Thursday, September 27, 2012

Summary of Benefits in Black & White

We knew it was coming and now it's here.  Yesterday I received my estimated Medical Assistance co-payment for my son and it was shocking.  There it was in black & white.  There was talk about what the co-pays would be for and how the cost would be figured out.  I didn't pay much attention because why get worked up for something people were only guessing about...right? 

We are very thankful for Medical Assistance and all the additional cost it absorbs.  Our son needs therapy.  Autism is expensive.  It can be mentally draining, physically exhausting and oh, did I say mentally draining?  There are only so many grants around that pay for items you may need for your child whether it goes towards therapies, devices, or equipment.  We pay so much already for our primary insurance that it was hard to actually read yesterday, when I saw in black & white, that the estimated monthly amount for us to pay out would be about $1,000.  Granted this is an estimate but who the heck has an additional $1,000 to spend?  Looking at it deeper our income was listed incorrectly so we will be appealing due to that alone but another thing that got my attention is that it clearly states it doesn't take any expenses into consideration.  Let me say that again....IT DOESN'T TAKE ANY EXPENSES INTO CONSIDERATION.  So, let's forget about the mortgage? car payments? utilities? food? activities?

Everyone has expenses including you, State of Pennsylvania.  Let's look at it from another view here.  You will be billing the parents of a special needs child for co-pays.  Did you take under consideration that their household is under financial stress already?  Many in-tact families are down to one income because of high unemployment rates.  Or how about down to one income because their special needs child needs so much additional support that one parent must stay home.  How about the single parent trying to make it?  You may say let the families and friends help out.  What if family was out of town.  Autism secludes you.  I know many families who are alone not because they want to be but how difficult their lives have become.  How do you meet people?

Did you know, State of Pennsylvania, that the divorce rates for special needs families are at 80% due to the extreme stress factors?  This would add more financial stress to that...don't you think?

Also, in order to pay for the co-pays families may cut back services or take desperate measures and pull out of all services for their children all together to get rid of any type of additional monthly payment.  Who does that hurt---the children.  It is critical to help these children when they are younger because guess what....they grow up to be adults.  Look down the line.  Will you be taking care of these adults when they need help?  Oh, by the way, will my social security even be there when I reach of age?  Probably not.  Have to save for our own retirement don't we?

I'll do what I can for my child.  We take full responsibility for him and that will never change.  He has made tremendous progress through all the therapies he has been in over the years.  He still needs to go to therapies in order to thrive.  We moved school districts to try to get him a better education in an autism-friendly school.  We don't sit back...we never have.  We will be filling out the Fair Hearing form and will be waiting for your call. 


  1. I'm in PA too and this is sickening, what they're doing to the kids and others on MA. We got our letter yesterday. I'm in a mild panic trying to reconfigure our budget. I hope the injunction goes through. I've been trying to get through to DPW all day today in between school and therapies. Good Luck!

  2. Not to mention that they gave people about a month to figure out where to pull this extra money from. Most of us will probably be paying our maximum if we have BHRS services but it's not even easy to know since they didn't give us any idea of what the copays would be (there's some at but just telling us that it won't be more than 20% of the MA fee doesn't help me figure out what I'm going to have to come up with in a month. Expenses need to be factored in! We pay primary insurance, we have one income because the kids need so many therapies, we put lots of gas and milage on the car to drive to therapy appointment, we have extra costs due to special diets, we have therapies that aren't covered by any insurance, the kids need certain equipment to regulate (I don't have a mini-trampoline in the middle of our small living room because I want to)...I don't have a cell phone plan, don't have expensive cable, my kids wear hand-me-downs or what's on sale for 80+% off... it's not like we're rolling in the dough just because we make more than the 200% limit. This is such a short term solution since these children, deprived of services when their brains are still developing and capable of creating new neuropathways, gaining self-esteem, etc. will result in less progress and ultimately more care down the road. From what I read there was less than 24 hours of thought given to the panel that presented all the issues that this law was not taking into consideration. This governor must be stupid because 1 in 88 families are possibly affected by this decision... across the state, how many votes does that equate to that will go to his opponent at the next election?

  3. I'm out here in CA.....So sorry you guys have to be dealing with that right now. It's insane!!!!

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