This is a very important piece of the puzzle. Medicaid can pick up what your insurance company doesn’t pay, including co-pays. Also, if your HMO has strict limits to the number of visits, Medicaid would kick in and pay after those visits have been exhausted, if you are using a Medicaid provider.
Most states have Medicaid (income-dependant) or Medwaiver (not income-dependant) plans available to children with ASD. Learn more about Medicaid within your state and eligibility.
Tips For State-Specific Waivers
This list contains information about state-specific Medicaid waiver and demonstration programs. Users can access fact sheets, copies of proposals, approval letters, and other documents related to specific programs.
For much more information, please read our Who Pays For What information.
Payer of Last Resort
This means that your doctor/therapist bills your primary insurance company first and Medicaid second. Medicaid pays LAST. If you have primary health insurance and try to bill Medicaid first, they will deny the whole thing.
If your primary insurance denies the therapy and it was prescribed by a Medicaid provider – a doctor who accepts Medicaid – the Medicaid will pay it after your insurance company denies it.
Let me be clear, a non-Medicaid provider (for example a pediatrician who doesn’t accept Medicaid) cannot write a prescription for a therapy and it will be covered by Medicaid.
But if the Medicaid provider writes the prescription for it, it will be covered by Medicaid even if your primary insurance denies it.
The most important reason to understand and acquire Medicaid coverage for your child is this: if you have typical health insurance and Medicaid coverage for your child and you get a prescription written by a Medicaid provider for Speech therapy, for example, and that speech therapist accepts your insurance and Medicaid, but your insurance refuses to cover the therapy, Medicaid will pay for it ALL. ALL OF IT.
Alternative State-Funded Insurance
If your state doesn’t have a Medicaid-waiver program and you don’t financially qualify for the straight Medicaid, every state also offers a lower cost HMO-type health insurance. The names vary by state but are generally called the “Healthy Kids” program. They are open to all children, not just those with disabilities. Healthy Kid’s programs can also cover some therapies.