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The Unforseen Costs: Assistance Programs

May 20, 2011

Part 3 in a series on the potentially unforeseen costs of special needs adoption.

I have spoken with enough families about secondary insurance –one of the most widely used forms of disability assistance –to know that it is confusing. Most families are considering public funds allotted to states by the Federal government. But no two states administer the program the same way. So take the specifics I will share as examples of how it works for our family. Then be sure to look into how it works in your state.

At the bottom of this post, I will provide links you can use to research options where you live.

Primary Insurance
Most families who are in an income bracket to be able to afford to adopt Internationally, or through private domestic adoption in the U.S., have health insurance through an employer or via a private policy. That is the family’s primary insurance health insurance policy. Policies are variable. For example, a family may enter an adoption with a policy that places a co-pay on office visits. That co-pay may not be burdensome for a family with typical kids. But between therapy and doctor visits, Joy has a minimum of 17 office visits a month.

With my husband working for a very small employer,  we carry private primary health insurance. We had the freedom to shop for a policy that has no co-pays (after we satisfy a yearly deductible); no limits on office visits; covers durable medical equipment (wheelchairs, braces etc.) –things that all work in our favor. This is a great option for us right now, but would change if my husband changes employers.

Secondary Insurance
We also carry secondary insurance on Joy. In exchange for a monthly payment, the state provides a secondary policy that pays for Joy’s eligible expenses not covered by our primary insurance. In our case, the secondary insurance reimburses us for Joy’s portion of our medical and dental insurance premiums; pays for the portion of our yearly deductible she expends; pays her PCAs’ wages; and pays for the administrative fees charged by our employment agency.

If that sounds too good to be true, it is. The amount of Joy’s expenses not covered by our primary insurance varies, as does the premium for the policy, from year to year. At the time we enrolled, our primary insurance did not cover durable medical goods and our premium was 35% lower. Our expenses have dropped due to an unexpected improvement in our primary insurance coverage. The premium has gone up not because our income has, but because of state and Federal budget cuts.

So at the moment we are paying in as much as we get out, which hardly makes the administrative burden worth it. We could budget to pay for her extra expenses out of pocket instead of via our monthly premium. But before we back out, we are investigating the burden of potentially re-enrolling if our primary insurance situation changes.

Before you walk away shaking your head thinking you could not possibly afford to adopt a child with special needs, know that while we are far from being in the highest tax bracket, our income places us in the highest percentage of the sliding scale our state uses to calculate our monthly premium. We can also afford to have me stay home with our children and pursue a career (history) that makes almost no money. Your family circumstances may be different.

The major variables that determine whether secondary insurance is cost-effective are:

  • your child’s diagnosis (eligibility)
  • your child’s level of dependence compared to children their age (level of benefits)
  • your primary insurance policy (how high your expenses may be)
  • your family income vs. the number of people in your family (how much you pay)
  • the economy (how much funding is available)
  • the number of children in your family with qualifying medical diagnoses (how cost effective it is for you)
    • In most public programs the monthly premium covers all people in the family with a  qualifying diagnosis. So if we enrolled another qualifying child, it would cost us no more than we already pay in for Joy.

Which assistance programs are you eligible for?
For more information on assistance programs like secondary insurance which may be available to you, go to disability.gov and use search box under Information by State the left menu. The click through the suggested menus until you find a site like this, which is Minnesota’s clearinghouse for disability benefits information.

If you find the range of programs and the eligibility requirements bewildering, use this Benefits.gov Search. Complete the questionnaire and see what the website suggests.

But for the best information, especially if you are considering a child who already has a diagnosis or known risk factors, use your county government web page to locate a county social worker who works with children who have developmental disabilities. (State and Federal programs are administered via counties. Counties also have programs they administer.) Beg a phone appointment, tell the social worker about the child, then play 20 Questions about the services available to similar kids in your county. If you don’t already know a family in your area who is raising a child with similar needs, also ask the SW to refer you to parents who have volunteered to be a resource. Real people beat government websites for the real story every single time.

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