Is there help to pay for what my child needs but our health insurance doesn’t cover it?
Caller: My 4-year-old was born with some health issues, and has also been diagnosed with autism. We have been taking him to all the therapies his doctors say he needs – speech, occupational, and physical. And now we are having an applied behavior analysis (ABA) therapist come to our home. Is there any help with paying for this? We have health insurance through my husband’s employer, but they have limits on the number of therapy visits they cover per year. He has a lot more visits than they cover. And to make matters worse we also have a $20 copay for every appointment, and travel expenses coming from a rural area of Weakley County. It’s really hard and quite expensive. I cannot go back to work because I have to take care of my child.
PATHFINDER: Pathfinder does have some resources which can help with the cost of healthcare needs for children of families with private health insurance. It can be very challenging raising a child with severe health issues and disability, and these programs can help with some of the costs.
Parents of children under age 16 who are covered by a commercial insurance plan can apply for a $5,000 grant from the charitable organization United Healthcare Children’s Foundation. That grant can be applied for twice, for a lifetime maximum of $10,000. Here’s their informational page in the Pathfinder directory of services:
The commercial insurance plan can be one from an employer like you have, or one that a family has purchased. There are income restrictions, and a child has to have a social security card. For your family of 3, your adjusted gross income has to be below $85,000. Applications are online only. You can read more about the eligibility requirements and exclusions on the Foundation’s website:
Secondly, the state-funded Family Support program has limited financial assistance for eligible persons, which can be used to help pay for health-related needs, transportation costs, equipment that insurance does not cover, and other disability-related expenses. There is an application process, and a waiting list is not uncommon. The program is administered by different regional councils which set the priorities for their area. The types of expenses they can help with is a fairly flexible list for families, but a person who is on a waiver program such as Employment and Community First Choices (ECF) is not eligible. The contact information for the coordinator covering Weakley County is below. Call Pathfinder for the Family Support contacts for other counties.
Thirdly, the Katie Beckett Program was designed to help children with the most severe needs in the state, who are covered by commercial insurance. You can read more about it, watch a very informative video, and learn about applying here on the TennCare website:
Eligible recipients have to be under age 18. The benefits vary with which group a child is in; Part A or Part B are the primary groups. For some Katie Beckett families getting the child TennCare (Medicaid) coverage is a benefit. Other services can include supportive home care, home and vehicle modification, therapies, medical treatments, caregiver training, transportation, respite, and other needs. Children in the select Part C group are able to keep their TennCare coverage, while they wait for an opening in the Part A group. These children would otherwise lose their coverage due to changes in a parent’s income, such as a parent’s promotion, or seasonal changes in income, for example.