Friday, February 17, 2012

Foster Parent Friday - Medicaid

Q: Do you have to pay for their medical care?

A: I think I've answered this type of question before, but because it's on my mind today I feel like sharing again.    It's on my mind today because I'm getting close to the point at which I need to make a dr. appointment for #10 I still have yet to pick a primary care dr. for him.  Or #9 frankly.

To make matters worse, ECI is asking for the NAME of the primary care doctor.  Out here we have something called the REACH clinic at the Children's Hospitals and they usually have a side-clinic specifically for foster care.  This is SO cool.  Not only is Children's the place to go if you have a serious illness or need a specialist, but they are so experienced with foster care and confidentiality.  Clearly, the foster care clinic is even MORE experienced with all the challenges of foster care and it's so nice to have that back-up.  Anywho, when I don't have a primary care doctor identified yet I usually just write Children's or the REACH clinic at Children's on various forms that ask for the primary care physician.  That'll do in an emergency anyway.  But, now I'm being asked for a specific doctor.

I don't have a specific doctor.  The doctor that I kind of sort of liked sent us notes that said they were having a dispute with medicaid and they thought it would be resolved in November 2011 (for all of our foster children, by the way, whether or not we had them any more...and I don't blame them I just thought it was funny).  I haven't needed a doctor since then for the kiddos and so it hasn't been a problem.  I called in Novemberish or maybe December when the kids came but they never called mie back to tell mie if they now accepted medicaid.  To be honest, I'm not all that eager to go back to him, he prescribed Summer a lethal dose of medication once and misdiagnosed her several times, but he was the best that I could find.

It's not easy to find a doctor that accepts medicaid.  In Texas, all foster care kiddos are on one specialized medicaid plan that is only for foster children.  Again, this is cool because they are familiar with working with foster children.  It is not cool because of the way the medicaid/dr system works.  It's just like any other private health insurance - doctors are signed up with certain plans and if they take yours great and if not then you can't use your insurance there.  Actually, private plans usually will do an "out-of-network" rate for doctors who do not accept their insurance and then the patient/guardian can decide if they like that doctor enough to pay the extra cost.  With medicaid, there is no "out-of-network" care, at least not that I'm aware of.  So, you can only go to a doctor that accepts medicaid and only the plan that you have.

That usually isn't a problem with private health insurance - most doctors take most plans.  With medicaid it's different.  Doctors tell mie that they lose money when they accept medicaid.  I wouldn't doubt it.  So, what they'll do is take one plan of medicaid as a charity to the community.  I think I've figured out that the other plans are generally regional based and so they'll kind of pick the major one in the area.  Most of them though are not aware of the foster care plan.  They're not aware that foster children receive medicaid and certainly not that they have a separate plan.  If you ask about it, the office will tell you to switch to the plan that they accept - that's not possible - foster children get the foster children plan.

So, then you're stuck with whoever accepts the plan, and there aren't that many.  Within 10 miles of my home there are about that many doctors who are in the healthplan's doctor directory.  I've called all of them. None of them are accepting patients (granted, it's been a while and I need to try again, but still).  They only accept so many patients with the plan because it costs the doctor's office too much to be profitable.  I don't blame them, but that puts mie in a bind.  If I look beyond the 10 miles I do get more options, but then about 9/10 of them are full so it takes forever to find one that will accept our kids as patients.  These offices are usually what I call medicaid/medicare factories - that's pretty much all they accept.  I've been to them out of necessity.  You wait for hours.  You get minimal bedside manner.  They aren't usually familiar with foster care either.  They are surprised you speak English (I wish I were kidding).  They prescribe too many medications.  And they take forever to get an appointment.  I'm talking months.

That doesn't work in foster care when you're expected to get a new placement into the doctor within 14-21 days.

This is frustrating.

So I signed my kiddos up for my private health insurance this time.  I haven't done this before basically because I didn't know I could.  What I figured is that I can take them for their annual/baby healthy child appointments and then there should be minimal/no co-pay, especially because I have a health-savings account.  If a specialist is needed, there is an emergency, or I run out of those HSA funds, I can always go to Children's at a moment's notice with the medicaid.

We'll see how this goes.  The good news is that Logan & Summer have THE BEST doctor ever.  He's great.  He's seen Logan since Logan was born.  He's written lots and lots of books.  He writes for  He's got his own pediatric website.  And he's wonderful in the office.  He's also offered to jump through hoops to accept the foster care medicaid plan and told mie "why didn't you tell me?  I would have done it a long time ago".  Seriously good.

I'll keep you updated on how this goes.

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