Catch-473 Paying for Mental Health Care

Medicaid or Catch-22, I Mean 473
Medicaid is a tricky thing. It is surely abused, but I really don’t follow those stories. In North Carolina it is being “overhauled.” You can figure out what that means.

Here is our problem. We can pay our bills. We don’t qualify for Medicaid because we make too much money. That’s fine. We have paid for two hospital stays and countless doctor, psychologist, and psychiatrist visits. Medication for all of us. The stress and anxiety have taken their toll. Breckin, our daughter, regularly sleeps in our room. Melanie has broken down in tears. I have my own issues, many of which I share with Ethan, and these events have affected me as well. We’ve travelled six hours to visit with Ethan when he was at Whetstone Academy in Mountain Rest, South Carolina. We paid for a hotel for the weekend and to go out for meals. We paid for 9 months at a therapeutic boarding school (thanks to a more than generous loan from my father).
So what to do when Ethan’s school, the only state funded therapeutic boarding school, recommends that Ethan be placed in a psychiatric residential treatment facility or PRTF. Well, get this. You can’t go to a PRTF (we were told) unless you have Medicaid.  That isn’t actually true.  If you can afford to pay out of pocket or your private insurance will pay, then I suppose you are golden.  We can’t get Medicaid because we make too much money and pay our bills. We are both teachers with advanced degrees and national certifications so we can make ends meet most months. We asked one of the PRTFs we visited what the cost was. His response was,“Don’t ask.” Finally we were told $501 (actually it’s $473) per day. OK, so that’s about $170,000 a year. It’s safe to say we don’t make enough money to cover that, but we do make too much money to get Medicaid which we need to pay for the $473 per day treatment. This is still difficult to wrap my mind around. Why are there facilities that require medicaid to get into when we have a medicaid system designed only to aid those who cannot afford to make basic bill payments. I am not really resentful of the situation, but we are the middle children of the mental health system. We have the wealthy who can drop $7000 per month for a residential boarding school or $40,000 for a couple of months of wilderness camp, the poor who are eligible for Medicaid so that they can afford to send a mentally ill child to a $473 per day facility. Then there is the majority. We can’t get medicaid for the $473 per day treatment. We can’t drop $16,000 for 4 weeks of wilderness camp or afford more than a month or two of a multi-thousand dollar a month boarding school.
But if anything, we are tenacious. Phone calls were made. Meetings were attended. People told us one thing; others told us something else. Sometimes these were people working for the same location. We applied for Medicaid but were turned down. We applied again and were turned down. Melanie did the grunt work on this, taking any free time to try to track down with whom she should talk. It is that difficult. No one knows anything. Anything about anything. If they do know something, they are likely mistaken, often sending us on unhelpful tangents.
Oh, but we found a loophole. Yes we did. It’s simple. Ethan simply had to be living out of the home to be able to be eligible for Medicaid. So, all we had to do was get Blue Cross/Blue Shield (the State Health Plan of North Carolina) to pay for one day at the PRTF. Well, they wouldn’t do it. But in a case of deus ex machina, it turned out that somehow, someway, we could be approved for Medicaid if Ethan were out of the home by the end of the day he was approved. He was accepted at Alexander Youth Network (PRTF) and granted Medicaid on a late Thursday morning in August 2014. We had to contact the Wright School so that they could have him ready to leave that afternoon. We had to pack his things, pick him, up and drive 3 hours to the location so that he could be there by midnight. We had a good hour or two to spare. Good guys win.

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One thought on “Catch-473 Paying for Mental Health Care

  1. I can completely sympathize with you and your family. I am the father of a 10 year old diagnosed with Autism Spectrum Disorder, ADHD, Oppositional Defiance Disorder, and Severe Depression in Raleigh NC as well. He is high functioning and in many respects possesses a brilliant intellectual mind, going so far as being accepted to skip grades in mathematics and sciences. He is polite, articulate, a boy scout, and generally a wonderful but damaged little boy. So I can feel your pain and frustration when I have to admit, the only reason we’re able to provide the services he needs to be able to thrive and grow and show us how gifted he is due to the fact that I am currently unemployed and having difficulty paying our bills.

    It is exceedingly disheartening to know that I have to struggle paying electricity, rent or groceries (take one to give up this month), in order to qualify for the benefits necessary to keep my son going to an Occupational Therapist, a Pediatric Psychologist/Psychiatrist, a Group Therapy Appointment, and his Medication Management group let alone the medications they have prescribed (I believe at last we checked it would be over $2000.00 to pay for the monthly meds alone without insurance or Medicaid or assistance). I say this to mention that if you make more than 2000 a month, you’re generally disqualified from SNAP (EBT) food benefits and Medicaid.

    I am currently sitting here looking at 4 stacks of forms required for me to resubmit proof that my child is disabled for SSI, in order to keep him eligible for several of his therapy programs, ALL of which we had to scrupulously dig through to find out who would even take Medicaid/SSI patients because, of course not every office will deal with the headache and hassle of our wonderful Government provided system. Four nearly Identical forms that ask me to provide information on the LAST time they asked me these very same questions. As if they couldn’t be bothered to keep that paper work and file it accordingly. (Thank you Paperwork Reduction act! I can’t imagine how much more pain and suffering would be inflicted on me without You!)

    We exist in a system that continually punishes and tramples the lives of families who legitimately need assistance due to the soul crushing costs of raising these wonderful, amazing kids who by no fault of their own have difficulties beyond their ability to manage. We suffer degrading thoughts of inadequacy as a parent not even by other parents but even from our own internal thoughts. All the while being treated a thousand times over as if I am suspicious of committing some Medicaid fraud. I honestly despise being treated like this, like a criminal while at the mercy of an organization which seems full of dishonest, lazy, and uncaring people with only a handful of true shining stars to give us hope.

    I will be glad to keep Ethan and all of your family in my thoughts. I know that it’s tough.

    Jeremy McGrew


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