a child receives extended care in an institutional setting, family income is disregarded as a qualification for Medicaid. The TEFRA State Plan Option makes it possible to do the same for a family whose child requires care at the level provided in an institution, but who choose to care for their child at home. (see Catalyst Center. “TEFRA & TEFRA Look-alike Programs.” Retrieved from http://www.hdwg.org/catalyst/cover-more-kids/tefra on November 12, 2010).

Not all states offer the TEFRA state plan option. Contact your state’s Department of Public Health & Human Services or your county’s Office of Public Assistance or Social Services to find out if your state offers this Medicaid state plan option.

Money Follows the Person

This is an incentive program for states to move people with disabilities from nursing home facilities into home- and community-based services.

2010 Health Care Reform update: States received more funding to facilitate transferring individuals with disabilities from nursing home facilities to home- and community-based services. The eligibility requirement that a person be in a nursing home for six months has been reduced to 90 days.

Supplemental Security Income (SSI)

This federal program provides people with disabilities who have little or no income with cash assistance for basic needs such as food and shelter. Eligibility for SSI can begin at birth and last until 18 years of age (or, if a student, until the age of 22). Eligibility is also based on:

• Financial need
• The Social Security Administration’s definition of “disability for children”

To continue coverage beyond 18 years of age, your child must meet the Social Security Administration’s requirements for need and definition of “disability for adults.” Individuals who receive SSI may not have more than $2,000 in assets such as cash, investments, vehicles, and personal property. Some states have stricter asset requirements, meaning individuals may own less than $2,000 in assets.

Anyone who qualifies for SSI automatically qualifies for Medicaid; however, Medicaid enrollment is not automatic in all states. Check with your county’s Office of Public Assistance or Social Services for information on SSI enrollment.

Social Security Disability Insurance (SSDI)

This federal program provides income to people with disabilities who are unable to work. Your child may be eligible if your child:

• Is over the age of 18 and:
  • You, the parents, have paid into the Social Security System though payroll taxes
  • Your child meets the Social Security Administration’s “definition of disability”
  • Your child’s disability occurred before the age of 22
• Paid into the Social Security System through payroll taxes

The SSDI benefit amount is based on the length of the work period, either yours or your child’s, and the total amount of income earned.

Access to Your Medical Records

At any time you can request to see your medical records, which must be sent to you within 30 days of the date you request them. You might have to pay for copying and postage costs.

Notice of Privacy Practices

You must be informed on how your health and medical information will be used. You’ll typically receive a notice of this information the first time you visit or use one of the health care providers listed above, and be requested to read and sign the notice.

Limits on How Your Health and Medical Information is Used

The health care providers listed above need certain information to provide you with the best possible care. However, your information may not be used in ways unrelated to your health care (like the example given in the introduction to this section). This means that if you share your personal information with a health care provider, it must first get your permission before sharing that information with marketers and advertisers.

Stronger State Laws

States may apply greater protective measures than what the federal HIPAA law requires.

Requests for Confidentiality

You may request that individuals of the health care providers listed above keep confidential any communications you have with them: verbal, electronic, written, or typed. Those individuals must take reasonable steps to meet your request for confidentiality.

Complaints

You may file a formal complaint if you think your or your child’s health and medical information is being used in ways unrelated to health care.

How to File a Complaint

You may file a complaint through the U.S. Department of Health and Human Services or your regional Office of Civil Rights (OCR).

The U.S. Department of Health and Human Services
Call 1-877-696-6775 (ask for your regional Office of Civil Rights (OCR) office)
Visit www.hhs.gov and click “Regulations”
Write
200 Independence Avenue, S.W.
Washington, D.C. 20201