? about Texas Medical Assistance

[arabeth]

Hi everyone...

I first posted here a few months ago when I was considering a move from Minnesota to south TX. I was asking about the climate since obviously there is a HUGE difference between MN and south TX. Well, we have made the final decision to move and I have a question about insurance in TX. With TX medical assistance is there anything particular I should be aware of? Such as medications, do certain ones need prior authorization (TOBI, Pulmozyme, etc.)? Is medical assistance readily accepted by the drs? Is there anything particular that isn't covered? Things like that. I just want to be prepared as well as I can be. Also is there anyone here who has children covered under TEX-CARE? Once I am working the kids won't be eligible for MA any longer but may still be eligible for TEX-CARE so I have the same questions about that. I am excited about the move but extremely nervous, hoping and praying that everything works out well. I have been in contact with the CF Center at Santa Rosa in San Antonio and they seemed very nice and helpful. We see our CF dr here in Minneapolis on Dec 28 and are leaving MN on Dec 29. Our dr here knows the CF dr in TX and is going to keep in touch with her to coordinate the girl's care to make it as smooth as possible. The girls are extremely healthy and I want to keep it that way. It's always scary to make a big change like this because there are all those "what if's" popping up. If we move and they get sick what will I do, will I blame myself?... Will the climate change be too much for them?... etc... We have several reasons for making the move, not the least of which is the extreme cold weather here. My husband has family in TX so that will also be nice. We don't have any family in MN. (my family is all in Kentucky which is where I'm from)... So, anyway, sorry for rambling... I'm nervous and just trying to cover all my bases... Thanks everyone!!!

 

[Joblazer86]

I live in texas but have never heard about tex care. what is that? There is a program that will take care of up to 30,000 dollars a yr. and takes care of copays! only bad part is there is a waiting list. don't know the name but will find it and post it by 2morrow for you. as far as pulmozyme and tobi you just need a prescription for that.

 

[anonymous]

Hello. I have a four year old son with CF and we live in Dallas. My son was 18 months when he was diagnosed and my husband had just gotten laid off. Needless tosay, we were overwhelmed with the diagnosis and had to find a way tp pay for everything! The CF clinic in Dallas gave us a ton of information about Tex-Care (also know as CHIP, Childrens Insurance Program), it was a life saver. Eligibilty may be different than it was a few years ago, but basically you have to be making more money than medicaid requires and less than $30,000 per year (a very rough estimate). My son is now on my husbands new insurance, but he was with Tex-Care for over two years. His copays were typically $5 for generic $20 for brand name (most CF drugs are not generic). He did have to go to a predetermined physician in order to get reffered to the CF clinic. We paid $15 a month and had to renew his membership every six months. I don't know all the current restrictions and rules for this program, but you should definitely look into it. It is a great program and I'd be more than happy to give you more info if you have any questions!!!! My email is sheli_janik@hotmail.com or visit Texcarepartnership.com or call 18006476558 Good luck

 

[anonymous]

I go to Cristus Santa Rosa and I love it there...I have never dealt with the pedi docs, I moved to the adults docs when i moved so never got to see the peds...But I hear they are amazing people as well and if your children ever need to go to the hospital the pedi floor loves them to death and will wait on you hand and foot and knows alot about cf patient care...(so i'm told <img src="i/expressions/face-icon-small-tongue.gif" border="0">) As an adult I am on another floor but they treat you with the same love and care.

For your medical assistance question, if you have a low income you can get them on medical, but it can be hard. There is also a program called Children with Special Health Care needs (ChShCN or also known as CIDC-name change) From ProtectTexas....It covers all copays and pays what your primary insurances do not cover......its great...BUT there is a huge waiting list. I got on it only months before they started the waiting list. They will keep me covered even though I am an adult....They keep cf patients on it for as long as you need it and meet the requirements for income. Getting them on any insurance through work is of course your best thing to do. I would look into the TexCare...it sounds good, I dont really know what it is. Also when you move down here I would get all their meds through the CF Pharmacy....they work with insurances and will double even triple bill....meaning if you have more than one insurance they bill the primary then with the co pay they bill the second insurance and so on. Most pharmacies do not do this and you have to pay out of pocket money. Plus they deliver to your front door and have all cf meds and even diabetic medications available, everything you can imagine a cf patient needs, even if you have had a transplant. I hope that all states are going to have this pharmacy available to them at some point. I think there is only two in the states. anyway.....Also ask the social worker at Chritus (she is awesome and very sweet) about programs that help pay for pulmozyne and tobi....and there is a program if your children take ultrase enzymes you can get a months supply of a weight booster (either shake or additive) and a months supply of ADEKS vitamins free. All you have to do is send them a copy of the proof of purchase or reciept.

I hope this helps some.
Amanda

 

[IG]

Well concerning the medical assistance, I have absolutely no clue, since I'm not the one that takes care of that yet. Sorry about that, but I thought I'd offer some input about the CF clinic at San Antonio Christus Santa Rosa. The clinic, to my thoughts, is wonderful, the people are great, the doctors are superb, you're in good hands there. <img src="i/expressions/face-icon-small-happy.gif" border="0"> I wouldn't choose to go anywhere else.

 

[arabeth]

Hi again, everyone. Thanks for your replies. First to respond to the question about TexCare... It's a program for children who's family does not quailfy for medical assistance due to income but still doesn't have a very high income. You have a very small premiun ($15.00 to $25.00 a month depending on income and that covers all the children in the family). You have to pay copays for dr visits and prescriptions unlike regular medical assistance. I'm lucky in one way because I have a large family so our income limit is higher. There's no way we would qualify for regular MA once we are working but I have done some research and have a plan for this to work out...lol...As we know with children and familiy members with major medical issues, we have to be quite creative sometimes to get what we or they need. I also currently work for Blue Cross Blue Shield of MN so that gives me a bit of an advantage in knowing insurance companies a little better. However, MA is completely different so that I am not so familiar with. Because I will not be working when I first move to TX I am going to apply for MA right away. If the kids get approved for MA they are automatically covered for 6 months regardless of change in income. After 6 months, I would have to reapply and at that point they would no longer be eligible for MA (at least I hope to be working by then...) but at that point they would switch them over to TexCare as long as we quailfy for that. If not, then hopefully I'll have coverage thru my job to cover then at that time. (the income limit for TexCare for a family of 7 is amost 60,000 a year compared to MA which is about half that) So the plan is to have the MA for 6 months to cover them until we get them covered thru an employer. I was just curious the MA in TX and how that all works since I'm not familiar with that. I also want to get them on the waiting list for Children with Special Health Care Needs ASAP.. I have been told the list is very long in TX. I have not yet found the phone number to get on that list, so if anyone has it that would be great. I'll keep searching thou and should be able to find it by the time I get there. Thanks very much also for the info on the CF center there. I am very nervous about that change. That's the one thing about Minnesota I will really miss. We have an excellent CF center here and I have to admit I am very scared about leaving it behind. To hear the positive stories about the one we will be going to is very reassuring so thanks for that.
One last note, I do have a backup plan if this doesn't work out...I will take COBRA for the kids to buy us some time if I have to. It's extremely expensive so it's a last resort option only, but one month of prescriptions for both my daughters would put me in the poor house so I'll do what I have to do....
Thanks again for all your help and support. I am so grateful for this website to have a place where we can ask these kind of questions. The average person just doesn't understand how scary all this can be....Take care everyone!!!

 

[pamela]

<img src="i/expressions/rose.gif" border="0">
Aloha Arabeth,

I live in Hawaii and really do not know much in regards to Texas (except that I have a friend that lives there) and it's insurance policy. There is one thing you need to know though, and this applies to everyone regardless of which state they live in. I became disabled over 6 years ago and was in a situalton that I could not get help with my medications from my state because they said my disability payments were too much. But of cource I could not afford the $700.00 per month that my medications cost, so what to do? After doing alot of research and running a pilot program my children and I have developed a website to assist others in receiving their medications free. The Pharmaceutical companies (over 170 of them offering over 1,000 brand name drugs) have programs for individuals who have no prescription drug coverage and who are having a hard time paying for prescription medications. Most of the critera is based on income, and all companies have their own criteria. I have been getting my medications free for over 2 years, and we have helped countless others do the same. If you need more information or want to be directed to our site just email me and I will assist you.

Aloha, and a Safe and Wonderful Holiday Season, Pamela