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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