Sometimes people with disabilities have complex health needs and need more specialized services. It is important for individuals and families to understand what resources are available to support their needs and how to maximize the coverage available.
It is important to understand your family’s health insurance. Every plan is different even if it is offered by the same company. Many people get their health insurance from their employer. However, insurance is also available from the state’s marketplace (see below) and can even be purchased from companies individually. Regardless of the type of insurance you have, it’s important to understand your health insurance policy in order to maximize your coverage and ultimately help to save you and your family money. Below are some resources to assist you:
Sometimes prescriptions can be very expensive, even if you have insurance. If you have insurance, it’s important for you to understand how prescription benefits are covered under your plan. For example, it is often less expensive if you order medications in bulk by mail order or if you use the insurance company’s preferred (or formulary) medications. Often generic medications can also be substituted for brand name medications. It is important to work with your doctor or pharmacist to make certain that a generic can replace a name brand medication without concerns. There are programs that can assist with the costs of medications. Each program has its own eligibility criteria. For more information, check out:
- Needy Meds
- Partnership for prescription assistance
- The Medicine Program
- RX assistance program
This is a shared program between the federal government and the state. The federal government sets specific mandatory requirements and the state can add optional benefits as well. Medicaid provides insurance coverage to individuals with low incomes and for those who are blind or disabled. However, each state sets its own specific income and eligibility criteria. To apply.
Benefits of EPSDT
Children who have Medicaid also have added benefits of the Early Periodic Screening Diagnostic and Treatment” (EPSDT) that requires the state to cover services that will help the child acquire skills or help to ameliorate the condition.
In January 2017, Nebraska moved all Medicaid recipients to managed care and contracted with three insurance companies to provide these services. Each insurance plan offers similar benefits but also provides unique services.
Nebraska A & D Waiver
If an individual has a “nursing facility level of care” needs and wants to live at home rather than a nursing facility, this waiver will provide Medicaid funding for an array of supports and services. For example, this waiver allows for a family to obtain nursing services, childcare and respite services, and it provides funds for specialized formulas. It can also help cover the cost of home/vehicle modifications. This program also provides service coordination. For more information:
Program provides home health nursing and other medical services to children who otherwise would be continuously hospitalized because of their high level of health care needs. (Examples: A ventilator, a tracheostomy, need for complex nursing services to be provided at home). Youth in the Katie Beckett program are eligible for Medicaid. Apply by calling 402-471-9621 to have your child assessed.
Program that provides specialized medical services for families with children with disabilities or ongoing health care needs. Services may include services coordination/case management, specialty medical team evaluations, access to specialty physicians and payment of treatment services.
Program provides up to $300 a month of funding for services to individuals with disabilities to help them continue to live independently or help families stay together.
Program provides $125 per month to eligible families to pay someone to take care of an individual of any age with special needs in order to give the primary family caregiver a temporary break. The program can be banked and used to send a child to camp.
Respite allows the family caregiver an opportunity to have a break. The Nebraska Lifespan Respite Network offers six state coordinators to help families get connected to respite providers and other resources.
A statewide helpline with trained counselors who can assist with children’s behavioral health needs. Call 888-866-8660.
Provides peer-to-peer navigational support to families who have children with behavioral health needs.
A developmental pediatrician is a physician who has specialized training in child development. There is a national shortage of these types of providers. Many families seek these specialized providers to help diagnose the child’s disability and obtain care. In Nebraska, there are currently four developmental pediatricians. They include:
- Drs. Howard Needelman and Cynthia Ellis, Munroe-Meyer Institute/Omaha Developmental Medicine department or call 402-559-4097
- Dr. Kent Amstutz Boys Town/Omaha
- Andrea Steenson, Childrens Hospital & Medical Center