HEALTHCARE IN THE UNITED STATES
SPECIAL POPULATIONS
including surgical intervention, medications, and rehabilitation therapies may be needed for years or a lifetime following the accident.
How does a family afford this care? One might think healthcare covers all of these needs for those with healthcare insurance. However, difficulties in obtaining coverage could include finding care providers “in network,” ensuring the family deductible is met, and meeting the co-pay amount for each support service and medical appointment required. Families living in rural or low-care provider areas may have trouble meeting all health insurance coverage criteria, leading to added burdens and more out-of-pocket expenses. Costs can skyrocket if an insurance company’s requirements for payment are inconsistent with a family’s specific situation, leading to emotional and financial distress. Families with no health insurance may find it impossible to meet the many needs of a disabled child.
The definition of childhood disability changes depending on the specific funding source—state or federal—and current legislation. A strict definition used by the Social Security Administration (SSA) (2019a) is “the child must have a physical or mental condition(s) that very seriously limits his or her activities; and the condition(s) must have lasted, or be expected to last, at least 1 year or result in death” (para. 2). The example of the child born with cerebral palsy would meet this definition.
The Supplemental Security Income (SSI) program, administered by the SSA, provides monthly payments to a disabled child whose condition meets the above definition and whose family meets the criteria of low income (SSA, 2019a). The application process is complicated and requires supporting documentation of disability and evidence generation to support financial need; it also includes careful management with an SSA case manager. Additional funding sources include Medicaid and Child Health Insurance Program (CHIP). According to Musumeci and Chidambaram (2019), “Medicaid and CHIP covered about half (47%) of the 13.3 million children with special healthcare needs in 2017” (para. 1). Medicaid/CHIP payments vary depending on the state of residence because some states provide more supplemental funds than others. Income eligibility for Medicaid is set at 138% of the Family Poverty Level (FPL). States have the option to expand eligibility above this percent. Musumeci and Chidambaram (2019) also write, “As of January 2019, the median financial eligibility level for Medicaid and CHIP children nationally is 255% FPL ($54,392/year for a family of three in 2019)” (para. 7). Figure 7.6 notes the 2017 health insurance status of children with special healthcare needs. However, of importance to consider is there being current legislation to cap Medicaid benefits, which in some states would include children with disabilities (Schubel, 2017).
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