Help from Medicaid for NICU bills

I haven't seen this topic at Inspire before, and it was such a huge help for us that I wanted to be sure that other parents were aware. We were told by the NICU social worker that if our kids stayed in the hospital for more than 30 days, they were considered separate from us and eligible for Medicaid even though we also had insurance for them. Of course any NICU babies without insurance would also be eligible for Medicaid. I have seen some parents write about NICU bills, so I wanted to be sure that parents still in the NICU knew about this program.

You sign up while still in the NICU. A hospital insurance coordinator came and helped us do it. Then Medicaid was just considered secondary insurance for our kids, so the hospital would bill our insurance first and then Medicaid would pick up any co-pays. The end result being, we paid nothing for our kids' NICU stay even though when we saw what our insurance was paying, it made our hearts stop a little. So ask the NICU social worker if your baby will be in the NICU longer than 30 days (or maybe it was longer than a month). It's definitely worth checking out. We were then told just to call and cancel it once our babies were home.

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Here in Texas, if your baby is below a certain birth weight they automatically qualify for SSI and Medicaid from the day you apply. It took forever (about 5 months) for my girls to get approved. This applies to the time they are in the NICU only. Once they came home we had to re-apply and they did not qualify due to our income. The whole process was a pain in the you-know-what but it was worth it not to have to pay anything.

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Wonderful information! Yes, state to state the rules do change. But this reminds everyone to ask, ask, ask!!!

Thank you for posting this!

d.d.

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My kids were born in Virginia, if that helps anyone.

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We're in VA also. My children qualified for institutional Medicaid about a month into their NICU stay. And they are still on it 3 years out. It was never cancelled but we did have to reapply annually. Our social worker made it clear to us (we checked, repeatedly!) that their eligibility was based on *their* income, not ours.

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TraceyPE- I would love to know what Medicaid program your children are accessing. Our daughter was denied coverage after her NICU stay until her diagnosis of CP two plus years later. She barely qualifies and we have an enormous copay each month- it's as much as our first mortgage a few years back. Incidentally, my little one was two ounces larger than the weight required for automatic medicaid for a year. Had we known about her bleed at the time she would have qualified automatically but that news didn't come until a year later. A good social worker from the NICU is worth his/ her weight in gold for sure!

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My daughter is a former 27 weeker, born at 2 lbs. 1.5 oz and I applied for SSI right after she came home from her 75 day in the NICU. When I applied for it I was asked by the caseworker why I waited until she came home and I just told her I had just found out about it. She qualified for SSI and starting receiving monthly checks and still does currently at almost 3 years old. It is based on my income and it is secondary to my BCBS policy she is on. It has been a lifesaver and pays all her copays and everything my policy doesn't pick up. She sees a lot of specialists so this has helped me a lot because my copays are 20 for regular dr and 40 for specialists. She also has braces on both legs and has gone through lots of testing. I wish I had found out about it while she was in the NICU. I was told that she automatically gets medicaid based on her SSI check which was based on her weights and CP diagnosis. There is one month of the year I usually don't get a check, DEC and she isn't supposed to be on medicaid during that month. However, I took her to the eye dr during that month and it paid her copay. It is definitely worth checking into. I am in NC by the way.

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CBMom- thanks for the information i just had my 25 week premie daughter Jasmine Rose march 2. i have already signed her up for SSI cause my social worker told me most premies get SSI now. My daughter just had surgery this morning because she has hydrocephalus. she was only 1lb 14.6 oz. she was delivered by emergency c section because i was 3 cm dilated and when they flew me to the other hospital i was 4 cm and she was breech. they tried to give me something to stop the contractions but it didnt work. she will be in the NICU for awhile but i am glad that I came on and saw your post because I was wondering about medicaid to because the social worker said something about that to. thank you for the information.

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Thank you so much for posting this! I had no idea and happen to be in VA too.

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In Ohio - if the birth weight is under a certain amount, the baby qualifies for coverage under BCMH (Bureaus of Children with Mental Hanidcaps) while in the hospital. This coverage paid for anything that our primary insurance did not cover. Your child does not need to have a diagnosis to get the coverage. The social worker at the hospital gave us all of the forms to complete shortly after our girls were born and it was great.

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Please don't forget if your state doesn't qualify your child for typical Medicaid there is a Katie Beckett waiver or TEFRA waiver. Many states have it for children with disabilities or chronic health conditions who aren't eligible for Medicaid based on income being too high. For some states I guess it might be free but in my state the monthly premiums are paid based upon income- the more you make the more you pay.

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Thanks for posting this information. It is so important! I wished I had known. For some reason, our NICU social worker did not talk to us until discharge day. She said that was because we had primary insurance via BC/BS. However, I later found out that we could have qualified for SSI as well, which would have covered our expensive parking passes at the very least.

Fortunately I did apply for Medi-Cal for my twins on my own and they were accepted. Unfortunately, we are now encountering tons of insurance problems (creditors!) because the hospital did not bill Medi-Cal despite numerous faxes/mail from us with the medi-cal information. They are now telling us that the hospital must bill Medi-Cal within a year of discharge so we may be on the hook despite having coverage during the NICU stay. In short, it really is easier if you go through this process with the hospital social worker who knows the system.

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We were fortunate that the social worker at our hospital mentioned SSI and Medicaid once Sean came off ECMO. We applied. It took awhile, but he qualified for SSI and then automatically from that got Medicaid (we're in NC). The SSI checks were small, but with Medicaid and being tube fed it covers all his formula and his recurrent dr appointments to specialists at the clinics at the Children's Hospital. We do have really good private insurance, but they bill Medicaid first. In addition because of this and that Sean gets early intervention through the state (CDSA) for his developmental, feeding/OT and Physical therapy, we also qualifed for another program (CAP/C) which provides in home care for medically fragile children. So we are able to have a CNA work in our home so that we can work. We both work from home so it's a win-win and I feel ok just going upstairs and getting stuff done.

So definitely talk to the social workers in the hospital. At our hospital they came around frequently to see how we were doing. SSI/Medicaid also paid for our out of pocket expenses from the 3 month hospital stay.

Don't get discouraged by the wait time for responses, give the offices a call to follow up. If your child gets early intervention your case worker for those therapies can assist you as well.

Good luck!

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