Q: Can I qualify for Medicaid assistance to keep my medically fragile child at home instead of in a hospital or residential care setting?
When people think of Medicaid planning, they often picture low-income individuals over 65 who need medical assistance or nursing home care. But Medicaid’s medical assistance benefits are not just for the elderly; they are for the disabled, blind, or low-income families and children who qualify for the joint federal-state program. And in one particular NC waiver program some very sick children can qualify for Medicaid help regardless of their family’s income.
Managing the medical needs and extended hospitalizations of a medically-fragile child is very stressful for families. A medically-fragile child is chronically and seriously ill and requires almost constant medical care and supervision. Certain premature babies and special needs children might be classified as medically fragile. Many of their parents just want their child home with them, receiving medical care outside of a hospital setting. In North Carolina, those wishes became reality due to a waiver in the Medicaid program that began in 2010.
Under the waiver program, known as Community Alternatives Program for Children (“CAP/C”), medically fragile children may be taken care of at home– provided the cost to do so is less than it would be to provide the needed care in a hospital or residential care setting. Supplemented by trained medical professionals, family members provide the bulk of the caregiver responsibilities, enabling the child to live in the family home while keeping the overall cost of care down.
Unfortunately, applications for the waiver program—which are generally granted on a first-come first-served basis and without regard to the family’s income– have far exceeded the projected number of applicants and resources allotted at the program’s inception. As a result, federal Medicaid officials directed North Carolina’s Medicaid officials to start a waiting list for new applicants on August 15, 2016, pending acceptance of the state’s proposed amended application for an extension and expansion of the waiver program to serve additional individuals. This freeze on new applications would not affect children who qualify for traditional Medicaid benefits.
If you need assistance with special needs and/or Medicaid planning, please contact the Monk Law Firm, PLLC. We assist clients throughout Charlotte, Rock Hill, Fort Mill and the surrounding areas.