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Helping Children With Special Healthcare Needs

Children’s Special Health Care Services is a state-wide program that serves children with chronic health problems and their families. The program can save families money and at the same time make sure that sick kids get what they need! The program's aim is to provide patients and caregivers with the knowledge and resources to receive the best quality care for their individual needs. In Washtenaw County we currently have about 940 children enrolled!

How Does it Work?

The program works as secondary insurance to help cover the cost of the child’s diagnosis. Which means the family’s primary insurance – such as employer insurance or Medicaid – pays first and then CSHCS picks-up the co-pays, deductible, and out-of-pocket costs related to the qualifying diagnosis.

Here is an example:

Max is enrolled is CSHCS because he has Type 1 Diabetes. One day, he loses consciousness during gym class. His school calls an ambulance. The paramedic finds that his blood sugar was too low. CSHCS will cover the cost of the ambulance ride, the ER visit, any medicine prescribed or tests run, and hospital admission if necessary. The out of pocket medical expense for Max's family is $0

But even during a good month where Max doesn't have to go to the hospital or to see a doctor, he still needs medication and supplies to help manage his Type 1 Diabetes. Look at the charts below to see how CSHCS helps Max's family cover those costs. 

Max has type 1 diabetes, he is covered by his mom's employeers insurance who pays 80% of medical costs after a $4000 deductible.png

It's important to note that CSHCS doesn't help cover all medical costs, only the costs related to the child's qualifying diagnosis. The program will not pay for visits to the primary care physician or any other unrelated medical costs. 

Who Can Enroll?

CSHCS covers children from birth to age 21 with one or more of the qualifying diagnoses. These diagnoses are any of 2,700 physical conditions like severe Asthma, Type 1 Diabetes, Cerebral Palsy, and different types of cancer. Click here for a list of these diagnoses.

A lot of times, if a child is diagnosed with one of the diseases on the list, a nurse or social worker will recommend the child for the program and a designated pediatrician decides whether or not the child is approved. But sometimes, the program receives calls from parents who believe their child is a good fit for the program and then our public health nurses will investigate those cases further. The program may even help pay for the costs of diagnostic tests if needed.

Is CSHCS Only For Low-Income Families?

A lot of families don't know that they can enroll in CSHCS even if they have private or employer insurance! CSHCS is based on the child’s diagnosis, not income. So anyone with a child who has one or more of the qualifying diagnoses can enroll. There is a sliding annual fee which is based on the family’s income, but in certain cases--for foster children or kids already on Medicaid--the fee can be waived. For almost all current enrollees, the annually fee is significantly less than what the cost of healthcare would be without CSHCS.

More Information

For more information you can visit the Children's Special Health Care Services website

If you live in Washtenaw County you can contact one of our RNs with questions:

  • Last names starting with A through J: Colleen Warner at 734-544-3080 or by email at warnerc@ewashtenaw.org.
  • Last names starting with K through Z: Muhammad Saifudin at 734-544-9750 or by email at saifudinm@ewashtenaw.org

If you are a service provider or community partner, please contact our program supervisor, Christina Katka at 734-544-2984 or katkac@ewashtenaw.org.

If you live outside of Washtenaw County you can find contacts here.

--K. Okarski

Editor's Note: This blog post was written by Kayla Okarski, a Washtenaw County Public Health and Washtenaw Health Plan summer intern who is a senior at Grand Valley State University. Thanks Kayla for all of your work!

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Health Insurance Scams - How to Spot Them and What to DO

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Now that everyone is required to have health insurance or pay a penalty, scammers and evil-doers are out there trying to take your money.  Below you will find trusted sources for information and tips on how to tell the real deal from the scammers.  

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If it sounds too good to be true, it probably is. 

If someone calls you and tells you about a health insurance plan that covers everything and will only cost you $35 dollars/month, be suspicious.  First ask them for the health insurance company name and their web address.  If they won't tell you either of those, it is a scam. If someone won't give you a call back number, they probably are not from a reputable company.  

If someone starts asking you lots of questions about your health (do you have asthma, cancer, high blood pressure), it is either a scam or a short-term plan. Year-round plans during open enrollment or special enrollment periods can only ask you your age, your address, and whether or not you are a smoker. 

Healthcare.gov is the Real Deal. 

The website to visit is

HTTP://WWW.HEALTHCARE.GOV/  

NOT healthcare.com.  

If you scroll to the bottom of the webpage at healthcare.COM printed in tiny letters is the following statement:  

HealthCare.com is a PRIVATELY OWNED website that is NOT owned or operated by any state or federal government agency.

Phone Call Scams

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The Marketplace (healthcare.gov) may call you if they were unable to answer your call and you left your phone number. They may also call to remind you that it is time to enroll, but the reminder calls are recordings.  If a person calls you and you are not sure who they are, ask for a callback number.  If the person is hesitant to provide a number, they are a scam. The Marketplace phone number is 1-800-318-2596 and you can call them 24 hours a day, 7 days a week.  

All Marketplace representatives have access to your account after you identify yourself. Marketplace representatives never ask you for financial information, such as bank names and account numbers. They will never ask you to pay for insurance over the phone.

What Does A Scammer Sound Like?

This a recording of a scammer who calls and leaves a voicemail.  This same voicemail was left for hundreds of people.   Do not call this person back, they are not from Healthcare.gov and can not sign you up for real health care.  

Protect Yourself

The Coalition Against Insurance Fraud has a list of fake health plans and health care scams with 10 warning signs. To protect yourself, they suggest:

  • Slow down: Avoid signing up if you feel pressured to buy
  • Ask to read the policy
  • Call the insurance company to verify the program offered is a real plan and not just a medical discount card.

Read more here.

What to do if you are believe you are the victim of a health insurance scam

If you believe you are the victim of a health insurance scam, contact the Federal Trade Commission (FTC).  Fill in this form online: http://www.ftccomplaintassistant.gov

You can report Medicaid fraud or abuse by calling 855-MI-FRAUD (643-7283) or by filing an online complaint

To contact your local Medicaid office or find out about your Medicaid benefits, contact your local DHHS office or call the Medicaid Helpline at 1-800-642-3195. 

 

resources about healthcare scams:

Protect yourself from Marketplace fraud  https://www.healthcare.gov/how-can-i-protect-myself-from-fraud-in-the-health-insurance-marketplace/

Read about recent scams or sign up for Scam Alerts from the FTC:  http://www.consumer.ftc.gov/scam-alerts

Stop Medicare Fraud http://www.stopmedicarefraud.gov/

 

-M. Buhalis

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What is WIC?

What is WIC?

WIC, as it is commonly called, is the Women, Infants and Children Supplemental Nutrition Program.  WIC provides nutrition support for moms, pregnant women, infants and children up to age 5 and is a great way to supplement your food budget!

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